Medical/Surgical Nursing: Lecture 1 Handout
I.
Introduction Medical Surgical Nursing
A. Care of _____________ during ______________
B. Goals: Promote & maintain ____________________ Alleviate ________________________
C. Nurses: “Focus on the clients _____________ to actual or ______________ disruption in health”
II.
5 Core competencies
A. Provide __________________ ________________ care
1. __________________________
2. __________________________
3. _____________________ & _____________________
4. Relieve ______________________
B. Working in __________________________________ teams
1. C___________________________
2. C___________________________
3. Collaborate
C. Using _______________________ ___________________ practices
1. Clinical ____________________
D. Appling ________________________ improvement principles
1. _________________
2. _________________
3. Quality A___________________
E. Using information _______________________________________
III.
Nursing Process
A. Introduction
1. A ____________________ method of providing ___________ to clients
2. Allows nurses to _______________________ plans and activities
a. _________________
b. Other ___________ care providers
c. _________________
3. Encourages _________________ thought, analysis, planning
4. Purpose: to provide client care that is:
a. ______________________________
b. ______________________________
c. ______________________________
d. _____________________________
5. Consists of ________ steps
a. _______________ on each other; not ___________________
6. Used throughout the ____________ spans in _____________ care setting
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IV.
Small Group Questions
1. Describe the steps of the nursing process?
2. What is the purpose of the nursing process?
3. In what clinical setting is the nursing process used?
B. Assessment: Step # ____
1. Involves
a. ___________________ , ____________________, _____________________,
______________________, _____________________ data
2. Purpose of assessment is ___________ collection
3. Types of assessments
a. __________________________
a. Base________________
b. __________________ & psychosocial
b. __________________________
a. ________________ in scope
b. Screening for a _____________ problem
c. ________________ stay
c. __________________________
a. Follow - _________
b. Monitoring and observing ________________
4. Types of data
a. ____________________
a. Data from the _____________ viewpoint: ________________
b. ____________________
a. Observable & _____________________
i. ________________
ii. ________________
iii. ________________ tests
C. Diagnosis: Step # _____
1. “A clinical ___________________ about individual, family or community responses to
actual or _________________ health problems/ life processes.”
2. The bases for selection of nursing ______________________ to achieve outcomes for
which the nurse is______________________________.
Medical Diagnosis
Nursing Diagnosis
Identifies conditions the _________________ is
Identifies situation the ____________ is licensed and
licensed and qualified to treat
qualified to treat
Focuses of ___________________, injury or disease
Focuses on the clients ___________________ to actual
processes
or potential health / life problems
Remains ___________________ until a cure is effected _________________ as the clients responses and or
the health problem changes
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D. Planning & Outcome identification: Step # _______
1. Types of planning
a. ______________, ongoing, _________________________
2. Identifying outcomes: _______________________
a. Short term goals: ___________________________________
b. Long term goals: ___________________________________
3. Developing specific nursing interventions
a. __________dependent Nursing interventions:_______________________
b. __________dependent Nursing interventions:_______________________
c. __________dependent Nursing interventions:_______________________
4. Prioritizing the nursing diagnosis
a. ________________________ hierarchy of needs
a. __________________________: breathing, food, water, sleep,
homeostasis, excretion
b. __________________________: security of body, employment,
recourses, morality, family, health, property
c. __________________________: Friendship, family, sexual intimacy
d. __________________________: Self-esteem, confidence, achievement,
respect
e. __________________________: Morality, creative, spontaneous
E. Implementation: Step #______
1. __________________________ of the care plan
a. ___________________ perform the plan, assist, ________________, delegate,
___________________, monitor
F. Evaluation: Step # __________
1. Have the client’s ______________ have been met, partially met, or not met
V.
Role of the LVN
A. Use the nursing _____________________________
B. _____________________________ to the diagnosis
C. The ________________ has ultimate responsibility
D. RN’s can work ___________________________ LVN’s work In ___________________ with RN’s
E. Provide _____________________ & _____________________________
F. Multiple Roles
1. ________________________
a. Provide ________________________, individual assistance
2. _________________________ / Leader
a. _____________________ care
b. Manage _____________________, ____________________, environment
c. ____________________________
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3. ______________________________
a. “One who ________ _______ for another”
b. Protect the client’s ___________________
a. ____________________________
b. ____________________________
c. ____________________________
d. ____________________________
4. _______________________________
a. Who? _______________________________________________
b. What? _______________ promotion, ___________________ prevention
c. Why? _____________________________ of care
d. How? ______________________________
VI.
Critical Thinking
A. “A goal-directed thinking in which a person attempts to use cognitive ___________________
and _______________________ to determine the best overall result or choose the best
_________________________ , given the particular circumstances.”
VII.
Nurse-Patient Relationship
A. Professional _______________________ “The _______________________maintained between
a person who is vulnerable _______________& the person with power___________”
VIII.
Communication
A. Convey
1. ___________________, _________ ______________, Caring, & ___________________
B. Establish the _______________________
C. ___________________________ communication
D. Interviewing techniques
1. ____________________________
2. ____________________________
3. ____________________ - ended questions
4. ____________________________
5. Clarification
IX.
Health-Illness continuum: The individuals stat of health is one of continual ____________________
X.
Culture/ race/ ethnic groups/ prejudice
A. Culture
B. Ethnic group
C. Ethnocentrism
D. Prejudice
E. Race
1. _____________ “A group of people who share and are unified by experiences and
background based on such factors as socioeconomic status, religion, education and
residence.”
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2. _____________“Belief that their own cultural group’s beliefs and values are the only
acceptable ones”
3. _____________“Is the learned behavior, values, beliefs, norms, and practices shared by
a particular group of people that guide their thinking, decisions and actions”
4. _____________“The act or state of holding unreasonable preconceived judgments or
convictions.”
5. ______________“To identify differences in physical characteristics, such as skin color,
eye shape and bone structure.”
F. Cultural Respect: Nurses must be
1. _______________________, _______________________, _______________________
G. 6 Cultural Characteristic
1. _________________________________
2. _________________________________
3. ______________ orientation
4. ______________
5. Environmental ____________________
6. ________________________ variations
XI.
Religious Care Considerations
A. Islam:
1. ____________________, washing, privacy
2. Caregivers of the same _______________________
3. Food: Do not eat _____________________
4. Fasting: _____________________
B. Judaism
1. Sabbath: _______________________
2. Food: ______________________, do not eat ____________________
C. Hinduism
1. Food: ___________________________ do not eat _____________________
D. Catholic:
1. No ________________ on Fridays
2. Icons:
3. Anointing for ____________________ and _________________
E. The Church of Jesus Christ of Latter-day Saints/ Mormon
1. Food: Do not eat_________________________
2. Wear special ________________________
F. Methodist/ Lutherans
1. Anointing
G. Assemblies of God
1. Pray & Laying on of ___________________ for healing
H. Jehovah’s Witness
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1. NO _________________ transfusions
2. Do not _________________________ holidays
I.
7th day Adventist
1. Food: Do not eat: _________________, ___________________, ________________
a. Vegetarians
2. Sabbath: _________________________
J.
Christian Science:
1. Do not ___________________ traditional medical treatment
2. Avoid ____________________________
XII.
Inflammation
A. “Non-__________________ response to injury
1. ________________ harmful agents
2. Limits ___________________
3. Begins to ________________
B. Body’s first line of Defense:__________________ & ________________ membranes
XIII.
Pathophysiology of Inflammation
A. 3 step process
1. ______________________ response
a. Vessels _____________________  release of chemical mediators
a. ____________________, bradykinin, prostaglandins
b. ______________ blood flow 
a. ______________________ & _________________
c. ______________ hydrostatic pressure 
d. Capillaries ______________ fluids into surrounding tissue  ____________
2. ______________________ response
a. ______ blood flow  _________ WBC
a. Neutrophils: Blood _____________  Injured tissue
i. “ Diapedesis”
b. Monocytes  ______________________________
i. _______________ harmful bacteria & Dead tissue
ii. “PHAGOCYTOSIS”
c. Neutrophils
d. Dead bacteria
___________ formation
e. Tissue debris
i. __________________ drainage
1. Staphylococcus, Streptococci, neisseria
3. ______________________ and tissue repair
a. Minor injury: ________________________ process heals
b. Major injury:
a. ___________ cells are produced  ______________ tissue
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XIV.
S&S of Inflammation
A. 5 cardinal S&S
1. ________________________ AKA: ___________________________
2. Heat
3. ______________________ AKA: ____________________________
4. Pain
5. Loss of ____________________________
XV.
Geriatric consideration of Inflammation
A. Conditions
1. _______________ skin
2. ______________ blood flow
3. ______________ macrophages
4. ______________ phagocytic activity
5. ___________________________ can interfere with inflammation & healing
B. Results:
1. ___________ risk of injury
2. ___________ wound healing
3. ___________ resistance
C. Diminished S&S
1. _____________________
2. _____________________
3. _____________________
XVI.
Acute vs Chronic
A. Acute inflammation
1. _________________ term reaction: Duration: _______________________
B. Chronic inflammation
1. _________________ onset: Duration: ______________________________________
C. Delayed healing 
1. Cellulites
a. Inflammation that _________________ to the surrounding
______________________ tissue
2. Abscesses
a. _____________ pockets
3. Fistula
a. Abnormal _________________ from one area to another
D. Diabetes mellitus and inflammation
1. ___________ risk of poor wound healing & ___________________________
2. High blood _____________________________________ levels 
a. _________ phagocytic function
b. ____________________ capillaries
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E. Systemic manifestations of inflammation
1. Enlarged _________________________ LYMPHADENPATHY
2. ___________ appetite
3. _____________________
4. __________ heart rate: _______________________
5. __________ respiratory rate: ____________________________
6. ________ WBC: LEUKOCYTOSIS
7. Fever
a. ______________________  chemicals “endogenous pyrogens” 
b. __________________________-
c. _________________ temperature set point
d. Fever
a. inhibits microorganism __________________
b. ______________ tissue repair
8. Geriatric considerations of FEVER
a. Best indicator of systemic infection in the elderly: ____________________ or
change in ______________________ function
XVII.
Diagnostic tests for inflammation
A. WBC with differential
1. ____________ leukocytes
2. _____________ of WBC made up by each type
3. Normal Total WBC: ______________ - ________________ mm3
4. > 10,000 mm3 = ________________________________
5. < 4,500 mm3 = ______________________________ (_____________ infection)
B. Erythrocyte sedimentation rate (ESR)
1. Detects ___________________ inflammation
2. ____________________ = inflammation
C. C-Reactive Protein (CRP)
1. Produced by the __________________  bloodstream, during inflammation
2. ____________ result = inflammation
D. Cultures
1. Culture blood or body fluids to determine if inflammation is due to infection
XVIII.
Medications for inflammation
A. Antibiotics
1. ___________ infection caused by __________________
2. ____________________ infection: Prophylactic
3. C&S done _________________________
4. Teach client to _____________________________________________
B. Acetaminophen AKA: ________________________________
1. Not an ____________ inflammatory
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2. Analgesic: _________________________________
3. Antipyretic: _________________________________
C. Anti-inflammatory Agents
1. Salicylates:
a.
e.g. _____________________________ Acetylsalicylic Acid (ASA)
b. WARNING: Do not give to _______________________ with
_____________________________ or influenza  REYE’S syndrome
2. (Other)Non-steroidal Anti-inflammatory Drugs
a. e.g. : __________________________________________________
b. Action:
a. Anti-______________________________________
b. Anti-_____________________________________
c. ____________________________
c. S/E
a. __________________ irritation
b. __________________________
3. Corticosteroids
a. Action:
a. Anti-__________________________
b. Anti-__________________________
c. Anti-__________________________
b. Indications:
a. Acute _______________________ reactions
b. ______________________ inflammatory disease
c. S/E
a. __________________ wound healing
b. ___________ & ____________ retention
d. WARNING:
a. ____________________ effective dose
b. Never stop _____________________: ________________ the dose
XIX.
Fluids & Diet with inflammation
A. Healing requires
1. Adequate __________________________
2. Adequate _____________________________
3. Adequate _______________________________
B. Catabolism: _____________________________________________________
C. Anabolism: _____________________________________________________
D. Foods/nutrients that promote healing
1. ______________________________
2. ______________________________
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3. Vitamins & Minerals
a. Vitamin _____________: Capillary formation & tissue growth
b. _________-complex: Wound healing
c. Vitamin _____________: collagen synthesis
d. Vitamin _____________: Blood clotting
e. ____________________: immune health
XX.
Nursing process for inflammation
A. _______________________________
1. Subjective / Objective data
a. Vital Signs
a. P___________
b. T___________
c. BP ___________
d. R ____________
b. Circulation
c. Skin check
d. Edema
e. Lymph nodes
B. _________________________________
1. Pain
a. Assess
b. __________________________
c. Encourage __________________
d. Apply: _______________ or ________________
e. Administer meds: ______________________________
2. Impaired tissue integrity
a. Protect
b. Clean
c. Rest
d. Movement
e. Diet
3. Risk for infection
a. Monitor ____________________
b. Culture
c. Enc. Fluids
d. Infection control measures
XXI.
Chain of Infection
A. _____________________________:
1. Pathogen
2. Virulence
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3. Invasiveness
B. _____________________________: Where the pathogen _________ & _______________
C. A ________________________ of exit from the reservoir
D. Mode of _____________________________
1. _______________________ contact
a. ________________ –to – person
2. _______________________ contact
a. Infected person to - ___________________ - to – Person
b. __________________ transmission
a. Large, _______________ droplets
c. _________borne
a. Small, ______________________ particles carried by air-currents
d. Vectors
a. ___________________ or animals that act and intermediate hosts
E. __________________________ or entry
F. Susceptible ______________________
1. _______________________
2. _______________________
3. Natural _________________ mechanisms
XXII.
Stages of infectious process
A. Initial stage
1. ______________________ period. Pathogen is ________________ but no _______
B. _____________________ stage
1. ______________________ begin to appear: vague
a. General malaise, Fever, Fatigue, Muscle ache
C. ______________________ stage
1. Pathogens continue to ______________________ & ________________
2. Obvious S&S:
D. _______________________ stage
1. Infection is ____________________________
2. Tissue _______________________
3. Symptoms ______________
E. Resolution
1. Infection is _____________________ from host
2. ___________ S&S
XXIII.
Health associated infections : AKA ______________________________ infections
A. High risk clients:
B. Common sites
1. #1: __________________________________
2. _________________________ infections / wounds
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3. ______________________________________
4. Bloodstream
C. Common pathogens
1. Escherichia coli
2. Staphylococcus aureus
3. Group A streptococci
4. Enterococcus
XXIV.
Resistant pathogens
A. Causes
1. Inappropriate use of ____________________________
B. Results
1. Resistance & _________________________________
C. Methicillin-Resistant Staphylococcus Aureus (MRSA)
1. Reservoir: ____________________ membranes & ______________________ tract
2. Isolation: ___________________________ precaution
D. Vancomycin-Resistant Enterococcus (VRE)
1. Reservoir: ________________ & ___________________ genital tract
2. Isolation: _______________________ precautions
XXV.
Diagnostic Tests for Infection
A. WBC – differential
B. Culture & Sensitivity
1. Culture
a. _____________________ technique collect sample  Immediately take to lab
b. Duration: _________________________
2. Sensitivity
a. Determine which _____________________ are most effective against the
identified pathogen
b. Duration: _________________________
C. Antibiotic peak and trough levels
1. Monitors blood level of medication: ____________________ range (Amount of drug
needed to effectively ____________pathogens while producing few __________effects)
2. Peak : When medication is at its ________________level in the blood stream
a. IM___________________
b. Oral_____________________
c. I.V. ______________________
3. Trough: When medication is at its _______________level in the blood
a. right ____________ next dose
XXVI.
Medications to treat infection
A. Antimicrobials: Drugs able to ____________or _______________________ pathogens
B. Types
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1. Antibiotics, Antifungal, Antiviral, Antiparasitic
C. Antibiotics
1. _________________ -spectrum antibiotics: Act against limited number of pathogens
2. _________________-spectrum antibiotics: Inhibit a wide variety of pathogens
D. Prophylactic
E. Super-infection
XXVII. Infection Control & Prevention
A. #1 ___________________________________
B. Personal _____________________________
C. _____________________________________
D. Standard precaution:
1. Do not touch
a. _____________
b. Body _____________ (except sweat)
c. Non-intact ________________
d. __________________ membranes
2. Hand washing
3. Gloves / Gown / Mask
4. Equipment
5. Linen
6. Needles / sharps
7. Client resuscitation
8. Respiratory hygiene
E. Airborne precaution
1. _______________ room & bath
2. __________________ pressure room
3. Keep door ________________________
4. ___________________ client during transportation
F. Droplet Precaution
1. __________________ room & bath
2. Wear _____________when within 3 feet of patient
3. __________________ client if being transported
G. Contact Precaution
1. __________________ room & bath
2. ________________ when entering the room
3. ___________________ & gloves when giving direct care or touching surfaces
4. Leave __________________________in the room
5. Wash hands immediately after __________________ gloves
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