Medical Surgical Nursing (Lecture) - Topic Outline - PDF

FIRST SEMESTER NUR81018: MEDICAL SURGICAL NURSING (LECTURE) ASST. PROF. MARGARET M. NATIVIDAD, EDD, RN LECTURE TRANSCRIPT / LIVE DISCUSSION / BOOK...

FIRST SEMESTER NUR81018: MEDICAL SURGICAL NURSING (LECTURE) ASST. PROF. MARGARET M. NATIVIDAD, EDD, RN LECTURE TRANSCRIPT / LIVE DISCUSSION / BOOK counteract the stimuli or TOPIC OUTLINE stresses to which it is subject Disease Process results in disturbances in the ○ Terminologies function and structure of any Narrative on the Patient with Long Term Illness part, organ, or system of the ○ Acute Illness body. ○ Chronic Illness Examples: Terminologies ○ CAD - Angina and MI Factors Affecting Patient Needs ○ Malaria – anopheles Effects of Chronic Illness. ○ Dengue - Aedes aegypti. ○ Rabies - dog bite Nursing Intervention ○ Leptospirosis - caused by water Principles of Care thru flood ○ Restoration of Optimal Functional Capacity Immediately wash ○ Prevention of Complications, Accidents And ○ Tuberculosis Injury Ex: PTB - managed by ○ Psychosocial Care RIPES ○ Continued Assessment of the Pt. Condition of being diseased MORBIDITY ○ Provision for Follow-Up and Home Care Heard more in the community Community agencies/facilities for continuing care of The proportion of diseases to health the chronically ill MORBIDITY RATE in a community Narrative on the Patient with Immediate Illness Condition or quality of being subject ○ Definition and Control to death ○ Areas to be Considered in Prevention and MORTALITY Example: Control ○ Ano ang mortality rate sa lugar Rehabilitative Nursing niyo? High or low? Preservative Methods The science of organisms as Restorative Methods affected by factors in their Rehabilitation Concepts environment; deals with the ○ Principles of Rehabilitation ECOLOGY relationship between disease and ○ Levels of Disability geographical environment ○ Goals of Rehabilitation Studied by Ecologists Rehabilitation Nursing The study of the patterns of health ○ Rehabilitation Team and disease, its occurrence and ○ Causes of Disability distribution in man, for the purpose ○ Disuse Syndrome EPIDEMIOLOGY of control and prevention of diseases Stages of Psychological Reaction Example: ○ Period of Confusion, Disorganization, and Denial ○ Rise of leptospirosis in a ○ Period of Depression and/or Anxiety and Grief community due to flooding ○ Period of Adaptation and Adjustment The degree of resistance the Preventing Complication and Deformities potential host has against the ○ Positioning pathogen. ○ Therapeutic Exercises Examples: ○ Range of Motion Exercises ○ Who is more susceptible to ○ Preventing External Rotation of Hip TB? Immunocompromised or ○ Preventing Footdrop students? ○ Preventing Bedsores SUSCEPTIBILITY Immunocompromised, ○ Treating Pressure Sores because of their weak immune system DISEASE PROCESS Who is more susceptible to HIV TERMINOLOGIES infections? Drug users and those who have a lot of sexual partners Disturbance of structure or of the (ex. same sex, bisexuals) function of the body or its constituent One that possesses the potential for parts producing injury or disease. ○ Lack of faulty or inadequate What is the etiologic agent of TB? DISEASE adaptation of the organism to its ETIOLOGIC AGENT What is the etiologic agent of environment Malaria? ○ Failure of the adaptive ○ From the bite of mosquito mechanism to adequately What if the cause is unknown? DACULA, DAZO, DE GUZMAN, S., DELA CRUZ, G., DIESTA, ESCARLAN, ESCUDERO, GIGANTONE, GUITTAP, IBAÑEZ | 3NUR-2 1  ○ Idiopathic A set of symptoms, the sum of which What if the drug has benefits but has constitutes a disease. negative effects? A group of symptoms which ○ Iatrogenic commonly occur together. What If the drug is causing cancer? A group of signs and symptoms ○ Carcinogenic which when considered together What if radiation causes something characterized a disease. to the baby during pregnancy? Examples: ○ Teratogenic SYNDROME ○ A patient with kernig’s sign, “Penia” - decrease (ex. babinski sign, turgor rigidity, pancytopenia) fever, seizure Relative power or the degree of ○ A patient with cough and pathogenicity of the invading hemoptysis = TUBERCULOSIS microorganism, the ability to produce Tests for Tuberculosis poisons that repel or destroy ○ Mantou test phagocytosis. ○ CBC Refers to the agent NOT the host. ○ Sputum analysis Wag mo sabihin sa patient na The branch of medicine which deals napaka virulent naman niya hahaha with the cause, nature, treatment The more virulent, the more harmful and resultant structural and Ability to cause disease functional changes of disease. VIRULENCE Example: PATHOLOGY Study of disease ○ Most virulent strain of COVID NOTE: When you make is Delta pathophysiology you need to know Susceptible pathologic mechanism that causes ○ Pag host diseases What makes the host susceptible? PATHOPHYSIOLOGY OF LIVER ○ Comorbidities FAILURE/ CIRRHOSIS ○ Bata or matanda? Matanda! Start with etiologic agent - kaya sila unang binigyan ng alcoholism (main cause) vaccine Predisposing factors - male SYMPTOMATOLOGY The study of symptoms. Precipitating factors - previous hepatic damage hepa infection Any disorder of appearance, Alcoholism can alter the liver cell sensation or function experienced which can cause infection/ by the pt, indicative of a certain inflammation → tissues will phase of a disease regenerate → fibrotic (hard) → Manifestation of perceptible changes scarring of the tissue → liver in the body which indicate the cirrhosis SYMPTOMS presence of a disease or disorder Liver cirrhosis = IRREVERSIBLE Symptom is subjective ○ Affects the production of ○ Example: albumin Fatigue Albumin Headache ○ Maintains osmotic colloidal Nausea pressure Dizziness ○ Pulling force An objective symptom or objective Hypoalbuminemia = decrease COP evidence or physical manifestation PATHOPHYSIOLOGY = leading to edema (ascites) made apparent by special methods MECHANISM that ○ Manifestations: Edema and of examination. causes the disease ascites Example: Liver = production of prothrombin ○ Edema is a sign of sodium fluid (clotting factor) therefore if there is retention liver disease the prothrombin will be SIGN How. to assess signs of meningitis? reduced or prolonged production ○ Kernig’s sign ○ If prothrombin has prolonged ○ Brudzinski sign clotting it will cause bleeding ○ Babinski is pathologic in adults ○ What types of bleeding? but normal in a pediatric patient Petechiae Si maam ba normal or pathologic? uhm normal kasi baby pa siya If severe or lethal = REFER 👶 Purpura Ecchymosis/ hematoma ○ That may lead to complication of prolonged bleeding and loss of blood = HYPOVOLEMIC SHOCK Liver produces ammonia converted to urea High ammonia is toxic to the brain that causes hepatic encephalopathy Complications: DACULA, DAZO, DE GUZMAN, S., DELA CRUZ, G., DIESTA, ESCARLAN, ESCUDERO, GIGANTONE, GUITTAP, IBAÑEZ | 3NUR-2 2  ○ Hyperalbumenimia weakness ○ Bleeding problem sequela of chickenpox ○ Hepatic encephalopathy is having rashes and Walang management sa scars pathophysiology A condition that occurs during or Signs and symptoms are mystery to after the course of illness US Not expected Who will solve the mystery? Example – Patients with ○ IKAW hypoprothrombinemia or dengue Method of origin and development of may have a complication of bleeding a disease, including sequence of ○ Is dengue always with processes or events from inception bleeding? NO, it is not always a to the development of characteristic sequela of hemorrhagic fever = lesion or disease complication Example – What is the cause of liver ○ Although the main manifestation PATHOGENESIS cirrhosis? is bleeding that may lead to ○ It can be caused by alcohol, shock and death malnutrition, hepatitis, Example – complication of cholecystitis, the predisposing thyroidectomy is air obstruction and factor (male), altered nutrition bleeding ○ Pathogenesis is knowing the ○ Is it always occurring? NO, they cause of the disease only watch out for it Art or act of determining the nature ○ The doctor places pressure of a disease dressing to prevent the COMPLICATION complication of bleeding Recognition of a diseased state Examples: ○ If it is a common complication, ○ The doctor said that I have nurses and doctors always lymphoma, or AIDS, TB watch out for it and prevents it How did they end up with that ○ Assessment: After diagnosis? tonsillectomy, the patient ○ Based on the assessments of frequently swallows = signs of the signs and symptoms bleeding ○ Even if the signs and symptoms Patient will be cannot be diagnosed by the returned to the OR to laboratories, you already have a ligate the bleeders hint of the disease of the patient ○ Example – This patient is suspected to have cholecystitis 💡 What sequela is the difference of due to upper quadrant pain, from complication? fever, nausea and vomiting Sequela is EXPECTED More definitive is through Complication is NOT diagnostic tests EXPECTED DIAGNOSIS ○ Example – diagnostic test for cholecystitis is ultrasound The ultrasound of the Prediction of the course and end of patient will have a disease gallstones Medical opinion as to the course of a ○ Example – main diagnostic test disease process for TB is the sputum ○ Example: patient is diagnosed examination with cancer Sputum will reveal the Diagnostic test for pathogen/microorgani cancer is biopsy sm Only the differentiated Active TB = check the ductal carcinoma sputum then RIPES ○ Example – patient is in stage 4 will be given cancer Mantoux test — if it PROGNOSIS BAD/POOR prognosis has a positive result, it Because the cancer does not mean that has already the patient has TB but metastasized = indicates that he/she automatically in stage has been exposed 4 cancer Management: The consequence that follows the Palliative/hospice normal course of an illness care – relieving Expected; normal course symptoms but does SEQUELA ○ Examples: not cure the disease sequela of fever is (pain management fatigue, lethargy, such as giving DACULA, DAZO, DE GUZMAN, S., DELA CRUZ, G., DIESTA, ESCARLAN, ESCUDERO, GIGANTONE, GUITTAP, IBAÑEZ | 3NUR-2 3  narcotics) Beri Beri Implies that the person has observable or known effects from his illness ○ Ano deficiency Knowledge deficiency Due to injury 😭 niyo? There is apparent restoration to the Examples: RECOVERY TRAUMATIC pre-illness state ○ Fracture due to vehicular Example – if the patient recovers accidents – common from surgery and has no Due to abnormal response of the complications body to chemical or protein substances or to physical stimuli CLASSIFICATION OF DISEASES Examples: Asthma ○ Management: ACCORDING TO ETIOLOGIC AGENT Remove the allergen ○ Early sign: Due to effect in the germ plasm of Urticaria/hives/rashes one or the other parent which is ○ Late sign: transmitted to the offspring Dyspnea (altered Examples: breath sounds, HEREDITARY wheezing, caused by ○ Diabetes mellitus ○ Hypertension bronchospasm ○ Sickle cell caused by ALLERGIC ○ Cancer bronchoconstriction Due to a defect in the development, or narrowing of hereditary factors, or prenatal airway) infection ○ In emergency cases: Present at birth Give bronchodilator Examples: (salbutamol or ○ Cleft palate and lip ventolin) CONGENITAL Management: ○ Bronchoconstriction is due to Cheiloplasty and edema caused by the release of Uranoplasty histamine ○ Hydrocephalus Medication given: Management: antihistamine ventriculoperitoneal (diphenhydramine or shunting benadryl) Due to disturbances or abnormality Due to abnormal or uncontrolled in the intricate processes of growth of cells metabolism ○ Neo – new ○ Examples: ○ Plastic – growth Phenylketonuria ○ Neoplasm – new growth = Diabetes mellitus tumor (altered metabolism Can be benign or of glucose) – most malignant tumor METABOLIC common Malignant is more NEOPLASTIC Hyperthyroidism (high harmful metabolism) – weight Benign can also be loss harmful so it should be removed Hypothyroidism (low metabolism) – weight Examples: -oma = tumor gain, myxedema and ○ Myoma cretinism (hypothyroid ○ Carcinoma in child) ○ Lipoma Management: Remove/excision Results from inadequate intake or absorption of essential dietary Cause is unknown factors IDIOPATHIC Self-originated; of spontaneous ○ Vitamin D deficiency origin Osteoporosis (may be Results from the degenerative due to bone charges that occurs in tissues and resorption, aging organs process or lack of Vit. Examples: DEFICIENCY ○ Cataract — commonly caused D Osteomalacia (in by aging; can also be by DM DEGENERATIVE adults) ○ Parkinsons Rickets (in children) ○ Osteoarthritis ○ Iron Deficiency causing Anemia ○ Rheumatic arthritis ○ Vitamin C deficiency causing ○ Gout — metabolic arthritis; due Scurvy to altered levels of purine ○ Vitamin B deficiency causing (hyperuricemia) DACULA, DAZO, DE GUZMAN, S., DELA CRUZ, G., DIESTA, ESCARLAN, ESCUDERO, GIGANTONE, GUITTAP, IBAÑEZ | 3NUR-2 4  Results from the treatment of a Example — Pneumoconiosis disease ○ Black lung due to exposure to Drug possess another effect that chemicals, industrial gas IATROGENIC causes harm (asbestos) Example: ○ Factory workers (coal, nuclear ○ Chemotherapy medicine, radioisotopes) ○ High exposure of radiation in ACCORDING TO DURATION OR ONSET workplace = prone to cancer Produces signs and symptoms Occurs in universal individuals of the within a short period of time same family Runs a short course ending in full FAMILIAL Example: recovery or abrupt termination in ○ Breast cancer ACUTE death ○ Lung cancer Rapid onset; short duration Usually acquired through sexual Reversible; could become chronic relation Example: Example: VENEREAL ○ Tonsillitis ○ Gonorrhea Symptoms appear within a variable ○ Syphilis period of time ○ HIV Runs a long course, ending in partial Attacks a large number of recovery and characterized by individuals in a community at the remission and exacerbation same time (sudden spike in cases in one ○ Remission - disappearance of EPIDEMIC Example: population) symptoms ○ Sore eyes ○ Exacerbation - Reappearance ○ Chickenpox of severity of symptoms ○ Dengue CHRONIC Slow onset; long duration Presents more or less, Irreversible ENDEMIC continuously, or recurs in a ○ Undergo through dialysis or community (constant among a population/area) kidney transplantation An epidemic disease which is Example: extremely widespread involving PANDEMIC ○ Coronary Artery Disease the entire country or continent ○ Hypertension Example: COVID-19 ○ Diabetes Melitus A disease in which only SPORADIC ○ Arthritis occasional cases occur ○ Cancer Symptoms are pronounced but NARRATIVE ON THE PATIENT WITH LONG TERM ILLNESS SUB-ACUTE more prolonged than in acute diseases ACUTE ILLNESS Produces symptoms soon after the exposure to the OTHER CLASSIFICATIONS OF DISEASE cause Results from changes in the normal Runs a short course structure There is usually full recovery or abrupt termination in ○ From recognizable anatomical death changes in an organ or tissue of Not all acute illnesses are severe nor all severe the body illnesses acute Problem with the organ or part of the Nursing measures are directed primarily toward the ORGANIC body relief of symptoms rather than at the disease that has NOT all signs & symptoms have caused them → Palliative Care organic cause ○ It could be psychological due to CHRONIC ILLNESS stress or anxiety “Long term illness” ○ What affects the mind, affects A condition involving impairment of structure and the body function continuing over an extended period of time No anatomical changes are Includes diseases of impairments requiring long period observed to account for the of care, lasting three months or longer (National Center symptoms present for Health Statistic) ○ May result from abnormal Lasts for a year or more and that can usually be responses to stimuli controlled but not cured (CDC’s National Center for FUNCTIONAL Example — Spinal cord Chronic Disease Prevention and Health Promotion compression (NCCDPHP)) ○ When motor root is compressed = paralysis (no movement); CHARACTERISTICS OF CHRONIC ILLNESS paresthesia (numbness; pins 1. Insidious onset, produces symptoms over a variable and needles) period of time Results from factors associated with 2. Runs a long course OCCUPATIONAL the occupation engaged in by the 3. Non-correctable changes leading to progressive client physical changes DACULA, DAZO, DE GUZMAN, S., DELA CRUZ, G., DIESTA, ESCARLAN, ESCUDERO, GIGANTONE, GUITTAP, IBAÑEZ | 3NUR-2 5  4. Left-over disabilities ○ Difference in care 5. Partial recovery, permanency ○ Plan care that goes beyond the period of 6. Periods of remissions and exacerbation hospitalization ○ Remission: period when disease is controlled ○ Consider many aspects of the patient’s total and symptoms are not obvious → no life situation symptoms An acutely ill person may have an underlying chronic ○ Exacerbation: activation of the disease and condition, an individual may have an acute condition the recurrence of pronounced symptoms → and a chronic condition at the same time. symptoms present Acute exacerbation often causes the TERMINOLOGIES patient to seek medical attention and may lead to hospitalization Not well and strong, disabled by 7. Long period of care illness or infirmity You still let them walk to prevent EXAMPLES OF CHRONIC ILLNESS muscle atrophy ○ Half paralysis = hemiplegia Scenario: Kapag may male, TB Asthma Sinusitis INVALID nakayuko, nanginginig? ○ Parkinson’s Disease Heart disease DM HPN Muscles not used = Atrophy Muscles overused = hypertrophy Allergy Rh fever Severe bronchitis ○ Preferred over atrophy Epilepsy CVA Cancer Lack of physical or mental fitness, maybe permanent or temporary, Peptic ulcer Kidney stones Arthritis DISABILITY partial or total infections Government caters to disabled individuals (parking, CR) A physical or mental condition that INCIDENCE HANDICAP renders success more difficult Most common in 45-65 years of age group Example: Crippled d/t Amputation Mostly elderly drink maintenance medications (e.g., A condition which lessens or limits antihypertensives) IMPAIRMENT function below normal One who limps, creeps, or halts, as RECALL CRIPPLE from loss of a limb, a partially disabled person. ANTIHYPERLIPIDEMICS FACTORS INFLUENCING THE PATIENT’S NEEDS HMG-CoA reductase -statin Atorvastatin, inhibitors Simvastatin Each long term patient will automatically fall into a medical Normal cholesterol =