Introduction To Medical Surgical Nursing PDF

INTRODUCTION MEDICAL SURGICAL NURSING 1  Objectives At the end of the this session you would able to: ▪ Define medical surgical nursing ▪ Identify the scope of practice for medical surgical nursing ▪ Identify the common concepts in health and illness ▪...

INTRODUCTION MEDICAL SURGICAL NURSING 1  Objectives At the end of the this session you would able to: ▪ Define medical surgical nursing ▪ Identify the scope of practice for medical surgical nursing ▪ Identify the common concepts in health and illness ▪ Discuss nursing process 2  Medical Surgical Nursing Medical surgical ▪ A subject deals concerning both medical and surgical care to the patient. Medical ▪ It refers to the study of disease and its treatment which doesn’t need surgical intervention. 3  Cont… Surgical /surgery Branch of medicine dealing with: ▪ Manual and operative procedures for correction of deformities and defects ▪ Repair of injuries ▪ Diagnosis and cure certain diseases with surgical intervention 4  Cont… Medical-Surgical Nursing ▪ Requires specialized knowledge and clinical skills to manage actual or potential health problems that affect individuals, their significant other(s), and the community. ▪ Provided to clients from adolescence throughout the life span. 5  Scope of Practice for Medical-Surgical Nursing The goal of the Medical-Surgical Nursing specialty ▪ To promote, maintain, and restore the health of the client in accordance with the best evidence available. 6  Cont… The client ▪ Is the recipient of nursing actions ▪ Can be an adult, family, group, or community When the client is an adult ▪ The focus is on the health state, problems, or needs of the individual throughout the life span. 7  Cont… When the client is a family or group ▪ The focus is on the reciprocal effects of an individual’s health state on the other members of the unit or the health state of the unit as a whole. When the client is a community ▪ The focus is on personal and environmental health and reducing the health risks of population groups. 8 Medical-Surgical Nursing Practice The Medical Surgical Nurse ▪ Possesses specialized knowledge ▪ Skilled in assessing, diagnosing, and treating actual or potential alterations in functional ability and lifestyle and evaluating the outcomes from those efforts. 9  Cont… The goal of Medical-Surgical Nursing ✓To assist clients in promoting, restoring, or maintaining optimal health. ▪ Medical-Surgical Nursing services are provided to clients throughout the life span. 10  Cont… Medical-Surgical Nursing is practiced in a variety of settings across the continuum of care: ▪ Acute and sub acute care facilities ▪ Home care agencies ▪ Ambulatory care clinics ▪ Outpatient services ▪ Skilled nursing facilities 11  Cont… ▪ Private practice ▪ Adult day care agencies ▪ Primary care and specialty practices ▪ Schools ▪ Insurance companies ▪ Private companies, and telehealth 12 The role of the Medical Surgical Nurse ▪ Care giver ▪ Consultant ▪ Care coordinator ▪ Researcher ▪ Client educator ▪ Administrator/manager ▪ Counselor ▪ Staff educator ▪ Client advocate 13 Health & illness 14  Changing concepts in Health Biomedical Concept ▪ Absence of disease ▪ If one was free from disease the person was considered healthy Ecological Concept ▪ Absence of pain and discomfort and a continuous adaptation and adjustment to the environment to ensure optimal function. 15  Conti… Psychosocial Concept ▪ Health is both a biological and social phenomenon Holistic Concept ▪ The combination of the above three ▪ A sound mind, in a sound body, in a sound family, in a sound environment ▪ Emphasize the connection of mind, body, and spirit 16 17  Definition of health WHO ▪ Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. 18  Limitations of WHO definition Complete ▪ Total or perfect health ▪ Realistically can not be achieved ▪ Impossible for any person State ▪ Health is a dynamic ▪ State is not achievable Well-being is subjective and difficult to measure 19  Conti… Disease ▪ A physical or mental disturbance involving symptoms, dysfunction or tissue damage. Illness (sickness) ▪ A more subjective concept related to personal experience of a disease. 20  Health-illness continuum ▪ Health and illness can be viewed as the opposite end of the health continuum. ▪ People move back and forth within this continuum day by day. ▪ Person’s health condition can move from high level wellness to death. ▪ Shows dynamic(ever-changing) state of health. 21 22  Nursing process ▪ It is a systematic problem- solving approach toward giving professional, holistic and individualized nursing care. ▪ It is an organized and systematic process of giving goal oriented and humanistic nursing care that is both effective and efficient. 23  Cont…. Purpose of Nursing Process ▪ Identify client health status/problems ▪ Establish plan to meet individual needs ▪ Deliver specific nursing intervention ▪ Evaluate the outcome 24  Cont…. Benefits of the nursing process ▪ Speed up diagnosis and treatment of actual and potential health problems ▪ Reducing the incidence of hospital stays ▪ Has precise documentation that improve communication ▪ Promotes flexibility and independent thinking ▪ Tailors interventions for the individual ▪ Helps nurses to gain satisfaction of getting results. 25  Nsg Vs Medical process Nursing process Medical process Deals with two types of health ▪ Deals mostly with problems problems with structure and function of organs or systems. 1. Human response for problems ▪ Uses the five step approach but 2. Problems with structure and has less precise rules for how function of organs or systems planning, implementation and requiring physicians’ orders evaluation are done- e.g. Goals Uses the five step approach are not clearly recorded during and provides strict rules for planning. how each step is followed. 26  Cont… Nursing process Medical process ▪ Considers the whole person, ▪ Mainly considers organ and organ and system function , system function as well as, the person’s ▪ Focuses on teaching about response to organ/system how diseases and trauma are malfunction treated. ▪ Focuses on teaching individuals or groups how to be independent on activities of daily living. 27  Cont…. Characteristics of nursing process ▪ Systematic ▪ Dynamic and continuous ▪ Client centered ▪ Goal-directed ▪ Universally applicable 28  Phases of nursing process 1. Assessment 2. Diagnosis 3. Planning 4. Implementation 5. Evaluation 29 30  Cont…. ▪ These steps are not discrete steps or linear but rather they overlap and build on each other. ▪ Each step of the nursing process depends on the accuracy of each step. ▪ The five phases of the nursing process don’t occur in isolation from one another. 31  1.Assessment ❑ It is the systematic & continuous collection, validation, organizing/clustering and communication of patient data. 32  Cont….. ❑Assessment is the deliberate and systematic collection of data to determine a client’s: ▪ Current and past health status ▪ Functional status and to evaluate the client’s present and past coping patterns 33  Cont…. Components of assessment ▪ The assessment phase of the nursing process has the following components: I. Subjective and objective data collection II. Validation of data III. Organizing data IV. Documentation of data 34  Cont…. Subjective data ▪ Subjective data are the facts presented by the patient that show his or her perception, understanding, and interpretation of what is happening. 35  Cont…. Objective data ▪ Is directly or indirectly observed through measurement by the nurse. ▪ This type of data is obtained by using the four physical examination techniques (inspection , palpation , percussion ,and auscultation). 36  Cont…. Example: ▪ Physical characteristics (skin color, posture, body function, (heart rate, respiratory rate) ▪ Measurements ( blood pressure , temperature , height ,weight ) ▪ Vital signs ( BP , PR , RR , T◦) 37  Cont….. Validating data ▪ Data validation focuses up on making sure that your data are factual. ▪ Validating the data with the client helps the nurse to avoid making incorrect inferences. 38  Cont… Validating data helps you to avoid: ▪ Missing pertinent information ▪ Misunderstanding situation ▪ Jumping to conclusion or focusing in the wrong direction. 39  Cont… Organizing (Clustering) Data Based on ▪ Human needs ▪ Functional health pattern (Gordon) ▪ Body systems 40  cont… Documentation data ❖Record assessment findings Importance of documentation of data ❖Communication ❖For evaluation 41  Cont… Source of data ▪ Primary source -the patient him/herself ▪ Secondary source- the patient’s family or significant other’s, the patient’s admission sheet form, the physician’s history, laboratory and x-ray results, information from other care givers. 42  TYPES OF ASSESSMENT A. Initial assessment ▪ Performed shortly after patient admission to a health agency or hospital. B. Focused assessment ▪ The nurse gathers data about a specific problem that has already been identified. 43  Cont… C. Emergency assessment ▪ The nurse performs this type of assessment on a physiological or psychological crisis to identify the life threatening problems. D. Time -lapsed assessment ▪ This assessment is done to compare a patients current health status to the base line data obtained earlier. 44  2.Nursing diagnosis ▪ It is clinical judgment about individual, family, or community responses to actual or potential health problems. ▪ It provides the base for selection of nursing intervention. 45  Types of nursing diagnosis 1. Actual Nursing Diagnosis ▪ Represents a problem that has been validated by the presence of its characteristics. E.g. Impaired physical mobility ,fatigue ,ineffective breathing pattern. 46  Cont… 2-Risk nursing diagnosis It is a clinical judgment that an individual , family ,community is more vulnerable (able) to develop the problem. E.g. Risk for deficient fluid volume 47  Cont…. 3-Possible Nursing Diagnosis -are statements describing a suspected problem requiring additional data. E.g. Possible chronic low self-esteem 4-Wellness Diagnosis -It is a clinical judgment about individual , group , or community in transition from specific level of wellness to a higher level. E.g. Readiness for enhanced health maintenance ,Readiness for enhanced self- esteem. 48  Cont… 5-Syndrome nursing diagnosis -a cluster of an actual or risk nursing diagnosis suspected to be present according to certain events or situations. E.g. Post trauma syndrome 49  Parts of nursing diagnosis 1-Problem (diagnostic label)-statement that describes the health problem of the patient clearly & concisely. 2-Etiology(Related factors) -the reason that identifies the physiological , psychological ,social ,spiritual & environmental factors related to the problem. 50  Cont…. 3-Defining characteristics (s/s ) The subjective & objective data that signal the existence of the problem. 51  Cont… NB: To write a diagnostic statement for an actual nursing diagnosis ,link the problem(P) and etiology (E) by using “related to” and link the etiology (E) with defining characteristics (S) by using “ as evidenced by” or “as manifested by ’’ 52  Cont… 1.An actual nursing diagnosis has 3 parts statement ( P + E + S) E.g. Pain related to surgical incision as evidence by verbal comments ,body posture… 2. Risk nursing diagnoses are two parts (P + E) E. g. Risk for injury related to lack of awareness of hazards 53  Cont… 3. Possible nursing diagnoses has two-part statements consisting of: The “related to” data that lead the nurse to suspect the diagnosis. Example -Possible disturbed body image related to isolating behaviors post surgery 54  Cont… 4. Diagnostic statements for wellness nursing diagnoses has one- part containing the diagnostic label. Example: Readiness for enhanced family process Readiness for enhanced nutrition 55  Cont… 5. Syndrome nursing diagnoses usually are one- part diagnostic statements with the contributing factors contained in the diagnostic label. Example ▪ Rape- trauma syndrome ▪ Disuse syndrome ▪ Post -trauma syndrome ▪ Relocation stress syndrome ▪ Impaired environmental Interpretation syndrome 56  3. Planning ▪ Setting priorities ▪ Setting goals ▪ Outcome identification ▪ Determining nursing interventions 57  Cont… Establishing a priority set of diagnosis ▪ Refers to determining the problems that need immediate attention. ▪ By identifying a priority set –a group of nursing diagnoses and collaborative problems that take precedence over others the nurse can best direct resources toward goal achievement. 58  Cont.. Several methods of assigning priorities are available: ▪ Some nurses assign priorities based on the life threat posed by a problem. ▪ For example, ineffective air way clearance would pose more of a threat to life than the diagnosis risk for impaired skin integrity. 59  Cont… Planning goal directed care ▪ Setting realistic goal ▪ Goals should be SMART (Specific Measurable, Attainable, realistic and time bounded). ▪ Short term goal- can be meet relatively quickly (i.e less than a week) ▪ Long term goals- may take a week and more or months or more. 60  Cont…. Patient Outcome ▪ It is an expected conclusion to patient health problem and the more specific measurable goal has been met. ▪ Expected outcomes are realistic, achievable, safe, and acceptable from the patient’s view point. ▪ E.g. Will demonstrate effective breathing pattern as evidenced by clear lungs and practicing deep breathing and coughing every 2 hours. 61  Cont…. Nursing intervention Generally intervention are categorized as ▪ Independent intervention ▪ Interdependent intervention ▪ Dependent intervention 62  Cont…. i. Independent intervention ▪ Those activities which is done by nurses (all nursing care /nursing diagnosis are independent). ii. Interdependent intervention ▪ Diagnostic, therapeutic procedure in collaboration with other professional. 63  Cont…. iii. Dependent intervention ▪ Done at direct request of other health professionals. ▪ Physicians’ orders are not orders for nurses; rather, they are orders for clients that nurses implement if indicated. 64  Cont…. Nursing care plan ▪ It is a written document that guides the nursing care provided to patient. ▪ It should contain all types of nursing process. 65  Cont…. Stages of planning Initial planning ▪ Is developed by the nurse, who performs the admission nursing history and the physical assessment. Ongoing planning ▪ Is carried by the nurse to keep the plan up date , by analyzing data to make plan more accurate. 66  Cont…. Discharge planning ▪ Is best carried out by the nurse ,who has worked most closely with patient and family. 67  4.Implementation ▪ A step of nursing process in which a planned nursing action is carried out and documented. 68  Cont… Types of nursing implementation : 1.Direct care intervention : ▪ Performed through intervention with patient and includes both physical and psychological nursing action also include both(laying of hands) or supportive and counseling in nature. 69  Cont… 2.Indirect care intervention ▪ A treatment performed away from the patient include management of patient environment. 3.A community intervention ▪ Targeted to promote and preserve the health of populations. 70  5. Evaluation ▪ You and the patient must determine how well the plan has worked and whether you need to make any changes in the plan. ▪ All phases of nursing process must be evaluated. ▪ Evaluation is not only occurring after implementation of the plan but is ongoing throughout the process. 71  Cont…. Evaluation involves three different considerations: ▪ Evaluation of the client’s status ▪ Evaluation of the client’s progress toward goal achievement/outcome. ▪ Evaluation of the care plan’s 72