Introducation to Medical-Surgical Nursing

For 2nd Year Midwifery students

By: Bekele Tesfaye (BSc, MSc)

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 Objectives

At the end of the unit, you will be able to:

Define medical-surgical nursing

Identify the role of the medical-surgical nurse

Describe scope of Medical-surgical Nursing

Apply nursing care for pts experiencing pain.

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 Medicine
A drug or remedy for illness
The area of science of the
Diagnosis
Treatment
Prevention of a disease
Maintenance of health
The art or technique of treating diseases without
surgery

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 Surgery/Surgical
Branch of medicine dealing with manual and
operative procedures for correction of
Deformities and defects
Repair of injuries,
Dx and cure certain diseases with surgical
intervention.

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 Nursing
Nursing is both an art and a science.
It is diagnosis and treatment of human
responses to health and illness- ANA
Goal
To put the patient in the best condition for
nature to act upon him,- Florence Nightingale

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 Medical-Surgical Nursing
Medical Nursing
Nursing care of adult patients whose condition or
disorders are treated pharmacologically.
Surgical Nursing
Nursing care of adult patient whose conditions or
disorders are treated surgically.
Medical-surgical Nursing
Health promotion, health care, and illness care of
adults based on knowledge derived from the arts
and sciences.

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 Medical-Surgical Nursing
Medical-surgical nurses must be:
Knowledgeable about:
All body systems, disorders that affect them
interrelatedness of body systems & health
problems
Able to effectively communicate with healthcare
team, patients, and their families
Safely perform nursing care skills and tasks.
Committed to assisting the client in achieving
the optimal level of function
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 Medical-Surgical Nursing
Client is the fundamental and central focus in the
delivery of nursing services
The goal of the medical-surgical nursing specialty is to
promote, restore, and maintain the clients health.
Nursing actions are directed toward:
Preventing disease
Arresting further disease and dysfunction
Assisting with rehabilitation

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 Medical-Surgical Nursing

The competencies are based on using:

Communication
Knowledge
Technical skills
Clinical reasoning
Critical thinking
Values in clinical practice.

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 Scope of medical surgical nursing practice

Medical surgical means a subject deals concerning

both medical and surgical care to the patient.

Previously (Traditionally) Medical surgical nursing

was limited in managing only acute care at inpatient
room in the hospital.

Now a days chronic illness are increasing with that

of communicable disease in our country, So that
Medical surgical nursing became community based.

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 Pain Management

Pain
A subjective response to both physical and
psychologic stressors.
An unpleasant sensory and emotional
experience associated with tissue damage
Suffering, or feelings of continuous distress,
often accompanies pain.
It is a protective mechanism or a warning.
Pain is referred to as the fifth vital sign

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 Pain Management

Components of pain
Sensory component- perception of many
characteristics of pain like intensity, location & quality
Affective component- negative emotions such as
unpleasantness, anxiety, fear, anticipation
Cognitive component- interpretation/ meaning of
pain by person experiencing it.
Behavioral component- strategies used by the
person to express, avoid or control pain
Physiologic component- nociception & stress
response(BP, HR, sweating, muscle tension)
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 Pain Management

Mechanisms of Pain Transmission

Pain is transmitted through four distinct processes
A. Transduction
Initiation of the stimulus and conversion of that
stimulus into an electrical impulse at time of injury
Chemical neurotransmitters are released from
damaged tissue.
These substances include prostaglandins,
bradykinin, serotonin, and substance P.

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 Pain Management
B. Transmission
The process of moving a painful message from the
peripheral nerve endings through ascending tract
of spinal cord to the brain.
C. Perception
Actually feeling the pain.
While the cerebral cortex receives the pain
message , the hypothalamus
Activates and controls emotional input
Generates purposeful goal-directed behavior

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 Pain Management

D. Modulation
The bodys attempt to interrupt pain impulses by
releasing endogenous opioids.
Endorphins
Endogenous chemicals that act like opioids
Inhibiting pain impulses in spinal cord & brain.

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 Pain Management
Pain Transmission: Nociceptive or Neuropathic?
Nociceptive pain
Pain caused by stimulation of peripheral or
visceral pain receptors.
Localized and responsive to treatment
Neuropathic pain
Pain associated with injury to either the peripheral
or central nervous system.
Unlike nociceptive pain, neuropathic pain is poorly
localized, distributed along nerve pathway.

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 Pain Management
Types of Pain
Acute Pain
Immediate and follows injury to the body
Usually self-limited, and is localized.
Subsides as healing takes place.
E.g Child birth, surgery, burn or other trauma
Chronic Pain
Lasts 3 months or longer
Persisting beyond the time of healing
E.g. limb pain, arthritis

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 Pain Management

Three major types of acute pain

Somatic pain
Localized in the skin, muscles or bones.
E.g: Acute pain from a fracture or sprain).
Visceral pain
Arises from body organs.
Dull and poorly localized due to nociceptors.
The viscera are sensitive to stretching,
inflammation, and ischemia
E.g: bowel obstruction and lung tumor
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 Pain Management
Referred pain
Pain that is perceived in an area distant from the
site of the stimuli.
Example:
A toothache may be felt in the ear
Pain from inflammation of the diaphragm may
be felt in the shoulder
Pain from ischemia of the heart muscle
(angina) may be felt in the left arm

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Fig: Referred pain
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 Pain Management

Grading of pain
Numerical Scale:
It has 0 at one end meaning no pain and 10 at
the other end meaning worst imaginable pain

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Pain Management

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Pain Management

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 Pain Management
Treatment of Pain
Analgesics - medications that relieve pain
Three main classes of analgesics:
Opioids: work mainly at CNS
Bind to opioid receptors in brain, spinal cord etc.
Inhibiting the perception of pain.
Nonopioids: work mainly peripherally at injury site
Include NSAIDs and acetaminophen
Adjuvants: given in addition to other medications
Mimic effects of opioids and nonopioids
Werent initially developed to treat pain(depression)
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 Adjuvants
They are not typically used for pain.
They include;
Anti depressantsamtriptylin
Anti-seizure
Muscle relaxants
Sedatives/ antianxiety
Botulinum toxin

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Three-step analgesic ladder of pain management

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