Bi 6 CHM SC NGI BNH TRC M

1. I CNG
Gii phu l k hoch c d kin v c s chun b, c m cp cu hay m chng trnh u mang tm quan trng nh nhau. Chun b cuc m lun thc hin mt cch an ton v hiu qu trnh tai bin cho ngi bnh trong m, ngn nga bin chng sau m v gip ngi bnh hi phc tt. Vai tr ca ngi iu dng rt quan trng trong vic sa son ngi bnh trc m. iu dng cn c nhng thng tin c bn v ngi bnh, mun th iu dng phi thu thp d kin t ngi bnh v bnh tt v cc ri lon km theo. iu dng phi hiu c phn ng ca ngi bnh trc m, phi bit nh gi nhng kt qu xt nghim tin phu v phi bit lng gi nhng thay i ca c th, nguy c, bin chng lin quan n phu thut.

2. PHNG VN NGI BNH TRC M

Phng vn ngi bnh trc m gip iu dng thu thp d kin v bnh s, tin s, triu chng, tnh trng ngi bnh, nhng kh khn ca ngi bnh v qua gip ngi bnh chn ngy, gi phu thut ph hp. Qua phng vn, iu dng s thng bo cho ngi bnh v phng php phu thut v gy m v thng ngi bnh rt lo u v phng php gy m, v loi phu thut cn thit, vic cung cp thng tin ny gip ngi bnh an tm. iu dng gip ngi bnh thc hin cam kt ng m ca ngi bnh, y l vn php l, ngi bnh phi hiu r trc khi k cam kt. Trong qu trnh trao i s gip iu dng nh gi tnh trng tm l ca ngi bnh, iu dng cn tip xc vi ngi bnh v ngi nh ngi bnh hiu r tm t, lo lng ca ngi bnh v c k hoch can thip kp thi.

3. LNG GI TIN PHU

Xc nh tnh trng sc kho, thu thp d kin v ngi bnh. Xc nh v iu chnh cc yu t nguy c trc khi phu thut. Cn nhc xem ngi bnh tin hnh phu thut theo ch no (ni tr, ngoi tr, trong ngy).

 Lp k hoch v thc hin vic chun b trc m. Qua hi chn: chn loi thuc gy m v phng php phu thut tt nht cho ngi bnh.

4. LNG GI CC D KIN CH QUAN

4.1. Tm l
Tm l ngi bnh c th l lo s au v khng thoi mi, s do khng hiu bit, s bin dng c th, s xa cch ngi thn, s cht, s gy m, s thay i li sng sau m, iu dng cn bit nhn thc ca ngi bnh nng v cung cp nhng thng tin trong sut thi gian trc m. iu dng l ngi nng tinh thn v gip ngi bnh gim au bun, gim s hi duy tr v hi phc nim tin cho ngi bnh.

4.2. Tin s sc kho

u tin, iu dng cn khai thc s hiu bit cn thit ca ngi bnh, v phu thut trc m v nhng than phin ca ngi bnh. Vi ph n, phi tm hiu tin s nh kinh nguyt, sinh , ngy c kinh sau cng vi mc ch trnh nh hng ca thuc gy m, sang chn tinh thn, tc dng thuc trn ngi bnh mang thai. i vi tr v thnh nin, iu dng cn cn thn dng nhng t ng ph hp khai thc cc vn v kinh nguyt, sinh sn, tnh dc. Nhng thng tin v gia nh nh bnh di truyn, lin quan n gy m, bnh tim mch, ni tit, thai k, hon cnh ngi bnh, kinh t, bnh tt ca ngi bnh v gia nh.

4.3. nh gi sc kho ton thn

Tng trng, cn nng, ch s BMI, tnh trng da nim, du chng sinh tn, pht hin nhng du hiu bt thng ca ngi bnh. 4.3.1. H tim mch Nhim v: H tim mch c nhim v p ng nhu cu oxy, dch th, thuc, dinh dng cho c th. y l nhim v rt quan trng v h thng ny cn mang thuc, khng sinh, thuc m trong qu trnh phu thut. V n cng c nhim v mang cc cht cn loi b ra khi c th. Hi: Vic khai thc du hiu bnh tt rt quan trng v n gip thy thuc c th iu tr, iu chnh hay tm ra phng php no trnh bin chng cho ngi bnh trong v sau m. V th iu dng cn khai thc bnh s v tim mch nh cao huyt p, au tht ngc, suy tim, bnh tim bm sinh, m tim. Cng cn c nhng thng tin v bc s ang iu tr, thuc tim mch ang s dng. Khm: nh gi mch, huyt p, da nim, tnh trng chy mu, o in tim gip pht hin bt thng trn in tim, nghe tim. Can thip iu dng: Nu ngi bnh c nhi mu c tim cn khuyn ngi bnh hon phu thut khong 6 thng sau trnh nguy c ti pht. Nu ngi bnh c bnh tim bm sinh, bnh van tim, thp tim cn thc hin khng sinh d phng trc m. Ngi bnh lon nhp tim cn theo di in tim trc m. Nu ngi bnh dng Digitalis cn theo di nh lng Kali trong huyt thanh trnh nh hng tc dng ph v c hi ca thuc m. Thc hin truyn dch i vi ngi bnh mt nc trc m, cn thn vi ngi bnh gi v ranh gii gia tha v thiu nc rt hp.

4.3.2. H h hp Nhim v: H hp c nhim v quan trng trong phu thut v n va l ng gy m va l ng thi thuc m, trao i kh. T bo thiu oxy s cht v oxy c vai tr quan trng nht i vi m no. C nhiu phng php gy m phi qua ng h hp, v th nu h hp c vn th rt nguy him cho ngi bnh. Hi: Ngi bnh c tin s kh th, ho, suyn, ho ra mu, lao, nhim trng ng h hp kinh nin trc khng? V y l nhng triu chng ca bnh ng h hp trc . Suyn l vn ngi bnh phu thut. Suyn c th xut hin khi lo s, mi cng c th gy cn kh th cho ngi bnh. Ngoi ra, nu khng khai thc k tin s suyn ca ngi bnh th khi gy m cng gy nguy c cao cho ngi bnh do vic tng tc thuc trong gy m. S tn thng trn phi c th lm gim kh nng trao i kh v chnh l nguyn nhn gy suy h hp cho ngi bnh trong v sau m, cng l nguy c gy nhim trng h hp sau m v nh th lm tnh trng ngi bnh nng n thm. Ngi ht thuc l c nguy c ng dch phi d gy tc nghn h hp v vim phi sau m. Khm: tu vo tng loi phu thut nhng c bn iu dng cn o tn s nhp th, kiu th, nghe phi, PaO2. Can thip: nu ngi bnh c nhim trng cp tnh ng h hp trn iu dng cn thc hin khng sinh theo y lnh gip iu tr dt im nhim trng. Nu ngi bnh ht thuc cn ngng ht thuc trc m mt tun. Phi ghi nhn ngi bnh c bt thng v ng h hp, ghi nhn chc nng h hp nh kh mu ng mch, nghe phi nh gi li tnh trng h hp. Hng dn ngi bnh cch ht th su, hng dn cch th hiu qu, cch xoay tr, ngi dy gip gin n phi ti a sau m. Hng dn ngi bnh cch ho, khc m. 4.3.3. Gan Nhim v: Gan lin quan n ng trong mu, bin dng m, tng hp protein, thuc, bin dng hormone, to bilirubin v bi tit gii c cho nhiu loi thuc m, thuc iu tr... Hi: tin s v vim gan trc , tim nga vim gan cha, s ln tim, thi gian tim. Tnh trng d ng da, nga v c vng da ln no khng. C bnh l v ng mt nh si mt, au h sn phi khng. C tin s m v mt, m gan. Tin s ung ru, s lng, thi gian khng. Khm: b gan to khng, tnh trng vng da, bng bng, du tun hon bng h, mu phn, cc du au trn bng v nn nh gi xt nghim chc nng gan, bilirubin. Can thip: nh gi tnh trng ri lon ng mu, ng thi thc hin iu chnh tnh trng chy mu qua thuc theo y lnh. Chm sc vng da, thuc gim nga, ung nhiu nc. Ngh ngi v dinh dng hp l gip nng chc nng gan. Thc hin thuc nng chc nng gan, trnh nhng thuc thi qua gan. Thng bo cho nhm phu thut v tnh trng ngi bnh. 4.3.4. Thn Nhim v: suy gim chc nng thn lin quan n s lng dch thay th, mt cn bng v dch th v in gii, chc nng ng mu, gia tng nguy c nhim trng, vt

thng lu lnh, thay i p ng ca iu tr v khng tin on c s bi tit ca thuc. Hi: Ngi bnh c ph khng, ph vo lc no v ph u. Tiu gt but, tiu c, s lng nc tiu. C tin s si niu, m thn, ghp thn khng. Khm: Cn nng, huyt p, nc tiu, da nim, du bp bnh thn, khm thy du hiu ph. Can thip: Theo di mt nc, thc hin b nc v thc hin cn bng in gii ngi bnh trc m, cn nng, theo di ph. Phng nga thiu nc v ri lon in gii, theo di s lng nc tiu. nh gi chc nng thn, Ion . Nhn nh sm trn lm sng du hiu thiu in gii. 4.3.5. Thn kinh trung ng nh gi: tri gic, nhn thc, thc hin cc y lnh ca ngi bnh. Khai thc tai nn v no, tu sng trc V khi c chn thng hay m ct sng c th c th nh hng trong t th t ni kh qun. nh gi v nhn thc rt c ch trong theo di sau m, gip iu dng nhn nh v tri gic v nhn thc ngi bnh chnh xc hn. 4.3.6. C xng khp Hi: Tin s vim xng khp, nht l ngi gi v n s lm hn ch c ng, t th ngi bnh trong v sau m. iu dng hng dn ngi bnh cch tp vn ng trc m. Sau m trnh ngi bnh au do vn ng, di chuyn. 4.3.7. Dinh dng Bo ph gy kh khn trong t th m v di chuyn ngi bnh sau m, d nhim trng vt thng, vt thng lu lnh, thuc m thm chm v tn ti trong m, do gii phng thuc sau m chm nn ngi bnh m lu hn v tnh chm hn. Nu khng m cp cu, iu dng cn hng dn ch n v tp luyn gim cn cho ngi bnh trc m. Suy dinh dng: gim protein, vitamin A, B ngi bnh hi phc chm, vt thng lu lnh. Ngi gi (do thiu rng, do n ung km), ngi ngho n t cht dinh dng, ngi bnh n ung km, ngi bnh mn tnh, ung th th thng c nguy c suy dinh dng v thiu ht dch th do thi quen king n hay khng n c. Nng cao th trng ngi bnh trc m l iu cn thit. iu dng hng dn ngi bnh thc n nhiu dinh dng, ch n ph hp bnh l. Nu ngi bnh suy kit nhiu hoc do bnh l khng n c iu dng thc hin nui n bng dch truyn an ton v nng lng. 4.3.8. Nghin ma tu hay ru Ngi nghin ma tu hay ru thng c nguy c suy dinh dng cao v c bit vi ngi nghin ru th chc nng gan cng suy gim. V th, vi nhng ngi bnh ny iu dng cn khai thc tin s mt cch cn thn qua ngi thn v chnh bn thn ngi bnh. Thng ngi bnh khng khai tht nn iu dng cn kho lo c nhng d kin chnh xc v ngi bnh Ngi bnh nghin ru hay ma tu c rt nhiu bin chng sau m do tnh trng suy dinh dng, do chc nng gan gim, do chc nng thn kinh cng c vn . iu dng cn c k hoch chm sc trong trng hp ngi bnh ln cn nghin sau phu thut hay cung sn do ru.

4.3.9. Ni tit Tiu ng l mt yu t nguy c cho c gy m v gii phu. Ngi bnh tiu ng c nguy c cao trong h ng huyt, bin chng tim mch, nguy c nhim trng cao, vt thng lu lnh. iu dng cn xc nh, theo di ng trong mu v gip bc s iu chnh lng ng trong mu. iu dng cn thc hin ch tit ch cho ngi bnh. 4.3.10. Nhim trng Nu nhim trng cp tnh, cuc m thng phi hu nu l m chng trnh. Nhim trng mn tnh nh lao, AIDS th tu trng hp c th m. Kim sot nhim trng trc m l iu cn thit cho ngi bnh, v th iu dng cn hi ngi bnh v thc hin khm chuyn khoa tai mi hng, rng, tit niu, sinh dc ngi bnh trc m. Theo di nhit . Thc hin y lnh trong iu tr dt im nhim trng trc m, thc hin thuc khng sinh phng nga theo y lnh iu tr. 4.3.11. Min dch iu dng cn tm hiu tin s d ng ca ngi bnh nh d ng thuc, iu dng cn khai thc loi thuc v ghi ch h s gip thy thuc v gy m trnh s dng nhng loi thuc ny. D ng thc n cng quan trng v sau m vn dinh dng rt cn thit nn cn hi r thng tin trnh tai bin d ng c th lm tnh trng sau m nng n hn. Trong nhng ngi bnh ghp tng thng kh nng min dch km nn iu dng cn c k hoch chm sc hon ton v khun trnh nguy c nhim trng cho ngi bnh. 4.3.12. Thuc iu dng hi ngi bnh v thuc h ang s dng v c nguy c tng tc vi thuc m, c th nh hng n thuc tim mch, huyt p, min dch chng ng mu, bit c s tng tc v phn ng ph ca thuc, d ng vi cc loi thc n, ho hc, nghin thuc, lm dng thuc, nghin ru. Thuc steroid: trong nhng trng hp ngi bnh mc bnh mn tnh cn iu tr lu di loi thuc ny, iu dng cn khai thc k cch s dng v khng nn dng t ngt, cn bo qua nhm gy m c hng iu chnh thuc kp thi. Thuc li tiu: thng km theo gim Kali mu cng nh hng n tim mch hay thuc Thiazide cng c th gy suy h hp trong qu trnh gy m. Ngoi ra, thuc li tiu cng gy tnh trng mt nc v in gii. Thuc chng trm cm: tc dng ph ca thuc ny cng gy nguy c tt huyt p. Aspirin: trong nhng bnh l tim mch ngi bnh thng s dng lu di aspirin. iu dng cn thng bo cho gy m c k hoch gy m c th trnh tnh trng chy mu sau m do trong mt s phu thut c th kt hp cng heparin trong m.

5. D KIN KHCH QUAN

Mi ngi bnh cn c h s bnh n y trc m. Khm xt th cht v phi hon tt d kin v ngi bnh trc m do phu thut vin, iu dng, gy m thc hin. Xt nghim cn lm sng c bn trc m nh:

Mu: cng thc mu, mu ng, mu chy, nhm mu, dung tch hng cu, tc lng mu, chc nng ng mu ton b, BUN, ng huyt, protid. Nc tiu: tng phn tch nc tiu. Chn on hnh nh: X quang phi, siu m, in tim, CT scan. Ngoi ra, tu loi phu thut ngi thy thuc c y lnh cc xt nghim khc v gan, tu , thn.

6. QUN L IU DNG

6.1. Gio dc ngi bnh trc phu thut

Vi ngi bnh ni tr, iu dng gio dc v dn d bui chiu trc m sau khi hi chn xong v khi chun b v sinh cho ngi bnh trc m. Vi ngi bnh ngoi tr, iu dng gio dc v dn d trong ngy khm bnh v sng ngy trc m. Hng dn ngi bnh cn n ng gi v thng n trc gi m 12 gi. Nu m trong ngy, iu dng lin h vi ngi bnh bo trc gi m. Ni dung gio dc chnh l cung cp thng tin cho ngi bnh v thn nhn ngi bnh, gip h bt cng thng, lo u trong thi gian ch i cuc m bao gm: phng on thi gian ca cuc phu thut, thi gian hi phc sau m, ni chuyn ngi bnh n sau m, thng tin v nhm chm sc sau m v nhng chm sc thng quy. Bn cnh , iu dng cng hng dn ngi bnh cch th su, ho, th gin, vn ng trc m sau m h hiu bit v t chm sc tt hn, cch s dng thuc bm gim au, gip ngi bnh bit c nhng thng tin c bit khi m. Thng tin cho ngi bnh bit cn tm, tht tho, ngng n ung trc m. iu dng lng nghe v quan st ngi bnh thc hin ng cha. Gi tr ca vic gio dc l gip ngi bnh gim s lo lng, gim s, gim nn i, gim au, gim bin chng, gim thi gian nm vin. Ngoi ra, ngi bnh cn hiu r hn mnh s lm th no gip cho sau cuc m tt hn, ngi bnh an tm hn.

6.2. Thc hin cam kt trc m

K giy cam kt trc m l ngi bnh t nguyn v ng thun m. H s ny bo v cho bc s, iu dng, bnh vin, chia s quyt nh gia ngi m v ngi c m. Nhng trc khi k giy cam kt ngi bnh cn bit chn on xc nh, mc ch iu tr, mc thnh cng ca cuc m, nguy c b thay i trong iu tr. V th, ngi bnh cn phi chng t hiu bit ton din v nhng thng tin c cung cp. Ngi bnh khng b thuyt phc hay b bt p. Ngi bnh c th k cam kt cho bn thn nu tui v tnh trng tinh thn cho php. Nu nh ngi bnh cn nh, hn m, ri lon tm thn th ngi thn c th k cam kt thay th. Nu ngi bnh l ngi nh tui, t do, trn 16 tui c th t k giy. Trong trng hp cp cu c th phi m cu sng m khng c mt ca gia nh th ngi k tn phi l ngi c trch nhim v pha bnh vin.

7. CNG VIC C TH M IU DNG CN CHUN B NGI BNH TRC M

7.1. Ngy trc m

Ci b t trang ngi bnh: iu dng nn gi t trang ca ngi bnh cho thn nhn v bn giao cn thn v nhng vt ny va gy tr ngi cn trong t th phu

thut, va gy nhim khun vng m. Tt nht nn hng dn ngi bnh ci b t trang li nh trc khi nhp vin. Tho rng gi l yu cu tuyt i v rng gi gy tr ngi trong vic t ni kh qun, gy hay st rng gi, d vt ng th nu rng rt vo kh qun. Tc di tht bm li hay buc tc gn gng. Tc gi cn c ly ra v n l nguyn nhn gy nhim trng cho vng m. Mng tay sn: chi sch mng tay, mng chn c sn mu gip quan st, theo di mu sc da nim, mng chnh xc. V sinh: nn cho ngi bnh v sinh sch s chiu hm trc m, v sinh vng m v tm ra sch vng m tt nht vi x bng st khun, nht l vng m. Hin nay, trong cc ti liu nc ngoi vic co lng hn ch thc hin, thay vo l vic lm v sinh vi dung dch savon st khun. Nu trong trng hp cn co lng th nn s dng dng c co ru. n ung: chiu trc m n nh long, ti trc m nhn n hon ton, thng nhn n ti thiu 8 gi trc m, ngng ung ti thiu trc 4 gi. Sng hm sau thc hin truyn dch cho ngi bnh trc m. Trong trng hp ngi bnh gy t th khng cn nhn n ung ti trc m, ch nhn n vo sng trc m. Tht tho: cn lm sch rut ti hm trc v sng hm m nh ung thuc x, bm hu mn bng dung dch ty x. Vi m i trng, nguyn tc l m bo sch phn i trng nn cn thc hin tht tho cho ngi bnh. Tm l trc m: trnh ngi bnh lo u, cng thng, iu dng cho ngi bnh gp g ngi nh, khuyn ngi bnh ng sm, c th thc hin thuc an thn cho ngi bnh m trc m.

7.2. Sng hm m
Tht tho li sng trc m, cng tu vo tng loi phu thut nhng thng m i trng vic ny l rt cn thit. Chun b ngi bnh: ngi bnh thay m sau khi tm sch vo bui sng. Tng trng: lun thc hin ly du chng sinh tn vo sng hm m v trc khi chuyn ngi bnh ln bn m. Ch kim tra mch vi nhng ngi bnh m bu gip, huyt p vi ngi bnh m tim, h hp vi ngi bnh c suyn hay m v h hp. Thng tin bn giao ngi bnh: eo bng tn, nn ghi r rng c h tn, tui, khoa, chn on, phng php phu thut. Vt thng: thay bng li vt thng sch s, bng kn. Dch th: truyn dch, thc hin thuc theo y lnh. Phng nga tnh trng thiu dch l nhim v rt quan trng ca iu dng trc m. t ng thng d dy (nu cn). t thng tiu (nu cn), cho ngi bnh i tiu. Chuyn bnh ln phng m: iu dng cng thn nhn chuyn ngi bnh n phng m bng cc phng tin an ton.

7.3. Thuc trc m

iu dng nn hiu bit tc dng v thi gian ca thuc trc m nh Benzodiazepines & Barbiturate thuc an thn gy m.

H2 receptor antagonis thuc ngn cn nguy c tn thng nim mc d dy do aspirin, do stress trc m i vi nhng ngi bnh nhy cm, lo lng nhiu hoc tu bnh l. Anticholinergic lm gim bi tit. Narcotic thuc gim au. Khng sinh: ngi bnh c bnh van tim, nhim trng trc , vt thng nhim trng, nguy c nhim trng, khng sinh d phng trc m. Heparin: tim di da 612 gi trc m ngn nga tc mch, trong cc trng hp m tim, ghp tng Thuc nh mt: nn thc hin trc m nu ngi bnh tng c m mt. Thuc trc m c s dng nhm gim lo lng, tng an thn, gip gim au, ngn nga nn i, ngn nga cc phn x t ng, gip t ni kh qun d dng trc m, gim s bi tit dch d dyrut, h hp. Thi gian v cch dng thuc nh sau: Thuc ung: nn cho trc 6090 pht trc khi a ngi bnh xung phng m v ngi bnh ch ung t nc. Tim bp (IM), tim trong da (ID): tim 3060 pht trc khi xung phng m. Tim tnh mch (IV), nn thc hin tim phng tin m. iu dng cn bo cho ngi bnh nhng tc dng chnh v ph ca thuc. Di chuyn ngi bnh ti phng m: iu dng cn di chuyn ngi bnh xung phng m an ton, hng dn ngi nh ni phng i v nhng thng tin khc. Cn di chuyn ngi bnh bng xe ln, bngca, trnh ngi bnh t i b.
BNG KIM SOT TRC M H tn ngi bnh: Khoa: Chn on trc m: Ngy m: Phng thc phu thut: Tng trng: Cn nng: Kt qu xt nghim: Hct Hgb Hnh nh: XQ ECG D ng: C Khng Thuc Nhn i: t gi n Ly cc loi dng c gi trn c th: Trng mt knh Mt knh Rng gi Ning rng Du chng sinh tn: Mch ln/pht Nhp th ln/pht Chun b da: tm Mc o chong bnh vin Trang im: ty trang Vt thng: thm dch B bt: c khng Nhit c ra

Kali Loi mu Thc n

Khc

Tai nghe Tc gi Huyt p C co lng

0

mmHg

sch mng do nc sn thay bng tho bt np

Dn lu: c khng dn lu vt thng CVP Nc tiu: thng tiu c khng Tht tho Thuc n phng m cng ngi bnh K tn ngi giao

ng Levine

K tn ngi nhn

CU HI LNG GI
Tr li ngn gn cc cu hi sau: 1. Lng gi chc nng tim mch, iu dng cn thm khm v: A. ... B. ... C. ... D. Nghe tim . Lng gi chc nng h hp, iu dng cn thm khm v: A. ... B. Kiu th .. C. ... D. ... Lng gi v chc nng thn, iu dng cn hi v: A. Ph .. B. ... C. ... D. ...

2.

3.

Tr li ng, sai cc cu sau bng cch nh du X vo thch hp:

TT 4 5 6 7 8 9 10 Cu hi Cn nhn n ung trc m 5-7 gi. Ngi bnh cn c cung cp thng tin trc m gip h an tm. Lng gi cn nng gip thy thuc thc hin thuc m trong m. Ch nng cao dinh dng ngi bnh suy dinh dng trc m. Lng gi thn kinh gip iu dng theo di tri gic chnh xc. Ngi bnh cn co tc trc m. Ly rng gi trc m. ng Sai

TI LIU THAM KHO

1. Kim Litwack. Preoperative patient, in Medical Surgical Nursing, MosbyYear book, Inc. 4th ed., St. Louis Missouri, (1996): 350370. 2. Phm Th Minh. Chun b tin phu (bng) trong chm sc ngoi khoa. Ti liu th im ging dy iu dng trung hc. n h tr h thng o to 03SIDA, H Ni 1994, trang 38. 3. Phan Th H Hi. Chun b ngi bnh trc m. Bi ging bnh hc ngoi khoa tp 1. i hc Y Dc TP. H Ch Minh, 1985. Nh xut bn Y hc, 1985, trang 911. 4. iu dng ni ngoi khoa tp 2, BRUNNER/ SUDDARTH, Nh xut bn Y hc ln 6, H Ni 1996, trang 1334. 5. Saundra L. Seidel, Knowledge base for Patients undergoing surgery, in Medical Surgical Nursing, W.B. Saunders company 2nd ed. (1998): 115158.

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