RLENCM112: MEDICAL SURGICAL NURSING
CONCEPTS IN THE CARE OF AT RISK AND SICK ADULT CLIENTS
CONCEPT IN THE CARE OF AT RISK AND SICK
ADULT CLIENTS
A. Health Care Situations
• Global health – is an attempt to
address health problems that
transcends national boundaries, may
be influenced by circumstances and
experience in other countries. Best
addresses by cooperative actions and
solutions
• Prominent global health issues –
pandemics, environmental factors,
economic disparities and access to
health care, political factors,
communicable and non-
communicable diseases
• National – high maternal and
newborn mortality rate, and a high
fertility rate. Shortage of healthcare
providers, lack of hospital beds and
medical equipment
• Local – shortage of doctors and other
health care providers, lack of
equipment in rural areas
B. Chronic Illness – a disease or condition
that usually lasts for 3 months or longer
and may get worse over time
▪ tends to occur in older adults and
can usually controlled but not
cure. Ex.: cancer, heart disease,
stroke, diabetes mellitus, and
arthritis
C. Cultural And Health Ethnic Disparities
and Culturally Competent Care –
variation across cultural traits such as
knowledge, skill, and belief.
▪ Example: differences
geography, lack of access to
adequate health coverage,
communication difficulties,
cultural barriers, provider
stereotyping, and lack of access to
providers
D. Cultural Competency in Health Care –
describes the ability of systems to provide
care to patient with diverse values, beliefs,
and behavior including the tailoring of
health care, delivery to meet patient’s
social, cultural, and linguistic.
E. Preoperative Nursing Care
1. Preoperative Care – refers to physical
and psychosocial care that prepares a
patient to undergo safely; it begins when a
patient is schedule for surgery and ends
with their transfer to surgical suite.
▪ Preoperative preparation –
medical history and PE, laboratory
tests, blood type and crossmatch,
CXR, ECG, diagnostic procedures,
written instructions, informed
consent, referrals to specialist for
clearance, giving of medications
prior to operation
▪ Importance of pre-op care –
patient that are prepare for their
surgery both physically and
psychologically tend to have a
better surgical outcome
▪ Through proper communication
the patient will have a further
understanding of the procedure
and be more prepared for it
2. Intraoperative Care – involves the
surgery itself.
▪ Starts when patient is wheeled
into surgical suite and ends when
the patient is brought to post
anesthesia care unit.
▪ Responsibilities include
in continuing assessment of patient’s
physiologic and psychologic
status. Promoting safety and
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privacy, preventing wound
infection, and promoting healing
3. Postoperative care – begins
immediately after surgery
▪ The type of post-op depends on
the type of surgery you have as
well as your health history
▪ Includes pain management and
wound care.
▪ It focuses on maintaining
ventilation and circulation,
monitoring oxygenation and level
of consciousness, preventing
shock, managing pain, and
preventing complications
CONCEPT IN THE CARE OF AT RISK AND SICK
ADULT CLIENTS
A. Assessment
▪ Subjective data (chief complaint)
▪ History – starts from oldest to
recent history
▪ Objective – physical assessment –
VS
▪ Diagnostic studies/procedures
B. Analysis/Nursing Diagnosis
▪ For patient experiencing decrease
oxygenation and dyspnea –
impaired gas exchange, ineffective
breathing pattern, ineffective
airway clearance, decrease cardiac
output and activity intolerance
▪ For patient with fluid and
electrolyte imbalance as well as
acid base imbalance – risk for
electrolyte imbalance r/t depends
on the disease of the patient
▪ For patient with infections – risk
for infection, anxiety, ineffective
coping
▪ For patient with inflammatory and
immunologic responses – assistance with routine bodily
impaired gas exchange, acute or
chronic pain, ineffective tissue
perfusion (specify) impaired
physical mobility risk for impaired
skin integrity
▪ For patient with acute and chronic
disease-impaired gas exchange
(specify) – anxiety, ineffective
coping, etc
C. Planning
1. Planning For Health Promotion
▪ It ensures systematic and logical
approach to establishing priorities.
▪ It helps direct resources to where
they will have most impact
▪ It makes clear what is to be
achieved, the methods and how
success will be demonstrated
Steps in Planning
1. Manage the planning process
2. Conduct assessment
3. Identify goal, interest, and
outcomes
4. Identify strategies, activities of
outputs process
5. Develop indicators
6. Review the program plan
2. Planning For Health Restoration and
Maintenance
▪ Defines as providing and directing
nursing care of the clients that
incorporates knowledge of
expected growth and
development principles
prevention, and early detection of
health problems, and strategies to
achieve optimal health
▪ It includes assistance with the
activities of daily living like:
▪ Getting in and out of bed,
wheelchair or motor vehicle,
functions such as bathing and
personal hygiene, dressing,
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CONCEPTS IN THE CARE OF AT RISK AND SICK ADULT CLIENTS
grooming feeding including
preparation and clean up.
D. Implementation Of Care Clients
1. Independent Nursing Care – tasks that
nurse can perform without input from
another without physician’s order
▪ Tepid sponge bath
▪ Providing water
▪ Repositioning patient
▪ Providing toilet assistance
▪ Bathing
• Physical Care
▪ Maintaining oral hygiene
▪ Nutritional needs
▪ Routine hygiene care
▪ Bowel and bladder care
▪ Adequate sleep
▪ Care of tracheostomy and NGT
• Psychosocial Care
▪ The culturally sensitive provision
of the psychological, social, and
spiritual care through therapeutic
communication
▪ Goal is to improve psychological
and emotional wellbeing like self-
esteem, disease adjustment,
communication, social
functioning, and interpersonal
relationships
▪ It includes social support,
loneliness, marriage status. Social
disruption, bereavement, work
environment, social status, and
social integration.
• Spiritual Care
▪ It involves listening to what is
important to the patient
▪ Respecting, caring, loving, being
fully present, and supporting one’s
search for meaning
▪ It is an approach that involves
religious or existential aspects
such as finding meaning and
purpose in life
▪ Example: spiritual counseling,
meaning-focused, meditation, or
psychotherapy.
2. Interdependent Care –
▪ Actions that are implemented in a
collaboration or consultation with
other health care professionals
▪ Example: treatment for injury
where the doctors prescribed
medications
▪ Nurse – administer it
▪ Therapist – helps the patient with
rehabilitation
• Pharmacological
▪ Pharmacology – defines as the
study of the actions of drugs,
incorporating knowledge from
other sciences
▪ Drugs are classified based on their
action or effect on the body by
their chemical characteristics
▪ Nurse must be familiar with both
generic and trade names of frugs
▪ Nurses must be equipped with
extended pharmacology
knowledge that will allow them to
recognize therapeutic responses
to drugs and adverse drug
reactions to ensure patients safety
and response to patients need
accordingly.
• Therapeutic
▪ Therapeutic nurse patient
relationships – defined as helping
relations that is based on mutual
trust and respect, the nurturing of
faith and hope, being sensitive to
self and others, and assisting with
the gratification of your patient’s
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physical, emotional, spiritual
needs through your knowledge
and skills
▪ It increases patient’s participation
in their care and accelerate their
recovery through patient
education.
Common Nursing Intervention Includes:
➢ Bedside care and assistance
➢ Administration of medication
➢ Postpartum support
➢ Feeding assistance
➢ Monitoring of vitals and recovery
progress
Therapeutic Communication Techniques
Include:
➢ Using silence at times
➢ Accepting
➢ Giving recognition
➢ Offering self
➢ Giving broad opening
➢ Active listening
➢ Seeking clarification
• Complementary and Alternative
Therapies
▪ Complementary therapy – means
you can use it alongside your
conventional medical treatment
▪ Ex: massage, meditation,
biofeedback, tai chi, reiki, music
therapy, guided imagery, and
dietary supplements
▪ Alternative therapy – generally
used instead of medical treatment
▪ Ex: acupuncture, ayurveda,
homeopathy, naturopathy,
Chinese or oriental medicine
• Nutritional and Diet Therapy
▪ Therapeutic diet – is a meal plan
that controls the intake or certain
food or nutrients
▪ Part of treatment of medical
condition and are normally
prescribed by a physician and
planned by dietician.
▪ It is a modification of a regular diet
▪ Its importance is its ability to
support management of chronic
diseases like DM, digestive
problems, heart disease and
cancer
▪ Losing weight and boosting your
immunity significantly reduces the
risk of chronic diseases
Main Objectives of Diet Therapy:
➢ Maintain good nutritional status
➢ Correct deficiencies or disease
➢ Provide rest to the body
➢ Help metabolize the nutrients
➢ Make changes in body weights
when necessary
• Surgical Intervention
▪ The act of surgery or operating on
a patient
▪ Goal of surgical intervention
▪ Removed or repair tissue or organ
▪ Removed an obstruction
▪ Reposition structures to their
normal positions
▪ Redirect blood vessels
▪ Helps align a broken bone (Ortho
SX)
▪ Types of Surgical intervention:
Emergency and Elective
▪ Example of Emergency Surgical
Intervention: Appendicitis, Hernia,
Testicular torsion
▪ Example of Elective Surgical
Intervention:
• Radiation Therapy
▪ Treatment of disease especially
cancer using x-rays or similar
forms of radiation
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CONCEPTS IN THE CARE OF AT RISK AND SICK ADULT CLIENTS

▪ It kills cancer or slows their growth Nursing Interventions:

by damaging their DNA, it shrinks
➢ Pre chemo – ensure patient safety,
tumors
protect patients from harm, verify
Nursing Interventions: hazardous medications for errors,
adhere to the guidelines of safe
➢ Monitor and assess the patient’s
handling, delivery and disposal of
pain level using the pain scale
cytotoxic drugs
➢ Refer patient with fatigue for
➢ During chemo – monitor for
physical therapy which can ease
possible adverse reactions of the
fatigue and improve stamina.
drugs, monitor VS
➢ Obtain a complete list of patient’s
➢ Post chemo – advise rest or take a
medications and monitor for drug
short nap (30 mins or less) rather
interactions
than long nap during the day
➢ Observe universal precautions
➢ Certain drugs used to treat pain,
while handling blood and body
nausea or depression can make a
fluids esp. urine
person feel tired and sleepy
➢ Leave all trash and food trays in
➢ Advised to use soft toothbrush
the room
➢ Avoid tart, salty, or acidic foods
➢ Upon leaving the room remove
➢ Eat soft bland or cool foods such as
gloves and shoe cover and place
ice creams
them in the trash box inside the
➢ Avoid alcohol-based mouth wash
room
➢ Advise not to eat raw vegetables
• Immunologic therapy
and fruits and avoid hard, dry
▪ Type of cancer treatment that
foods such as chips or pretzels
helps your immune system fights
➢ Avoid exposure at least one arm’s
cancer
length or six feet
▪ Immune system helps your body
➢ Advised no kissing or sexual
fight infections and other disease
contact for at least a week
▪ It is made up of WBC, organs, and
tissues of the lymph system
• Chemotherapy
▪ This therapy is a type of biological
▪ The treatment of disease by the use of
therapy
chemical substances esp. the
treatment of cancer by cytotoxic and Types of Immunotherapies:
other drugs
➢ Monoclonal AB (MABs) – have an
▪ It uses powerful chemicals to kill fast
effect on immune system
growing cells in the body like cancer,
➢ Checkpoint inhibitors – it blocks
since cancer cells grows rapidly and
different checkpoint proteins
multiply more quickly than most cells
➢ Cytokines
in the body
➢ Vaccines to treat cancer
▪ Chemo usually takes 3-6 months
➢ CAR T-cells therapy – chimeric
although can be less
antigen receptor T-cells
▪ It may be given thru IV or as tablets or
➢ Immunotherapy may cause lower
capsules
blood counts which may lead to
bleeding, anemia, and other
problems.
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CONCEPTS IN THE CARE OF AT RISK AND SICK ADULT CLIENTS

➢ It may cause pneumonitis Steps in Client Education Process:

Side Effects of Immunotherapy: ➢ Needs assessment

➢ Planning
➢ Chills
➢ Implementing
➢ Constipation
➢ Evaluating
➢ Coughing
➢ Decreased appetite Ways To Deliver Client Education:
➢ Diarrhea
➢ One on one teaching
➢ Fatigue
➢ Demonstration
➢ Fever and flu like symptoms
➢ Analogies or word pictures to
➢ Headache
explain concepts
➢ Infusion related reaction
➢ Injection site pain
➢ Itching
➢ Localized rashes and/or blisters F. Evaluation of Outcomes of Care
▪ This focuses on the effectiveness
Nursing Interventions of the nursing interventions by
reviewing the expected outcomes
➢ Promote safety
to determine if they were met by
➢ Administer medications
the time frames indicated.
➢ Apply cold/warm compress to
affected area Five Steps in Evidence Based Process:
➢ Increase fluid intake
➢ Proper position ➢ Ask a clinical question
➢ Diet rich in fiber like fruits, ➢ Obtain the best research literature
vegetables, and legumes ➢ Critically appraise the evidence
➢ Integrate the evidence with
clinical expertise, patient’s
preferences
E. Client Education
➢ Evaluate the outcomes of the
▪ This is important for building
decisions
patient’s knowledge,
understanding and preparedness Outcomes in Nursing Process:
for self-management
➢ A measurable demonstrated by
▪ It promotes patient-centered care
the patient responsive to nursing
and increases adherence to
interventions.
medications and treatment
➢ Outcomes should be identified
▪ It ensured continuity of care
before nursing interventions are
planned.
Purposes of Client Education: ➢ After nursing interventions are
implemented – the nurse will
➢ To maintain and promote health
evaluate f the outcomes are met in
➢ Prevent illness, restore the
the frame indicated for that
patient’s health
patient.
➢ Teach the patient how to cope
with their condition
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CONCEPTS IN THE CARE OF AT RISK AND SICK ADULT CLIENTS

Evaluation is Important: client’s care. Concise data are easy

to understand.
➢ It supports an evidence-based
➢ Currentness – ongoing decisions
approach to practice delivery
about care must be based on
➢ It is used to assist in judging how
currently reported information.
well something is working
➢ Organization – the nurse
➢ It can inform decisions about the
communicates in a logical format
effectiveness of a service and what
or order
changes could be considered to
➢ Confidentiality – a confidential
improve service delivery
communication is info given by
one person to another with trust
and confidence that such info will
G. Reporting and Documentation of Care not be disclosed.
▪ Documentation – serves as a
permanent record of client
information and care.
▪ Reporting – takes place when 2 or
more people share information
about client care either face to
face or by telephone.

Why is it Important:
➢ Help ensure consent and
expectations
➢ It helps to tell the narrative for
decisions made, and how yourself
or the client responded to
different situations.
➢ In the same manor, it is important
to record information that can
help support the proper treatment
and the reasoning for such
services.

Guidelines for Good Documentation and

Reporting:

➢ Fact – information about clients

and care must be factual.
➢ Accuracy – info must be accurate
so that health team members
have confidence in it.
➢ Completeness – the info within a
record or a report should be
complete, containing concise and
thorough information about a