introduction to medical surgical nursing- history of evolution of medical surgical nursing, nursing in India, brief description about Florence Nightingale, nursing process, phases and characteristics of nursing process, nursing care plan, concept of health, disease, causes of disease, wellness, illness, effects of illness, stages of illness, theories of illness, wellness model, illness-wellness continuum, illness as a human experience, health behavior, illness behavior,

1. UNIT-1
INTRODUCTION TO MEDICAL
SURGICAL NURSING
presented by:jyoti bhagat

2. Brief historyof evolution of modern medicine & surgery
HOMEOPATHY
NATUROPATHY
UNANI
SIDDHA
YOGA
AYURVEDA
AYUSH
ALLOPATHY

3. Briefhistoryof evolution of modernmedicine& surgery
 Indian medicine is ancient. Its earliest concepts are set out
in the sacred writings called the Vedas. According to a
later writer , the system of medicine called Ayurveda was
received by a certain Dhanvantari from Brahma and
Dhanvantari was defined as the god if medicine .
 The period of vedic medicine lasted until about 800 BC.
The vedas are rich in magical practices for the treatment
of diseases and in charms for the expulsion of the demons
traditionally supposed to cause diseases. The chief
condition mentioned are fever, cough, constipation,
diarrhea, dropsy, abscesses, seizures, tumors and skin
diseases ( including leprosy).

4. Cont…
 At that time , the Hindus were prohibited by their religion from
cutting the dead body , their knowledge of anatomy was
limited. The Hindus believed that the body contained three
elementary substances, microcosmic representatives of the
three divines universal forces , which they called spirit (air),
phlegm and bile.
 The spirit has its seat below the navel, the phlegm about the
heart and the bile between the heart and the navel. The seven
primary constituents of body are blood, flesh, fat, bone ,
marrow , chyle and semen are produced by the action of
elementary substances .

5. Cont…
 In Surgery, ancient Hindu medicine reached its zenith. It has been
said that Hindus knew all ancient operations were grouped broadly
such as excision of tumours, incision of abscesses punctures of
collection of fluid in the abdomen , extraction of foreign body and
stitching of wound.
 The instruments used are sharp and blunt. The sharp instruments
included knives of various pattern , scissors and needles. And the
blunt instruments are forceps, specula, tubes, hooks and probes.

6. brief history
 A brief description of chronological events related to
development of health and medicine in India is given below -
 3000 BC: Health was given high priority in daily life and
this concept of health included physical, mental, social and
spiritual well-being.
 2000 BC : Rigveda marks the beginning of Indian system
medicines. Medicines was considered part of Vedas. Good
health implies and ideal balance between tridoshic factors
that are wind bile and phelgm(vata, pita and kapha)

7. Cont…
 1000 BC : Atharvaveda mentions the twin aims of
medical sciences as health and longevity and curative
treatment. Hygiene and dietetics are considered
important in treatment.
 600 BC : A treatise by kashyapa mainly dealing with
Pediatrics.
 100 BC : Charaka Samhita , the first classical
exposition of Indian system medicines deals with all
branches of medicines , anatomy, physiology, etiology,
prognosis , pathology and treatment.

8. Cont…
 500 – 600 AD: Vagbhata wrote Astanga Hridaya (8 limbs
and heart ). The 8 limbs are therapeutics, surgery, ear, nose
and throat(ENT), mental and superstitious diseases,
infantile diseases and treatment, toxicology, arresting
physical and mental decay and rejuvenation or regaining
lost virility potency.
 1300 – 1600 AD: It contains the list of diseases and their
symptoms and complete list of drugs including many not
mentioned in earlier works. It includes etiology and
treatment of syphilis, a disease brought into India by
Portuguese seamen.

9. Important Events
 1871 : Basic program for combined general nursing and midwifery
formulated.
 1874 – 1885 : Christian Mission Hospitals began training of Indian
nurses only Christian girls have opted training.
 1926 : A nursing council constituted in Madras ( now Chennai ).
 1949 : The Indian Nursing Council was constituted.
 1951 : Training program of 2 years for Auxillary Nurse Midwife
(ANM) program started at Punjab .
 1971 : College of nursing started at Bangalore , Karnataka.

10. Nursing in India
 In India the first person to improve the medical care was King
Ashoka.
 The first important thing was to prevent diseases. Hygiene
practice were adopted , people must wear clean clothes, should
keep their nails short and cut. The women after delivery should
live in rooms, which are clean and well ventilated.
 The era of modern nursing begin with the work of FLORENCE
NIGHTINGALE in the Crimean War (1854 – 1856). She was
born on May 12, 1820. She was the daughter of wealthy
English parents. She felt that God had called her to full fill
‘Mission of Mercy’. She observed the life of poor and tried to
relieve the sick.

11. Cont…
 She was born in Florence Italy, on May 12, 1820, and was named
after her birthplace, died on August 13, 1910, London, England.
 During the Crimean War, Nightingale was put in charge of nursing
British and allied soldiers in Turkey. She spent many hours in the
wards and during nights provide care to the wounded laid on the
ground, established her image as the “Lady with the Lamp”.
 Every year May 12 is celebrated as International Nurses day to
remember her birth and recognize the important role of nurses in
providing health care .

12. FLORENCE NIGHTINGALE

13. Concept of health, wellness, disease and illness
 Health
 “health is a state of complete physical, mental and social
wellbeing and not merely an absence of disease or infirmity”.
 the state of being free from illness or injury.
 health is a state that allows the individual to adequately cope
with all demands of daily life.

14. Cont…
 Wellness
 An integrated method of functioning which is oriented toward
maximizing the potential of which the individual is capable
within the environment where he is functioning.
 High level wellness is a method of functioning oriented towards
maximizing individual potential within the environment.
 High level wellness Involves-
 Progression toward a higher level of functioning, integration
of the whole being and an open-ended future within the
challenge of full potential.

15. Wellness model

17. Cont…
Disease
 Any harmful deviation from the normal structural or functional
state of an organism.

18. CAUSE OF DISEASE
 A disease is an abnormal condition affecting the body of an
organism.
 It is a medical condition affecting the signs and symptoms .
 Disease may be caused by :-
Mechanical cause: trauma and extreme temperature.
Biological cause: genetics defect, infection, alteration in immune
system
Normative cause: normative causes are physiological but involve a
body mind interactions, here manifestations occur in response to
psychological disturbance.
Nutritional causes: malnutrition and over nutrition.
Environmental causes: toxic chemicals, cigarette smoking, pollutants
and infectious agents such as viruses and bacteria.

19. cont…
 Illness
 It is the deviation from wellness. It is alteration in health.
 Illness may be acute, chronic or terminal illness.
 Acute illness- it is a type of illness resulting from exposure to
cause. Acute illness may terminate to death or full recovery.
 Myocardial Infarction, gas poisoning, head injury.
 Chronic illness- it is long lasting illness usually interfere with
patient’s routine daily activities.
 Diabetes mellitus, hyperthyroidism.
 Terminal illness- it is a type of illness that is expected to result
in death.
 Advanced cancer.

20. Stages of illness
 Illness is body response to a disease.
 It varies from person to person.
 Some people become panic to illness and some take it very
casually.
 The stages of illness are mentioned below:-
1. Experiencing symptoms: As the body is exposed to
pathogens/external stimuli, some physiological changes will
occur.
2. Assuming the sick role: at this stage, symptoms persists,
person starts assuming himself as sick. He starts discussing
this with his close family members and colleagues.
 .

21. Cont…
3. Seeking medical care: In this stage, person consults the doctor
for his illness.
4. Assuming a dependent role: As the symptoms persist and
person starts taking treatment, he perceives himself as a
dependent.
5. Achieving recovery and rehabilitation: This is the last stage
of illness. Recover phase stints as the body starts responding to
treatment. It will be completed at home and at the hospital
settings.

22. EFFECTS OF ILLNESS
 Illness leaves a great impact on human life, whether it is a patient
or family members.
 Effect of illness vary depending upon the type of illness, severity
of illness and prognosis.
 The effect of illness on patients and his family members
separately are:
 Effect of illness on individual
As discussed earlier, individuals respond differently to the
illness. Some person respond it and some take it seriously.
Person who take it seriously ,experience a lot of changes in his
behaviour.
In chronic illness, person have feeling of helplessness,
powerlessness and sorrowness.

23. Cont…
Effect of illness on family
Family members of patients with chronic illness experience
stress, role strain, powerlessness and grieve because of
decreased socialization, lost income and increased medical
expenses.
They may be exhausted in doing their new roles along with
routine activities.
Effect of illness on elderly person
When an elderly person is ill, a son or a daughter often assumes
the role of parent to the elderly person, providing housing,
meals and assistance with daily needs over a prolonged time.
This role reversal may be only temporary and may end when
the illness ends or it may become permanent.

24. Cont…
Effect of illness on elderly person
When the sick person is a parent, the degree to which the
family experiences change is related to the responsibilities.
e.g. When a father is sick for a long time, his roles are
usually taken over by the mother.
Effect of illness in children
A child is dependent on parents for so many daily needs , both
sick children and their families may need to make fewer role
adjustments than sick adults and their families.

25. THEORIES OF ILLNESS
Supernatural theory of disease
In the early past, the disease was thought to be caused due to
either the curse of god or due to the evil force of the demons and
the movements of the planets.
As germs cannot be seen through naked eyes, they had no
knowledge about this. They believed that disease is caused due
to deeds of individuals.
These supernatural beliefs are perpetuated by ignorance,
illiteracy and poverty.

26. Cont…
Ecological theory
 According to this theory, disease occurs when there is
imbalance in human and its environment.
 Hippocrates is the first epidemiologist who advise to search the
environment for the cause of disease.
 It is the first scientific approach or reasoning regarding disease
causation.

27. Cont…
Pasteur’s germtheory
 Germ theory believed that microbes (germs)were found to be
the cause for many known diseases.
 Pasteur, Henle and Koch discovered the microorganisms in the
patient’s secretions/excretions.
 Henle and Koch have postulated that each disease is caused by
a germ, and that germ can again be isolated from that sick
animal.
 Though these postulates are true to some extent for infectious
disease, they cannot explain the etiology of all diseases,
particularly non-infectious diseases.

28. Cont…
Multifactorial causation theory
Interaction between the agent, host and environment causes
infections.
Pettenkoffer stated that agent, host and environmental factor will
act and interact synergistically and act as joint independent
partners in causing the disease.
Pettenkoffer contradicted the unifactorial theory of disease
causation and emphasized that disease is multifactorial in
causation.
This theory of web of causation explains both the infectious and
non-infectious diseases.

29. Illness as human experience
 Human behavior has the potential capacity to foster health &
to prevent illness.
 Health professionals are confronted in wellness and illness
care settings.
 It is important for nurses to be aware of certain behavior
patterns that both well and ill people commonly experience.

30. Cont…
 Health behavior
 The activities undertaken by healthy individuals who believe
they are well to prevent or detect disease is called health
behavior.
 It is directed towards an individual’s health. It includes-eating
well-balanced diet, adequate rest and daily exercise.
 Health behavior directed toward detecting illness include seeking
routine screening of vision and hearing, pap smears, physical
examination, chest x-ray studies and prenatal and postnatal care.

31. Cont…
Illness Behavior
 It has three components-
 First person must perceive themselves to be ill. This perception
is influenced by familiarity of symptoms or knowledge that
illness is present.
 Second, person should evaluate the degree or threat to self that
the illness presents.
 The last component is the action taken. This action may consist
of self-treatment or seeking assistance or advice from others
perceived to be able to provide the necessary assistance.
 The study of illness behavior is important and it is also increase
the accuracy of history taking.

33. Review of Nursingprocess and Nursingcare plan
Nursing process
 It is defined as a systematic problem solving approach for
giving comprehensive nursing care.
 It can also defined as an orderly , systemic way of indentifying
the client’s problems, making plans to solve them, initiating the
plan or assigning other to implement it and evaluating the
extent to which the plan was effective in resolving the problems
identified.

34. Characteristics of Nursing Process
 It is systematic and orderly.
 It is dynamic.
 It is interpersonal.
 It is outcome oriented.
 Provides encouragement to nurses to work together to help
clients to use their strength to meet all human needs.
 This process is universally applicable in all nursing situations.

35. Phases of Nursing Process

36. 1. ASSESSMENT
 It is a deliberate, systematic and logical collection of subjective and
objective data that are helpful to identify and define problems of
the client, before the nurse proceeds to plan the care.
 PURPOSE OF ASSESSMENT
 Gather data about the client.
 Use the data for diagnosis, identifying outcomes, planning and
implementing care.
 ASSESSMENT SKILLS
 Observation
 Interviewing
 Physical Examination

37. Types of datacollectionin assessment
 OBJECTIVE DATA: It is the collection of medical data that is
measurable and substantiated.
 This subset of data can be collected using five senses in a clinical
setting.
 Observation is the main component of acquiring objective data.
 SUBJECTIVE DATA :
It is defined as the anything patient says about the reason for
their doctor’s visit.
 The phrase ‘signs and symptoms’ are used to describe patient’s
health problems.
 The signs refer to the objective data and are based on what nurse
sees.
 The symptoms refer to the subjective data and based on what
patients say they feel.

38. 2. NURSINGDIAGNOSIS(“what is the problem”)
 This is the second step of nursing process .
 The nurse will analyse all the gathered information and
diagnose the client’s needs.
 Diagnosing involves analyzing data, identifying health
problems, risks and strength and formulating diagnostic
statements about a patient potential or actual health problems.
 More than one diagnosis is sometimes made for a single
patient.

39. 3.PLANNING(“Howto manage the problem”)
 It is the third step of nursing process.
 It provides the direction for nursing intervention.
 The planning phase is where goals and outcomes are formulated
that directly impact patient care based on evidence based practice
(EBP).
 TYPES OF PLANNING
 Initial Planning:
 It is done by the nurse who conducts the admission assessment.
Ongoing Planning:
 It is done by all the nurses who work with the client.
Discharge Planning:
 It is the process of anticipating and planning for needs after discharge.

40. 4. IMPLEMENTATION: (Putting the plan into action)
 The implementation of the nursing process is when the nurse
put the treatment plan into effect.
 It involves action or doing and the actual carrying out of
nursing intervention outlined in the plan of care.
 It should be specific to patient and focus on achievable
outcomes.
 Process of Implementing:
Reassessing the client
Determining the nurse’s need for assistance
Implementing the nursing interventions
Supervising the delegated care
Documenting nursing activities

41. 5. EVALUATION (“Did the plan work”)
 It is the fifth step of nursing process.
 This final phase of nursing process is vital to a positive
patient outcome.
 Whenever a healthcare provider implement care , they must
reassess or evaluate to ensure the desired outcome has been
met.
 STEPS IN EVALUATION
 Collecting data
 Comparing collected data with desired outcomes
 Analysing client’s response relating to nursing activities
 Identifying factors that contribute to success or failure
 Continuing , modifying or terminating the nursing care plan
 Planning for future nursing care.

42. NCP ON fever
1. Vital signs are
collected-
temperature,
pulse, respiration.
2. Cold sponging is
provided with
cotton towel.
3. Extra blanket is
given to the
patient.
4. Healthy diet-
khichdi, Dalia,
fruits and salad is
given to the
patient.
5. Acetaminophen is
given to the
patient.