REVIEW OF MEDICAL-SURGICAL

NURSING I,II,III

Mr. KETEMA BADHASA, 2020

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NURSING DEFINITION
“To put the patient in the best condition for nature to act upon
him.”(Florence Nightingale,1858).
‘’the diagnosis and treatment of human responses to health and illness”
(ANA, 1995)

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 When do you use this diagram/rule?

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Critical Thinking, Ethical Decision Making,
and
the Nursing Process

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Why critical thinking is important in
today’s health care arena?
advanced technology
greater acuity of patients in hospital and community settings
an aging population
complex disease processes
ethical and cultural factors.

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Definition of Critical Thinking
 a multidimensional skill, a cognitive or mental process or set
of procedures.
 It involves reasoning and purposeful, systematic, reflective,
rational, outcome-directed thinking based on a body of
knowledge, examination and analysis of all available
information and ideas.

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Critical Thinking Process
Interpretation
Analysis
 Evaluation
 Inference
Explanation, And
Self-regulation

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1. Interpretation:- is used to determine the significance of data that
are gathered.
2. analysis:- is used to identify patient problems indicated by the
data.
3. Inference:- nurses use it to draw conclusions.
4. Explanation:- is the justification of actions or interventions used
to address patient problems and to help a patient move toward
desired outcomes.
5. Evaluation :- is the process of determining whether outcomes
have been or are being met.
6. self-regulation:- is the process of examining the care provided and
adjusting the interventions as needed.
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 Ethical Nursing Care
In the complex modern world, we are surrounded by ethical
issues in all facets of our lives.
Today, sophisticated technology can prolong life well
beyond the time when death would have occurred in the past.
E.g. the prenatal period has been influenced by genetic
screening, in vitro fertilization, the harvesting and freezing of
embryos, and prenatal surgery

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Domain of Nursing Ethics
The ethical dilemmas a nurse may encounter in the medical
surgical arena are numerous and diverse.
An awareness of underlying philosophical concepts will help
the nurse to reason through these dilemmas.

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 ETHICS VERSUS MORALITY
 The terms ethics and morality are used to describe beliefs about
right and wrong and to suggest appropriate guidelines for action.
Ethics - is the formal, systematic study of moral beliefs( e.g.
Nursing ethics)
Morality - is the adherence to informal personal values.

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 Common Ethical Principles
1. Autonomy-refers to self-rule.
It includes individual rights, privacy, and choice.
entails the ability to make a choice free from external constraints.
2. Beneficence:- Beneficence is the duty to do good and the active
promotion of benevolent acts (e.g, goodness, kindness, charity).
3. Confidentiality:-relates to the concept of privacy.
 Information obtained from an individual will not be disclosed to
another unless it will benefit the person or there is a direct threat to
the social good.

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4. Fidelity:- is promise keeping; the duty to be faithful to one’s
commitments.
5. Nonmaleficence-is the duty not to inflict harm as well as to
prevent and remove harm.
6. Paternalism:- is the intentional limitation of another’s autonomy,
justified by an appeal to beneficence or the welfare or needs of
another.
Under this principle, the prevention of evils or harm takes
precedence over any potential evils caused by interference with the
individual’s autonomy or liberty.
7. Veracity;- is the obligation to tell the truth and not to lie or
deceive others.
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 8. Justice:- From a broad perspective, justice states that like
cases should be treated alike.
But the distribution of social benefits and burdens based on
the following criteria:-
Equality
Individual need
Individual effort
Societal contribution
Individual merit
Legal entitlement

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 Pain Management
Pain is an unpleasant sensory and emotional experience
associated with actual or potential tissue damage.
It is the most common reason for seeking health care.
Since nurses spend more time with the patient in pain than do other
health care providers, nurses need to understand the
pathophysiology of pain, the physiologic and psychological
consequences of acute and chronic pain, and the methods used to
treat pain.

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Definition …
A broad definition of pain is
“whatever the person says it is, existing whenever the
experiencing person says it does”
it is equally important to be alert to patients who deny pain in
situations where pain would be expected.

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Types of Pain
Pain is categorized according to its:-
 duration
 location, and
 etiology.

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According to Duration…
Acute pain
chronic (nonmalignant) pain, and
cancer-related pain.
generally recognized type of pain

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 ACUTE PAIN
Usually of recent onset and commonly associated with a specific
injury
Indicates that damage or injury has occurred
Usually decreases along with healing
Can be described as lasting from seconds to 6 months (but
criticized)

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 CHRONIC (NONMALIGNANT) PAIN
Is constant or intermittent pain that persists beyond the expected
healing time and that can seldom be attributed to a specific cause
or injury.
It may have a poorly defined onset.
It is often difficult to treat because the cause or origin may be
unclear.
May be defined as pain that lasts for 6 months or longer

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CANCER-RELATED PAIN
Pain associated with cancer may be acute or chronic.
it is the second most common fear of newly diagnosed cancer
patients

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 PAIN CLASSIFIED BY ETIOLOGY

Burn pain
postherpetic neuralgia
Surgical site pain
Clinician can predict the course of pain.

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PAIN CLASSIFIED BY LOCATION
Pelvic pain
Headache
Chest pain

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Pain Syndromes and Unusual Severe
Pain Problems
Complex Regional Pain Syndrome
painful conditions that often follow an injury
X-cs: unexplained diffuse burning pain, weakness, a skin color and temperature
change, dec ROM, hyperesthesia, hypoesthesia, edema, altered hair growth, and
sweating
. Postmastectomy Pain Syndrome (PMP)
occurs after mastectomy with node dissection
X-CS: burning, prickling, or numbness in the posterior arm, axilla, or chest wall
aggravated by shoulder movement.

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AIDS-Related Pain
X-cs: neuropathy, esophagitis, headaches, postherpetic pain, and
abdominal, back, bone, and joint pain
Guillain-Barré Syndrome and Pain
A progressive, inflammatory disorder of the peripheral nervous
system.
characterized by flaccid paralysis accompanied by paresthesia and
pain—muscle pain and severe, unrelenting, burning pain.
Fibromyalgia (Fibrositis)
Fibromyalgia, a chronic pain syndrome characterized by
generalized musculoskeletal pain, trigger points, stiffness,
fatigability, and sleep disturbances, is aggravated by stress and
overexertion.
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FACTORS INFLUENCING THE PAIN RESPONSE
Past Experience: less anxious and more tolerant of pain
Anxiety and Depression: anxiety will increase pain, though some
researches disapprove it.
Culture: Beliefs about pain and how to respond to it differ from one
culture to the next.
Age
some researchers have found that older adults require a higher
intensity of noxious stimuli than do younger adults before they report
pain.
elderly patients reported significantly less pain than younger patients

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Gender
Women tended to report higher levels of pain than Men and reported
their highest intensity of pain during the day, while men reported the
highest intensity at night.
Women had higher pain intensity, pain unpleasantness, frustration,
and fear compared to men.
Placebo effect
Occurs when a person responds to the medication or other treatment
because of an expectation that the treatment will work rather than
because it actually does so.

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 CHARACTERISTICS OF PAIN
Intensity ( mild, moderate, severe)
Timing ( sudden, gradual, time-intensity r/sh- e.g arthritis morning ,night)
Location ( point/local,general body, referred pain/radiates)
Quality (burning, aching, throbbing, or stabbing)-described pt’s own words)
Personal Meaning (how the pain has affected the person’s daily life)-
huuba
Aggravating and Alleviating Factors
Pain Behaviors ( grimace, cry, rub the affected area, guard the affected
area, or immobilize. Others may moan, groan, grunt, or sigh)
should not be used to determine pain. (hysteria)
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 INSTRUMENTS FOR ASSESSING
THE PERCEPTION OF PAIN
Only the patient can accurately describe and assess his or her pain.

Clinicians consistently underestimate a patient’s level of pain

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Pain Intensity Scales

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 Common Concerns and Misconceptions
About Pain and Analgesia
Complaining about pain will distract my doctor from his
primary responsibility—curing my illness.
Pain is a natural part of aging.
I don’t want to bother the nurse—he/she is busy with other
patients.
Pain medicine can’t really control pain.

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People get addicted to pain medicine easily.
It is easier to put up with pain than with the side effects that come
from pain medicine.
Good patients avoid talking about pain.
Pain medicine should be saved in case the pain gets worse.
Pain builds character. It’s good for you.
Patients should expect to have pain; it’s part of almost every
Hospitalization.

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Pain Management Strategies
pharmacologic and
nonpharmacologic approaches.

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PHARMACOLOGIC INTERVENTIONS
BALANCED ANESTHESIA
refers to use of more than one form of analgesia concurrently to
obtain more pain relief with fewer side effects.
Opioids( morphine…)
NSAIDs, and
local anesthetics.

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 PRO RE NATA (PRN)
The PRN approach to analgesia leaves the patient sedated or in
severe pain much of the time.
PATIENT-CONTROLLED ANALGESIA
Patients who use PCA achieve better pain relief
Local Anesthetic Agents( topical vs intraspinal adm)
E.g, a topical anesthetic spray for sunburn
directly to nerve fibers by injection or at the time of surgery.

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Opioid Analgesic Agents( tramadol, morphine)
Administered through oral, intravenous, subcutaneous, intraspinal,
intranasal, rectal, and transdermal routes.
S/E
- respiratory depression and sedation
-nausea and vomiting
-constipation
-tolerance and addiction
-drug allergies

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Nonsteroidal Anti-inflammatory Drugs

Diclofenac
Endomethacin
Ibuprofen
aspirin

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 NONPHARMACOLOGIC INTERVENTIONS
Cutaneous Stimulation and Massage
stimulation of fibers that transmit nonpainful sensations can block or
decrease the transmission of pain impulses.
Ice and Heat Therapies
ice should be placed on the injury site immediately after injury or
surgery
Application of heat increases blood flow to an area and contributes to
pain reduction by speeding healing
Application of heat to inflamed joints may provide temporary comfort.

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Transcutaneous Electrical Nerve Stimulation/TENS
Distraction
Focusing the patient’s attention on something other than the pain
Relaxation Techniques
Skeletal muscle relaxation is believed to reduce pain/Chronic low
back pain
Guided Imagery
The nurse instructs the patient to close the eyes and breathe slowly
in and out.
patient imagines muscle tension and discomfort being breathed
out, carrying away pain and tension
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 THANK YOU!

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