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INTRODUCTION TO MEDICAL-SURGICAL NURSING Homeostasis -- Body is in a state of equilibrium ,[object Object],normal physical &/or mental function -- cold  = goosebumps -- fever  = diaphoresis -- shock  = increased pulse rate --  maintenance of a stable internal environment ,[object Object],maintain itself -- Many of the  signs & symptoms  of disease is the result of this adaptive process
It is  our ability to adjust  to environmental, physiological, & psychological changes that  determines our ability to maintain health STRESS --  Involves two components : ,[object Object],[object Object],--  Even the behavior we see are often  Defense Mechanism  for the reduction of  emotional stress --  is the response of the body to demands placed on it
COMMON STRESSORS Physiological  or Biological ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Type of Stressor Examples Manifestations of Stress Cardiovascular /  respiratory effects --Increased pulse  --Increased BP  --Rapid, shallow resp. Neurologic effects --Dilated pupils --Dizziness --Headaches G.I. effects --Nausea --Altered appetite --Diarrhea/constipation Endocrine effects --Increased levels glucose & cortisol
Psychological Cognitive ,[object Object],[object Object],[object Object],[object Object],Type of Stressor Examples Manifestations of Stress --Irritability --Increased sensitivity (feelings are easily hurt) --Sadness, depression --Feeling "on edge" ,[object Object],[object Object],[object Object],of events ,[object Object],of events significance --Impaired memory --Confusion --Impaired judgement --Poor decision making --Delayed response time --Altered perceptions --Inability to concentrate
Sociocultural  &/or Spiritual --- Some Behavioral Manifestations of Stress include : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Type of Stressor Examples Manifestations of Stress ,[object Object],promotion ,[object Object],[object Object],interpersonal relationships ,[object Object],conflict --Alienation --Social isolation --Feelings of emptiness
Stress Response Adaptation ,[object Object],[object Object],How  successful  a person is in adapting or coping with stress can be influenced by: -- ongoing process by which an individual adjust to stress  in order to achieve   homeostasis Shock Single organ/system ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
3 Stages of Stress When stressors are threatening or perceived to be threatening, the body activates physiological changes that ready it for  FIGHT OR FLIGHT . The fight-or-flight response occurs.  Long-term coping with stressors depletes adaptive energy, resulting in exhaustion. When the body has used up its adaptive energy & can no longer cope with stressors, it breaks down in disease, collapse, or death Stage One:  ALARM Stage Two:  RESISTANCE Stage Three:  EXHAUSTION
Supportive Care 1.  Health Education 2.  Proper Explanations 3.  Comfort Measures -- teaching  stress  management ,[object Object],involves the entire health team ,[object Object],regardless of what therapy used.  ,[object Object],nursing   role is to provide: -- eliminating conditions that promote stress -- promoting health behaviors to avoid stress ,[object Object],care "
Nurses work towards supporting the  normal adaptive  processes used by patients to establish a state of equilibrium ,[object Object],[object Object],As Florence Nightingale once said,  " Put the patient in the best condition for nature to act upon him"   Notes on Nursing Nurses recognize that  applying stressors  are also an important part of the adaptive process:  How? ,[object Object],etc
REST & SLEEP -- Characteristics ,[object Object],[object Object],[object Object],--  body is less rigid & tense --  individual seemingly unconscious --  body & mind in decreased state of activity
SLEEP CYCLE REM Sleep NREM Stage 2 NREM Stage 3 NREM Stage 4 NREM Stage 3 NREM Stage 2 The  Sleep  Cycle NREM Stage 1
Adequate  high quality  sleep  is  essential for health   & for physiological & psychological healing to occur It is believed that during " REM " sleep,  adjustment are made that are  necessary for learning & memory Need 20 hours of sleep Need 5 - 6 hours
Biologic Cycles -- can be over a long time or in a  24 hour cycle --  Examples : ,[object Object],[object Object],[object Object],-- Biorhythms are  physical / mental cycles   that reoccur in predictable patterns ( Circadian cycle ) -- When our biorhythms are disturbed,  we don't feel well. ,[object Object],to another
How would knowing about biological   rhythms be helpful? Factors that Influence Sleep ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sleep loss can result in physical / emotional change ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],hallucinations & delusions -- Symptoms frequently seen in patient who require frequent vital signs & treatments
COMMON SLEEP PROBLEMS ,[object Object],1.  Symptoms ,[object Object],[object Object],[object Object],-- Most incidences of insomnia resolve themselves -- if last longer than  3 weeks , may become chronic
2.  Treatment ,[object Object],--but not just before bed ,[object Object],--get up, keep busy & occupied until ready to try again ,[object Object],watch TV ,[object Object]
1.  More common in children 2.  Safety is a factor 3.  Some drugs can cause this problem -- some antidepressants, tranquilizers, or antihistamines ,[object Object],1.  Due to narrowing of the air passageways ,[object Object],2.  Can be caused by position or sinus problems
[object Object],1.  May experience  30 or more  episodes 5.  Symptoms : --hypertension --daytime fatigue --morning headache --personality changes --intellectual impairment 2.  More common in men; in the obese; & increases with age 3.  Can be due to obstruction of airways ; inhibited ventilatory drive, or both 4.  Increased  CO 2  & decreased  O 2  causes person to start breathing
6.  Treatment Nasal CPAP --Continuous positive airway pressure ( CPAP ) --lose weight (only  50%  successful) -- Uvulopalatopharyngoplasty to remove excess tissue from soft palate, uvula, & pharynx
[object Object],[object Object],1.  Neurological disorder 2.  125,000 in U.S have disorder -- Can occur in families 3.  Safety is an issue --Only disturbs the person sharing the room 4.  Treat with drugs that cause wakefulness such as Dexedrine or Ritalin
What do we mean by comfort? Dictionary Definitions:  Comfort   (Webster)   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Relief   I need help because I’m lonely.
Ease I feel totally  peaceful.
Transcendence I did it! (with the help of my coach…)
What do we, as nurses, do to promote physical comfort? positioning Pain & sleep meds Quiet room Comfortable lighting Limit visitors
But physical comfort and positioning isn’t the only important type of comfort There are three more comfort themes that need to be addressed: 1.  Comfort theme of self-esteem  (psychospiritual)
2.  Comfort theme of approach and   attitudes of staff  (sociocultural)
3.  Comfort theme of hospital life  (environment).
Technical definition of  Comfort ,[object Object],[object Object]
Comfort Theory  (3 parts) ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Sensory Stimulus ,[object Object],-- both can cause : 1.  withdrawal 2.  depression 4.  confusion 3.  impaired problem solving 5.  irritability ,[object Object],[object Object],that is sufficient to cause a response ,[object Object],Deprivation
PAIN ,[object Object],[object Object],[object Object],[object Object],potentially harmful stimulus --nerves that receive & transmit painful stimuli
Components of Pain ,[object Object],1.  Pain  Threshold 2.  Pain  Tolerance Characteristics of Pain ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],--easily perceived even during sleep Assessment of Pain ,[object Object],[object Object],[object Object],[object Object],[object Object],(What personal experiences with pain do you think will most affect your assessment & interventions for pain?) ,[object Object],consciousness ,[object Object],pain --Do this  first   before any intervention
MEMORY JOGGER FOR PAIN P   Provocative or palliative ,[object Object],[object Object],Quality or quantity ,[object Object],[object Object],[object Object],[object Object],Q
R   Region and radiation ,[object Object],[object Object],Severity ,[object Object],[object Object],S   T   Timing ,[object Object],[object Object],[object Object],[object Object]
Pain Scale
 
ACUTE PAIN VERSUS CHRONIC PAIN ACUTE CHRONIC Time span Less than 6 months More than 6 months Location Localized, associated with a specific injury Difficult to pinpoint Characteristics Often described as sharp, diminishes as healing occurs Often described as dull, diffuse, & aching Physiologic signs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],weight Behavioral signs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],pain when asked
Why do nurses tend to underestimate the characteristics of chronic pain? Intermittent Pain ,[object Object],[object Object],Intractable Pain ,[object Object],Referred Pain ,[object Object],considered incurable ,[object Object],rather than in the area diseased or injured
Areas of Referred Pain Liver Appendix Ureter Liver Heart Stomach Gallbladder Small intestines Ovary Kidney Colon Bladder
Nursing Interventions : ,[object Object],[object Object],[object Object],A fellow nurse tells you that she only gives  half the dose  of narcotics to her terminal cancer patient, because of the danger of respiratory depression.  What should you do ? ,[object Object],[object Object],rather than on the size of the dose
Other treatments for pain control: -- Uses Gate theory Box with batteries Lead wires Electrodes ,[object Object],(TENS) -- Stimulates release of Endorphins ,[object Object],they  close the gate  to small fibers, thus relieving pain ,[object Object],small nerve fibers ,[object Object],are carried by  large fibers
--may need to destroy nerves --give patient a measure of control ,[object Object],--possible to achieve anesthesia or modify pain ,[object Object],[object Object],--teaches patients to recognize  stress-related responses Acupuncture/acupressure ,[object Object]
[object Object],1.  Quiet room, dim lights, soft music 2.  Distraction 3.  Soothing bath; back rub 4.  Humor 5.  Make sure other things aren't contributing to the discomfort: (full bladder, thirst,  hunger; wrinkled bed) 6.  Plan activities  so patient is  not  disturbed frequently
REHABILITATION Terms : ,[object Object],[object Object],[object Object],[object Object],optimum level of functioning ,[object Object],[object Object],of  nursing care, regardless of setting --disturbance in structure or function --degree of observable and measurable impairment --how this disability limits normal level of functioning
Example : Jack injured his  left leg,  which caused an impairment in his  ability to flex his knee 50%. Since he was a school bus driver, this handicap made him  no longer able to operate  the bus safely.
Case Study Mr. Thompson, age 72, suffered a left-sided brain hemorrhage 3 weeks earlier.  Because of this, he was unable to speak or use his right arm or leg.  He was also incontinent of urine and exhibited some right-sided facial paralysis.  After 5 days in the hospital, it was determined that Mr. Thompson’s condition had stabilized, and he was transferred to a rehabilitation facility to continue the rehabilitation process.  At this time, his speech had returned, but was slurred and halting.
He had minimal movement in his right arm and leg but was still unable to walk or feed himself.  The incontinence of urine persisted, and he had several reddened areas on his right hip and coccyx.  Before his injury Mr. Thompson had been living with only his wife of 50 years, who also was in poor health.  They had no family living in the state, and she was quite concerned about how she would care for him once he was sent home.
To comprehend all that is involved in helping Mr. Thompson’s return to full functioning (if that is possible), first you need to imagine a typical day in the Thompson household and to identify all the ADL and IADL competencies required to get through the day.  Next, think about all the people and services that may be necessary to prevent further injury and to increase functioning.
The Rehabilitation Team ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PATIENT & FAMILY Rehab Team NUTRITIONIST NURSE PSYCHOLOGIST PHYSICAL THERAPIST OCCUPATIONAL THERAPIST SOCIAL  WORKER PHYSICIAN RECREATIONAL  THERAPIST SPEECH THERAPIST
Nursing Interventions ,[object Object],-- Physical & mental abilities --Economic status -- Knowledge level --Patient & family goals -- Experience/Skills --Home environment -- Motivation --Community resources
[object Object],1.  Supporting daily self-care 3.  Overcoming elimination problems 6.  Providing information 2.  Assisting with ambulation & mobility 4.  Meeting nutritional needs 5.  Positive attitude about disabilities/self
Community Assistance ,[object Object],provided for training for employment ,[object Object],[object Object],facilities in U.S. ,[object Object],must make those facilities accessible to the handicapped
Support Groups ,[object Object],effect on one another ; both constructive & destructive ,[object Object],non-threatening environment ,[object Object],problem-solving techniques
CHRONIC ILLNESS ,[object Object],[object Object],[object Object],for the remainder of his/her life --estimated that  number  of persons with chronic illness  will triple by the year 2040 --worldwide problem
[object Object],1.  Development of symptoms 2.  Period of accepted illness 3.  Convalescence (dealing with disabilities) ,[object Object],is influenced by: -- Heredity -- Lifestyle -- Age *** This is the  difference  between an acute illness and a chronic illness
CHRONIC CARE GOALS ,[object Object],[object Object],1.  Increase self-care capacity 2.  Decrease deterioration & decline 4.  Support the dying client ,[object Object],set of goals 3.  Promote the highest possible quality of life
ROLE OF THE LPN ,[object Object],[object Object],with clients with chronic illness ,[object Object],multi-system involvement   ,[object Object],in ways to prevent &   decrease complications

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Intro To Med-Surge

  • 1.
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  • 5.
  • 6.
  • 7. 3 Stages of Stress When stressors are threatening or perceived to be threatening, the body activates physiological changes that ready it for FIGHT OR FLIGHT . The fight-or-flight response occurs. Long-term coping with stressors depletes adaptive energy, resulting in exhaustion. When the body has used up its adaptive energy & can no longer cope with stressors, it breaks down in disease, collapse, or death Stage One: ALARM Stage Two: RESISTANCE Stage Three: EXHAUSTION
  • 8.
  • 9.
  • 10.
  • 11. SLEEP CYCLE REM Sleep NREM Stage 2 NREM Stage 3 NREM Stage 4 NREM Stage 3 NREM Stage 2 The Sleep Cycle NREM Stage 1
  • 12. Adequate high quality sleep is essential for health & for physiological & psychological healing to occur It is believed that during " REM " sleep, adjustment are made that are necessary for learning & memory Need 20 hours of sleep Need 5 - 6 hours
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
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  • 19.
  • 20. 6. Treatment Nasal CPAP --Continuous positive airway pressure ( CPAP ) --lose weight (only 50% successful) -- Uvulopalatopharyngoplasty to remove excess tissue from soft palate, uvula, & pharynx
  • 21.
  • 22.
  • 23. Relief I need help because I’m lonely.
  • 24. Ease I feel totally peaceful.
  • 25. Transcendence I did it! (with the help of my coach…)
  • 26. What do we, as nurses, do to promote physical comfort? positioning Pain & sleep meds Quiet room Comfortable lighting Limit visitors
  • 27. But physical comfort and positioning isn’t the only important type of comfort There are three more comfort themes that need to be addressed: 1. Comfort theme of self-esteem (psychospiritual)
  • 28. 2. Comfort theme of approach and attitudes of staff (sociocultural)
  • 29. 3. Comfort theme of hospital life (environment).
  • 30.
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  • 36.
  • 37.
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  • 40.  
  • 41.
  • 42.
  • 43. Areas of Referred Pain Liver Appendix Ureter Liver Heart Stomach Gallbladder Small intestines Ovary Kidney Colon Bladder
  • 44.
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  • 48.
  • 49. Example : Jack injured his left leg, which caused an impairment in his ability to flex his knee 50%. Since he was a school bus driver, this handicap made him no longer able to operate the bus safely.
  • 50. Case Study Mr. Thompson, age 72, suffered a left-sided brain hemorrhage 3 weeks earlier. Because of this, he was unable to speak or use his right arm or leg. He was also incontinent of urine and exhibited some right-sided facial paralysis. After 5 days in the hospital, it was determined that Mr. Thompson’s condition had stabilized, and he was transferred to a rehabilitation facility to continue the rehabilitation process. At this time, his speech had returned, but was slurred and halting.
  • 51. He had minimal movement in his right arm and leg but was still unable to walk or feed himself. The incontinence of urine persisted, and he had several reddened areas on his right hip and coccyx. Before his injury Mr. Thompson had been living with only his wife of 50 years, who also was in poor health. They had no family living in the state, and she was quite concerned about how she would care for him once he was sent home.
  • 52. To comprehend all that is involved in helping Mr. Thompson’s return to full functioning (if that is possible), first you need to imagine a typical day in the Thompson household and to identify all the ADL and IADL competencies required to get through the day. Next, think about all the people and services that may be necessary to prevent further injury and to increase functioning.
  • 53.
  • 54. PATIENT & FAMILY Rehab Team NUTRITIONIST NURSE PSYCHOLOGIST PHYSICAL THERAPIST OCCUPATIONAL THERAPIST SOCIAL WORKER PHYSICIAN RECREATIONAL THERAPIST SPEECH THERAPIST
  • 55.
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Editor's Notes

  1. Disease: and anything that disrupts function, limits freedom of action. Have students discuss what this means to them