msn

1. P R E S E N T E D B Y : -
M R S . K H U S H N A S I B
A S S O C I A T E P R O F E S S O R
INTRODUCTION TO MEDICAL
AND SURGICAL NURSING

2. Evolution of Medical Surgical nursing
 Introduction of Medical and Surgical
nursing evolution and trends of medical and surgical
nursing – In ancient times, when medical lore was
associated with good or evil spirits, the sick were
usually cared for in temples and houses of worship.
These women had no real training by today’s
standards, but experience taught them valuable
skills, especially in the use of herbs and drugs, and
some gained fame as the physicians of their era.

3.  In the 17th cent., St. Vincent de Paul began to encourage women to
undertake some form of training for their work, but there was no
real hospital training school for nurses until one was established in
Kaiserwerth, Germany, in 1846.
 There, Florence Nightingale received the training that later enabled
her to establish, at St. Thomas’s Hospital in London, the first school
designed primarily to train nurses rather than to provide nursing
service for the hospital
 In the United States, nursing modernized rapidly during the late
19th and early 20th centuries. The number of hospitals nationwide
grew from only 149 in 1873 to 4,400 in 1910. With this growth, new
positions for nurses developed, and nursing gained respectable
social status.
 Nursing subsequently became one of the most important
professions open to women until the social changes brought by the
revival of the feminist movement that began in the 1960s.

4.  During the late nineteenth and early twentieth centuries in
the United States, adult patients in many of the larger
hospitals were typically assigned to separate medical, surgical,
and obstetrical wards.
 Nursing education in hospital training schools reflected these
divisions to prepare nurses for work on these units
 Early National League of Nursing Education (NLNE)
curriculum guides treated medical nursing, surgical nursing,
and disease prevention (incorporating personal hygiene and
public sanitation) as separate topics.
 By the 1930s, however, advocates recommended that medical
and surgical nursing be taught in a single, interdisciplinary
course, because the division of the two was considered an
artificial distinction. Surgical nursing came to be seen as the
care of medical patients who were being treated surgically.

5.  The NLNE’s 1937 guide called for a “Combined Course” of medical and
surgical nursing
 Students were expected to learn not only the theory and treatment of
abnormal physiological conditions, but also to provide total care of the
patient by understanding the role of health promotion and the
psychological, social, and physical aspects that affected a patient’s health.
 1960s, nursing schools emphasized the interdisciplinary study and practice
of medical and surgical nursing.
 1960s and 1970s, standards were developed for many nursing specialties,
including medical-surgical nursing.
 Standards, Medical and Surgical Nursing Practice, written by a committee
of the Division on Medical-Surgical Nursing of the American Nurses’
Association (ANA), was published in 1974. It focused on the collection of
data, development of nursing diagnoses and goals for nursing, and
development, implementation, and evaluation of plans of care.

6.  A Statement on the Scope of Medical-Surgical Nursing
Practice followed in 1980.
 In 1991, the Academy of Medical-Surgical Nurses
(AMSN) was formed to provide an independent specialty
professional organization for medical-surgical and adult
health nurses.
 In 1996, the AMSN published its own Scope and
Standards of Medical-Surgical Nursing Practice
 The second edition appeared in 2000 [15]. Both the ANA
and AMSN documents stated that while only clinical
nurse specialists were expected to participate in research,
all medical-surgical nurses must incorporate research
findings in their practice.

7. Trends in Medical Surgical nursing
 Recent trends have affected medical-surgical nurses,
including:
 The increasing use of nursing case management
 The expansion of advanced practice nursing
 Total quality improvement
 Development of clinical pathways
 Changes in the professional practice model
 Health care reform
 The trend toward increased acuity of patients, begun
in the 1980s, has become a fact of life.

8. Influences on future nursing practice
 Expanding knowledge & technology
 Healthy people initiatives
 Evidence based practice
 Standardized nursing terminologies
 Health care informatics
 Nursing informatics

9. Registered Nurse Licensure
 Critical care nurse
 Emergency nurse
 Flight nurse
 Dialysis nurse
 Addiction nurse
 Ambulatory care nurse

10.  Perianathesia nurse
 Cardiac/vascular Nurse
 First assistant nurse
 Holistic nurse
 Home health nurse
 School nurse

11. practitioner
 Acute care NP
 Adult care NP
 Family NP
 Gerontological NP
 Palliative Care NP
 Pediatric NP

12. Clinical specialist
 Adult psychiatric & mental
 Community health nursing
 Medical surgical nursing
 Palliative nursing
 Pediatric nursing

13. Others
 Advanced nursing health nursing administration
 Advanced oncology clinical specialist
 Clinical nurse leader

14. Social Trends Influencing the Development of
Nursing
 Ancient Civilizations
 Care of sick was related to physical maintenance &
comfort
 first by family members, relatives , servants or prisoners
 eventually by religious orders or humanitarian societies
 Mental Health
 Linda Richards and Dorthea Dix worked to improve the care of
the mentally ill v Modern Civilization
 focus in on technology

15.  Religious Tradition-Catholic/Protestant
 Courage
 care of sick in battlefields, military/naval hospitals
and prisons
 care of sick and dying during epidemics like cholera,
typhus, smallpox

16. Women’s Movement
 Nursing has been a premiere political force for women’s
rights .Nurse’s organized the first major professional
organization for women . Edited & published the first
professional magazine by a woman, Sarah Josepha Hale.
 Margaret Sanger was a public health nurse in
New York
 opened the first birth control clinic in U.S. because of
large number of unwanted pregnancies.
 Lavina Dock was a writer & political activist
 early feminist devoted to women’s suffrage
 participated in protest & demonstrations until passage of
the 19th Amendment in 1920, women right to vote.

17. Wars
 Nightingale in the Crimean War . mortality rate dropped from
60% to 2% as a result of the environmental changes she
implemented
 Clara Barton organized nurses to provide care in the American
civil War and established the American Red Cross that serves
in war and peace time. American Red Cross was responsible
for recruiting women for the Army Nurse Corp during WW I
.Their motto was , American Nurses for American Men
 Educational Factors
 1893 Dock with Isabel Hampton Robb and Mary Nutting
founded the American Society of Superintendents of Training
Schools for Nurses of the U.S. and Canada. this organization
was very politically active & became The National League For
Nursing which promotes quality nursing education to this
day.

18. Political Factors
 Nightingale was a political influencerfirst nurse to exert
political pressure on government .influential in
reforming hospitals & implementing public health
policies in Britain
 Clara Barton persuaded Congress in 1882 to ratify the
Treaty of Geneva so the Red Cross could perform in
peace time impacted on national & international policies
 Lillian Wald’s political pressure lead to the creation of
the U.S. Children’s Bureau established by congress in
1912 to oversee child labor laws
 Nursing represents 67% of healthcare providers in the
U.S. few nurses are in positions where they can influence
health care policy making

19. Social Trends Influencing the Development of
Nursing
 Groups of practitioners who band together to
perform social or political functions b’coz they could
not do alone
 Define & regulate the profession
 Development of a knowledge base for practice
 Research
 Transmit norms, values, knowledge, and skills
 Communicate/advocate contributions of the
profession
 Address members social & general welfare needs

20. International Classification of Diseases
 The International Classification of Diseases (ICD) is a
globally used medical classification used in epidemiology, health
management and for clinical purposes. The ICD is maintained by
the World Health Organization (WHO), which is the directing and
coordinating authority for health within the United Nations
System.[1] The ICD is originally designed as a health
care classification system, providing a system of diagnostic codes for
classifying diseases, including nuanced classifications of a wide
variety of signs, symptoms, abnormal findings, complaints, social
circumstances, and external causes of injury or disease. This system
is designed to map health conditions to corresponding generic
categories together with specific variations, assigning for these a
designated code, up to six characters long. Thus, major categories
are designed to include a set of similar diseases.

21.  ICD is arranged in 21 major chapters:-
 certain infectious and parasitic diseases
 neoplasms
 diseases of blood and blood forming organs and
certain disorders involving the immune mechanism
 endocrine nutritional and metabolic diseases

22.  mental and behavioural disorders
 disorders of nervous system
 diseases of eye and adnexa
 diseases of ear and mastoid process
 diseases of circulatory system
 diseases of respiratory system
 diseases of digestive system

23.  diseases of skin and subcutaneous tissues
 diseases of musculoskeletal system and connective
tissue
 diseases of genito urinary system
 pregnancy , child birth and puerperium
 certain conditions originating in peri natal period

24.  congenital malformations , deformities and
chromosomal abnormalities
 signs , symptoms and abnormal clinical and
laboratory findings not else where classified
 injury , poisoning and certain other consequences of
external causes
 external causes of morbidity and mortality
 Factors influencing health status and contact with
health services

25. OUTPATIENT DEPARTMENT
 Outpatient Department OPD is a place where a
patient goes first when he feels ill Patients who do
not need overnight hospitalization are admitted in
the outpatient department

26. Objectives of OPD
 To provide adequate quality of care
 All modern technique for investigation and
treatment
 Creating facilities for total patient satisfaction
 Good public relation

27. Importance of OPD
 Visited by large section of community
 First point of contact between patient and hospital
staff
 A good OPD service reduce the load on in-patient
services
 It is a place for implementing preventive &
promotive health activities

28. Functions of OPD
 Provide a major source of specialist medical opinion
• Early diagnosis, curative, preventive & rehabilitative
care
• Screening for admission to hospital
• Follow up care & care after discharge
• Promotion of health by health education
• Rendering of preventive health care

29. Types of OPD Service
1) Centralized Outpatient Services :
• All services are provided in a compact area which
includes all diagnostic and therapeutics facilities being
provided in the same place.
2) Decentralized Outpatient Services :
• Services are provided in the respective departments.

30. Types of Out Patient
1) General Outpatient
• All the patients other than emergencies who report
directly to the OPD
2. Emergency Outpatient
• A person given emergency medical care for condition
which is real or perceived emergency.
3. Referred Outpatient
• A person referred to an OPD by his attending
medical/dental practitioner for specific
diagnostic/treatment procedure.

31. Role of nurse in OPD
 Direct Care:
 The nurses role focuses on the provision of direct care to people in
an outpatient or clinical environment. The nurse may work with
people of all ages and with different health and social care needs.
 Nurses in this role will:
 assess needs, plan, implement and evaluate evidence-based nursing
care.
 provide healthcare advice through educating patients, care takers
and families.
 ensure the smooth running of clinics.
 carry out clinical nursing procedures.
 work collaboratively with other members of the health and social
care team. supervise other staff and students.
 contribute to the dissemination of good practice by participating in
teaching and learning activities.

32. Charting
 Just like in the hospital setting, nurses in outpatient
environments keep detailed records of their work.
They must record their findings after administering
tests and keep a careful log of their patients’
progress. They record test findings as they return
from the lab and document observations of patients’
conditions. Nurses record patient symptoms before
the doctor arrives to streamline the process of
patient care in outpatient facilities.

33. Education
 Nurses are involved in patient education in
outpatient settings and often are the primary contact
between patients and their caregivers in home health
situations. They may teach patients how to
administer their own medicines and manage physical
therapy requirements. Nurses teach patients about
nutrition and pain management as well as how to
recognize symptoms and complications. Outpatient
nurses hold seminars and community meetings on
specific health care concerns and teach family
caregivers how to manage their loved ones’
conditions.

34. Communication
 Communication in every health care situation is crucial,
and nurses play a vital role in maintaining the flow of
information between patients, caregivers and physicians.
In home health situations, nurses manage aides that visit
daily and serve as the link between the hands-on
providers and the treating physicians. Nurses supervise
in-home aides and must clearly communicate care
instructions to the aides to ensure proper patient care. In
clinics and doctors’ offices, nurses must clearly
communicate the history and symptoms presented by
patients so doctors can diagnose and treat patients
appropriately

35. IN PATIENT DEPARTMENT
 In Patients Department (IPD) refers to the areas of
the hospital where patients are accommodated after
being admitted, based on doctor’s/specialist’s
assessment, from the Out-Patient Department,
Emergency Services and Ambulatory Care. In-
patients require a higher level of care through
nursing services, availability of drugs/diagnostic
facilities, observation by doctors, etc.

36. ROLES AND RESPONSIBILITIES OF NURSE IN
IN PATIENT DEPARTMENT :-
 A nurse's responsibilities may vary depending on
where they work, what licenses they have obtained
and how experienced they are. Here are 13 of the
most common tasks nurses are responsible for:
 Record medical history and symptoms
 Nurses record and maintain accurate documentation
of their patients' health to ensure they receive the
proper treatment.

37.  Most nurses begin this process by asking patients
questions about their medical history to gather
information about previous diagnoses and surgeries,
current medications, allergies and relevant family
medical information. They may also ask the patient
questions about any symptoms they are currently
experiencing and record their vitals.

38.  f the patient receives a new diagnosis, medication or
treatment plan during their visit, a nurse may be
responsible for updating their medical record with
this information. Maintaining detailed and accurate
medical records is critical for ensuring patients
receive the best possible care.

39. Administer medications and treatments
 Most nurses can administer medications and
treatments to their patients with a physician's
order. They can also help develop a treatment plan
for their patients. Specialized nurses, such as nurse
practitioners, may be able to prescribe medications
without a doctor's approval. Some treatments
nurses may help with include cleaning and
dressing wounds, changing bandages and inserting
catheters. Nurses may also assist doctors with
more advanced procedures or administer
emergency care to patients in critical condition.

40. Collaborate with teams for patient care
 Nurses play a vital role in collecting information
from patients and sharing it with the rest of their
medical team. Because this is such a key
responsibility for those in the nursing profession,
nurses must have excellent verbal and
written communication skills to effectively
collaborate with physicians and other healthcare
providers. Clear, concise communication can also
ensure that patients and their family members
understand all of the information they receive.

41. Perform diagnostic tests
 Nurses may perform a wide variety of diagnostic
tests, including checking vitals and collecting tissue,
blood, stool or urine samples for analysis. It is
important for nurses to pay close attention to detail
to ensure these tests are administered properly
because they need this information to diagnose
patients and develop treatment plans. Nurses may
also be responsible for analyzing the results and
sharing what they find with the rest of their medical
team.

42. Conduct physical examinations
 Nurses often conduct a physical examination of patients
at the beginning of their visit to assess their overall
health. This may involve taking the patient's
temperature, recording their weight, monitoring their
heartbeat and checking their blood pressure. This
examination may also include testing the patient's
reflexes, checking their lymph nodes and examining their
eyes, ears, nose and throat. The physical examination
provides nurses and the rest of the medical team with a
current update on the patient's health and an
opportunity to talk to patients about their health goals
and concerns.

43. Monitor patients' health
 Nurses must carefully monitor and observe their
patients to record any symptoms or relevant
information that could lead to a diagnosis or a
change in their treatment plan. This may involve
carefully checking patient records to ensure the
correct medications and dosages are listed,
maintaining intravenous (IV) lines to ensure they are
changed regularly and monitoring the patient's vital
signs. Nurses must also pay close attention to
nonverbal cues from their patients to help them
identify underlying causes for their health-related
issues.

44. Provide support and advice to patients
 It is important to make sure patients feel cared for,
listened to and understood, especially when nurses
need to deliver challenging medical news. Patients
often look to nurses for support and advice to help
them process their diagnoses and determine what
steps they should take next. Nurses who are
empathetic toward patients and their family
members can provide comfort and guidance during
these situations. They may also equip their patients
with effective coping strategies or provide them with
inpatient and outpatient resources.

45. Operate medical equipment
 Nurses use a wide variety of diagnostic tools to care
for their patients, including stethoscopes,
glucometers, pulse oximeters, thermometers and
blood pressure machines. Depending on where they
work and what licenses they hold, nurses may also be
trained to operate more specialized machinery, such
as intravenous infusion pumps, ventilation
equipment and wound drainage systems. Having a
strong background in technology and mathematics
can help nurses properly operate medical equipment
and analyze the results.

46. Educate patients about how to manage an
illness
Part of a nurse's role is to educate their patients
about various medical conditions and provide clear
instructions on how they can manage their symptoms.
This could include explaining what medications the
patient needs to take, when the patient should
schedule a follow-up appointment and instructions for
rehabilitative exercises or practices.

47.  Nurses may also be responsible for explaining
additional post-treatment home care needs to a
patient's family or caregiver. This can include
recommendations for the patient's diet and
nutrition, exercise routine and physical therapy.
 Some nurses may also proactively educate people
about common diseases by speaking at seminars,
helping with blood drives or offering their services at
health screening and immunization clinics.

48. Advocate for the health and well-being of
patients
 In order to properly care for their patients and ensure
their safety, nurses may often act as advocates for their
health and overall well-being. This can involve
translating the medical information or diagnosis a doctor
provides to ensure the patient understands the important
details, encouraging patients to ask questions or
connecting patients with resources at another facility
that's better suited for their needs. Nurses can also
advocate for their patients by taking the time to actively
listen to their concerns, respecting their wishes and
communicating what the patient wants with their family
or other staff members.

49. Provide basic bedside care
 Nurses may be responsible for a wide range of basic
bedside care tasks, depending on their particular
working environment. These tasks can include
helping patients bathe, use the bathroom and
perform other hygiene-related activities. Bedside
nurses also offer their patients emotional support,
administer medications and track their vitals.

50. Train and educate staff
 In addition to the clinical work they do to take care
of patients, qualified nurses with an appropriate
amount of experience may help train and supervise
newer members of their medical team, including
practical nurses and nurses' aides. Some nurses may
even work with nursing students by offering training
courses through a local college or providing
continuing education programs for nurses looking to
advance in their careers.

51. Maintain inventory
 Experienced nurses may take on extra job roles, such
as maintaining inventory and ordering supplies. This
is often a shared responsibility, but tenured nurses
may supervise entire departments. Making sure
supplies are properly organized, accounted for and
restocked on time can help ensure the medical team
has all of the resources they need to provide quality
care for their patients.

52. INTENSIVE CARE UNIT
 An intensive care unit (ICU) nurse is a health
professional who oversees critically ill patients who
require specialised medical supervision. They work
in the intensive care units of healthcare facilities and
hospitals. Knowing an ICU nurse's duties can help to
decide if this is the right medical career path

53. ICU nurse responsibilities
 ICU nurse responsibilities include providing vital
care to seriously injured or ill patients. They undergo
additional training to treat patients who have
suffered heart attacks, strokes or major invasive
surgery. ICU nurses monitor their patients closely
and respond swiftly to any changes in the patient's
condition. An ICU nurse requires analytical skills,
excellent interpersonal skills and communication
skills. Their responsibilities may include:

54. Monitoring patient progress
 An ICU nurse monitors a patient's vital signs,
including oxygen levels, respiratory rate, blood
pressure, temperature and pulse rate. They check
their patients regularly and record all their
observations. If there are significant changes in the
patient's condition, they report them to the physician
or senior members of the healthcare team. They also
look for signs of sepsis or shock that require urgent
intervention.

55. Assisting physicians with procedures
 An ICU nurse can prepare equipment for the
procedures a patient requires. They may assist the
doctor in performing the procedure.
 Some procedures may include:
 diagnostic or therapeutic bronchoscopy
 endoscopy
 endotracheal intubations

56.  elective cardioversion
 bone marrow transplant
 chest or peritoneal drain insertion
 mechanical ventilation.

57. Performing diagnostic tests
 An ICU nurse may order or perform diagnostic tests to
assess a patient's progress or as part of medical discovery
to determine suitable treatment. Some examples of these
tests may include:
 Fluoroscopy: to determine an intestinal disease or
heart disease
 Colonoscopy: to examine the colon for signs of
cancerous growth
 Electrocardiogram (ECG): to assess the levels of
cardiac markers that indicate heart function
 Arterial blood gas (ABG): to check the levels of
oxygen and carbon dioxide in a patient's blood, plus
blood acidity

58. Observing a patient's diet and fluid intake
 Close observation of a patient's fluid intake and
output can alert the nurse to emerging problems,
such as fluid and electrolyte imbalances. ICU nurses
monitor each patient's diet to prevent the risk of
complications due to nutritional status. They assess
the need for nasogastric tube feeding or nutritional
supplements for post-operative patients who are not
able to eat what their bodies require.

59. Overseeing physical activity levels
 An ICU nurse may work with physiotherapists to
introduce levels of movement for post-operative
patients. This includes small milestones, such as
moving to sit in a chair for short periods or assisted
walking. During these activities, the nurse may watch
the patient closely to ensure they're making progress,
but not getting overtired by doing too much, too
soon.

60. Administering medications
 ICU nurses administer medications to patients
according to the doctor's orders. Setting up and
monitoring intravenous fluids is part of this area of
responsibility. They keep a close watch on patients
after administering new medication to watch for
adverse side effects and contact the doctor in charge
of the patient with any concerns.

61. Managing pain and sedation in patients
 Managing a patient's pain and sedation levels is an
important part of creating an environment that
promotes healing. If a patient experiences unrelieved
pain, it can have a negative psychological effect on
their healing by compromising immune function.
The ICU nurse can assess whether the dosage of pain
relief is correct or if it needs adjusting by using
different pain assessment methods. This includes the
level of sedation a patient requires at different stages
of the healing process.

62. Managing wounds
 Bedridden patients in ICU can develop sores from
lying in the same position. ICU nurses help them
move and change positions throughout the day. They
treat any wounds that may develop to prevent them
from becoming advanced or chronic wounds. Nurses
change bedding regularly, as clean bedding can help
create a germ-free environment that is conducive to
healing.

63. Providing life support
 Life support augments failing body organs by
assisting them to continue to function with
mechanical aid. Ventilators keep the lungs
functioning and dialysis machines aid kidney
function. Other procedures considered as life
support are feeding tubes for patients who are
unable to eat and electric shocks for a heart that is
failing.

64. Ensuring all ICU equipment works
 ICU nurses typically check that all the equipment at
their station is functioning and in good condition.
They identify malfunctioning equipment or devices
and arrange for urgent repairs. They clean and store
all equipment correctly after use.
 Some of the equipment they may use includes:
 ventilators
 patient monitors
 defibrillators

65.  arterial lines
 central venous pressure lines
 endotracheal tube (ET Tube)
 feeding tubes
 pulse oximetry meters
 cervical braces
 shunts
 test tubes.

66. Providing pre-operative care
 Pre-operative care involves preparing the patient
mentally and physically for surgery. An ICU nurse
helps the patient remain calm by explaining the
procedure, reassuring them and medicating if
necessary. The physical preparation of a patient for
surgery includes taking a patient's history in detail to
alert the surgeon of anything that may cause
complications, such as a history of smoking, diabetes
or allergies. The nurse verifies the surgical site, notes
any ethical concerns and lists any medications the
patient is on. During this stage, the patient signs
consent for the operation.

67. Providing post-operative care
 Post-operative care starts when a patient arrives in
the recovery room. The nurses oversee the patient's
mental state as they recover from the effects of being
under anaesthetic and return to normal. Caring for a
patient in the recovery room often involves
controlling pain and monitoring for any post-
operative complications. Post-operative infections
can occur and a trained ICU nurse watches their
patient for any signs showing an infection.

68. Responding to medical emergencies
 An ICU nurse monitors their patient for any subtle or
sudden changes in their medical status and vital
signs. If the condition of the patient changes, an ICU
nurse responds by stabilising the patient and alerting
the doctor. They may assist the doctor in performing
any necessary procedures to restore the patient to a
stable condition.

69. Knowing the Glasgow Coma Scale (GCS)
 GCS is a scoring system to describe the level of
consciousness in a patient after experiencing a
traumatic brain injury. Using GCS allows an ICU
nurse to assess and record the initial and subsequent
levels of responsiveness in coma patients. This
assessment often applies to victims of car crashes,
sports injuries or brain injuries sustained during
work-related accidents.

70. Providing emotional support to patients
 The emotional mindset of a critically ill person can
play a significant role in their recovery. An ICU nurse
can help their patient remain in a positive frame of
mind. ICU nurses often have excellent interpersonal
skills, are highly empathetic and possess an
optimistic, encouraging outlook.

71. Providing emotional support to families
 ICU nurses can provide emotional support to the
families of those under their care. They may educate
the patient's family on the illness or injury
responsible for their loved one being in ICU. As they
work closely with each patient, they can provide
current updates on the patient's condition. They may
explain all the machines attached to the patient. It
can be difficult for a family to cope with seeing their
loved one connected to all the strange-looking
equipment. The ICU nurse can assess whether each
family is coping or if intervention is necessary.

72. Supervising less-skilled nurses
 An experienced ICU nurse may mentor less-
experienced nurses in the field. While some
institutions have organised mentoring programs,
mentorship that happens informally can provide just
as much value for the less-experienced nurse.
Healthcare professionals in an intensive care setting
often work in teams to provide the most holistic care
for each patient. Mentorship can be a helpful part of
that dynamic.

73. Documenting and reporting
 An ICU nurse records precise, detailed reports of the
patients in the ICU. This typically includes any
symptoms and changes in the patient's condition.
Keeping notes of a patient's medical history is vital,
plus any assessment findings as this keep a record of
the patient's progress. They consult with the
healthcare team responsible for patient care and
document patient treatment plans. They monitor
and record any interventions, plan outcomes or
modifications to the plan as determined by the
patient's condition and responses.