NRSG 102
MED_Surg exam 1
MED-SURG/NRSG 102/EXAM 1
MED-SURG VOLUME 1 (8TH)
CHAPTER 1
• Med-Surg nursing: adult health nursing is a specialty practice are in which nurses
promote, restore, or maintain optimal health. 18-100 years.
• Med-Surg health problems occur when a patient’s basic needs are not met.
• Priority on safety & quality care
o Ensure patient safety as the priority in practice.
o IOM (institute of medicine) 44-98,000 deaths result each year from preventable errors.
o The Joint Commission peer evaluation for accreditation every 3 yrs. for health agencies.
o Medical Harm: not only physician incidents but also errors caused by all members
that lead to injury or death.
o IHI (five million lives) (Institute for healthcare improvement.
• RRT (Rapid Response Teams) (IHI implemented)
o Medical emergency team. Decrease risk for harm by providing care to pt before a
respiratory or cardiac arrest occurs. DON’T replace CODE team, but intervene
rapidly when needed for those who are beginning to clinically decline.
o May be part of (ICU)
• IHI interventions to save pt lives
o Deploy RRT
o Provide reliable EBP care for acute myocardial infarction
o Prevent central line infections
o Prevent adverse drug events (ADE’s)
o Prevent surgical site infections (SSI’s)
o Prevent ventilator-associated pneumonia (VAP).
• IHI interventions to prevent pt harm
o prevent harm from high-alert drugs (e.g. anticoagulants, insulin, opioids)
o Reduce surgical complications
o Prevent pressure ulcers
o Reduce methicillin-resistant Staphylococcus aureus (MRSA) infections
o Provide reliable, EBP care for congestive heart failure.
o Get boards of health care organizations to support measures to promote safe pt care.
• IMPORTANT: most clinical changes in condition occur in most pts 48 hrs. before a code blue, so
observe, document & report early indicators of pt decline, (decrease bp, high bp, increase
heart rate, increase pain, change in mental status.
• QSEN
o 1) Pt-centered care: Begins when nurse learns as much about pt (assessment)
& Courteous cultural needs
o 2) Teamwork & collaboration
o 3) EBP (is best quality of care possible being given to pt?)
o 4) Quality improvement/safety
o 5) Informatics: use of info/tech
• As nurses we should advocate for family & pt. Empower them using this acronym
o S- speak up if you have questions/concerns/don’t understand, ask again.
,NRSG 102
MED_Surg exam 1
o P- pay attention to care you are receiving (right treatment/medication)
o E- educate yourself about diagnosis, tests, treatments
o A- ask someone trusted to be your advocate
o K- know what medications you take & why
o U- use a hospital, clinic, surgery center that are up to date on TJC standards
o P- participate in all decision about your treatment.
• Recommended pt interview questions about sexual orientation/gender I.D. & health care
o Do you have sex w/ men, women, both, neither?
o Does anyone live in your household?
o If you have a sexual partner, have you or your partner been evaluate about possibility
of transmitting infections w/ each other?
o Have you disclosed your gender identity and sexual orientation to your health care
provider?
o If you have not, may I have your permission to provide that information to member
of the health care team who are involved in your care?
• COMMUNICATION/ ISBAR
o I: Introduction
o S: Situation
o B: Background
o A: Assessment
o R: Recommendation
o R: Response (Q&A)
• Delegation & Supervision
o Nurse is always responsible for the delegation task.
o HAVE to supervise UAP (unlicensed assistant personal)
o Give guidance/direction, evaluation, follow-up (ensure task was
performed appropriately)
• FIVE RIGHTS OF DELEGATION!
o Right Task: Task is w/in UAP scope/competence
o Right Circumstance: The pt care setting & resources are appropriate for delegation.
o Right Person: UAP is competent to perform delegated task/activity.
o Right Communication: Nurse provides clear & concise explanation of
task/activity including limits & expectations.
o Right Supervision: Nurse appropriately monitors, evaluates, intervenes, & provides
feedback on delegation process as needed.
• Quality Improvement
o Use data to monitor outcomes of care process & use improvement methods to design
& test changes to continuously improve quality & safety.
• Informatics
o Using info & tech to communicate, manage knowledge, mitigate error &
support decision making.
• Safety
o Minimize risk of harm to pt & provide through both system effectiveness &
individual performance.
,NRSG 102
MED_Surg exam 1
o NCSBN (national council of state boards of nursing: 9 key areas of nursing needs
that need improved.
▪ Med admin.
▪ Clearly comm. Pt data & clinical assessment
▪ Attentiveness/surveillance of pt
▪ Clinical reasoning or judgement
▪ Preventions of errors or complications
▪ Intervention (carrying out nursing action in appropriate/timely manner).
▪ Interpretation of authorized provider orders
▪ Professional responsibility & pt advocacy
▪ Mandatory reporting.
CHAPTER 3
ASSESSMENT & CARE OF PT W/ PAIN
• Definition of pain
o An unpleasant sensory & emotional experience associated w/ actual or potential
tissue damage.
o Pain is whatever the experiencing person says it is & exists whenever he or she says it
exists.
o Self-report is always the most reliable indication of pain.
• Pain categorized by duration
o Acute: Biological purpose is a warning by activating SNS causing various
physiologic responses.
▪ Response might be similar to Fight or Flight
▪ + Vitals, sweating, dilated pupils.
▪ Behavior signs: restlessness, inability to concentrate, apprehension,
overall distress of varying degree.
▪ Decreases healing
▪ Mile-Severe
▪ May be accompanied by anxiety & restlessness.
▪ When unrelieved can increase morbidity & mortality & prolong hospital stay
▪ Pain is usually localized
▪ Pain after surgery is an example & isn’t always well managed.
▪ Those who experience unrelieved severe post-op pain at high risk for
chronic postsurgical pain.
o Chronic:
▪ Lasts more than 3 months
▪ Gradual onset, pain can change over time
▪ Serves no biological purpose
▪ Infers w/ relationships & ADL’s
▪ Body can adapt to pain so vitals might be lower.
▪ May or may not have well-defined cause
▪ Mild-severe
, NRSG 102
MED_Surg exam 1
▪ Depression, fatigue, financial burden & increased dependence on family,
friends & health care system
o Chronic Cancer Pain:
▪ Cancer report pain @ time of diagnosis, which + in advances stages of disease
▪ Result of tumor growth (nerve compression, invasion of tissue, or
bone metastasis.
▪ Cancer treatments can cause acute pain (repetitive blood draws) surgery
toxicities from chemo/radiation
▪ Generally have pain in 2+ areas but usually talk about only primary area. (Do
a complete pain assessment).
o Chronic Non-Cancer Pain:
▪ Global & occurs in 65 year old +
▪ Neck, shoulder, & low back pain following injury.
▪ Diabetes, rheumatoid arthritis, Crohn’s disease, & initial cystitis.
▪ Stroke/Paralysis report persistent pain b/c of CNS damage.
▪ Fibromyalgia has unknown cause.
• Categorization of pain by underlying mechanisms
o Classic Gate control theory: a gating mechanism exists in spinal cord. When gate is
open, pain impulses ascend to brain where the person perceives that pain is present.
When gate is closed, the impulses are blocked d& pain isn’t perceived.
o Nociception: how pain becomes a conscious experience.
▪ Involves normal functioning of physiologic systems that process noxious
stimuli w/ ultimate result being stimuli are perceived to be painful.
▪ “normal” pain transmission & generally discussed in terms of four processes
• Transduction: first process. When noxious events activate neurons
that exist in body (skin, subcutaneous tissue, visceral or somatic
structures) have ability to respond selectively to specific noxious
stimuli. Neurons are nociceptors. When they’re stimulated directly, a
# of compounds (serotonin, bradykinin, histamine, substance P &
prostaglandins) are released further activate more nociceptors.
• Transmission: 2nd process. Nociceptors have small-diameter axons either
A-delta or C fibers. Effective transduction generates electric signal (AP)
that’s transmitted in nerve fibers form periphery toward CNS.
• A-delta fibers: lightly myelinated & faster conducting.
o Detect thermal & mechanical injury
o Sensory perception activates a sharp & well localized & leads
to appropriately rapid protective response, reflex w/draw.
• C-fibers: unmyelinated or poorly myelinated slow conductors & respond
to mechanical, thermal & chemical stimuli.
o Activation after acute injury yield a poorly localized
(more widely distributed) typically aching or burning
pain.
o Produce more continuous pain.
• Perception:
MED_Surg exam 1
MED-SURG/NRSG 102/EXAM 1
MED-SURG VOLUME 1 (8TH)
CHAPTER 1
• Med-Surg nursing: adult health nursing is a specialty practice are in which nurses
promote, restore, or maintain optimal health. 18-100 years.
• Med-Surg health problems occur when a patient’s basic needs are not met.
• Priority on safety & quality care
o Ensure patient safety as the priority in practice.
o IOM (institute of medicine) 44-98,000 deaths result each year from preventable errors.
o The Joint Commission peer evaluation for accreditation every 3 yrs. for health agencies.
o Medical Harm: not only physician incidents but also errors caused by all members
that lead to injury or death.
o IHI (five million lives) (Institute for healthcare improvement.
• RRT (Rapid Response Teams) (IHI implemented)
o Medical emergency team. Decrease risk for harm by providing care to pt before a
respiratory or cardiac arrest occurs. DON’T replace CODE team, but intervene
rapidly when needed for those who are beginning to clinically decline.
o May be part of (ICU)
• IHI interventions to save pt lives
o Deploy RRT
o Provide reliable EBP care for acute myocardial infarction
o Prevent central line infections
o Prevent adverse drug events (ADE’s)
o Prevent surgical site infections (SSI’s)
o Prevent ventilator-associated pneumonia (VAP).
• IHI interventions to prevent pt harm
o prevent harm from high-alert drugs (e.g. anticoagulants, insulin, opioids)
o Reduce surgical complications
o Prevent pressure ulcers
o Reduce methicillin-resistant Staphylococcus aureus (MRSA) infections
o Provide reliable, EBP care for congestive heart failure.
o Get boards of health care organizations to support measures to promote safe pt care.
• IMPORTANT: most clinical changes in condition occur in most pts 48 hrs. before a code blue, so
observe, document & report early indicators of pt decline, (decrease bp, high bp, increase
heart rate, increase pain, change in mental status.
• QSEN
o 1) Pt-centered care: Begins when nurse learns as much about pt (assessment)
& Courteous cultural needs
o 2) Teamwork & collaboration
o 3) EBP (is best quality of care possible being given to pt?)
o 4) Quality improvement/safety
o 5) Informatics: use of info/tech
• As nurses we should advocate for family & pt. Empower them using this acronym
o S- speak up if you have questions/concerns/don’t understand, ask again.
,NRSG 102
MED_Surg exam 1
o P- pay attention to care you are receiving (right treatment/medication)
o E- educate yourself about diagnosis, tests, treatments
o A- ask someone trusted to be your advocate
o K- know what medications you take & why
o U- use a hospital, clinic, surgery center that are up to date on TJC standards
o P- participate in all decision about your treatment.
• Recommended pt interview questions about sexual orientation/gender I.D. & health care
o Do you have sex w/ men, women, both, neither?
o Does anyone live in your household?
o If you have a sexual partner, have you or your partner been evaluate about possibility
of transmitting infections w/ each other?
o Have you disclosed your gender identity and sexual orientation to your health care
provider?
o If you have not, may I have your permission to provide that information to member
of the health care team who are involved in your care?
• COMMUNICATION/ ISBAR
o I: Introduction
o S: Situation
o B: Background
o A: Assessment
o R: Recommendation
o R: Response (Q&A)
• Delegation & Supervision
o Nurse is always responsible for the delegation task.
o HAVE to supervise UAP (unlicensed assistant personal)
o Give guidance/direction, evaluation, follow-up (ensure task was
performed appropriately)
• FIVE RIGHTS OF DELEGATION!
o Right Task: Task is w/in UAP scope/competence
o Right Circumstance: The pt care setting & resources are appropriate for delegation.
o Right Person: UAP is competent to perform delegated task/activity.
o Right Communication: Nurse provides clear & concise explanation of
task/activity including limits & expectations.
o Right Supervision: Nurse appropriately monitors, evaluates, intervenes, & provides
feedback on delegation process as needed.
• Quality Improvement
o Use data to monitor outcomes of care process & use improvement methods to design
& test changes to continuously improve quality & safety.
• Informatics
o Using info & tech to communicate, manage knowledge, mitigate error &
support decision making.
• Safety
o Minimize risk of harm to pt & provide through both system effectiveness &
individual performance.
,NRSG 102
MED_Surg exam 1
o NCSBN (national council of state boards of nursing: 9 key areas of nursing needs
that need improved.
▪ Med admin.
▪ Clearly comm. Pt data & clinical assessment
▪ Attentiveness/surveillance of pt
▪ Clinical reasoning or judgement
▪ Preventions of errors or complications
▪ Intervention (carrying out nursing action in appropriate/timely manner).
▪ Interpretation of authorized provider orders
▪ Professional responsibility & pt advocacy
▪ Mandatory reporting.
CHAPTER 3
ASSESSMENT & CARE OF PT W/ PAIN
• Definition of pain
o An unpleasant sensory & emotional experience associated w/ actual or potential
tissue damage.
o Pain is whatever the experiencing person says it is & exists whenever he or she says it
exists.
o Self-report is always the most reliable indication of pain.
• Pain categorized by duration
o Acute: Biological purpose is a warning by activating SNS causing various
physiologic responses.
▪ Response might be similar to Fight or Flight
▪ + Vitals, sweating, dilated pupils.
▪ Behavior signs: restlessness, inability to concentrate, apprehension,
overall distress of varying degree.
▪ Decreases healing
▪ Mile-Severe
▪ May be accompanied by anxiety & restlessness.
▪ When unrelieved can increase morbidity & mortality & prolong hospital stay
▪ Pain is usually localized
▪ Pain after surgery is an example & isn’t always well managed.
▪ Those who experience unrelieved severe post-op pain at high risk for
chronic postsurgical pain.
o Chronic:
▪ Lasts more than 3 months
▪ Gradual onset, pain can change over time
▪ Serves no biological purpose
▪ Infers w/ relationships & ADL’s
▪ Body can adapt to pain so vitals might be lower.
▪ May or may not have well-defined cause
▪ Mild-severe
, NRSG 102
MED_Surg exam 1
▪ Depression, fatigue, financial burden & increased dependence on family,
friends & health care system
o Chronic Cancer Pain:
▪ Cancer report pain @ time of diagnosis, which + in advances stages of disease
▪ Result of tumor growth (nerve compression, invasion of tissue, or
bone metastasis.
▪ Cancer treatments can cause acute pain (repetitive blood draws) surgery
toxicities from chemo/radiation
▪ Generally have pain in 2+ areas but usually talk about only primary area. (Do
a complete pain assessment).
o Chronic Non-Cancer Pain:
▪ Global & occurs in 65 year old +
▪ Neck, shoulder, & low back pain following injury.
▪ Diabetes, rheumatoid arthritis, Crohn’s disease, & initial cystitis.
▪ Stroke/Paralysis report persistent pain b/c of CNS damage.
▪ Fibromyalgia has unknown cause.
• Categorization of pain by underlying mechanisms
o Classic Gate control theory: a gating mechanism exists in spinal cord. When gate is
open, pain impulses ascend to brain where the person perceives that pain is present.
When gate is closed, the impulses are blocked d& pain isn’t perceived.
o Nociception: how pain becomes a conscious experience.
▪ Involves normal functioning of physiologic systems that process noxious
stimuli w/ ultimate result being stimuli are perceived to be painful.
▪ “normal” pain transmission & generally discussed in terms of four processes
• Transduction: first process. When noxious events activate neurons
that exist in body (skin, subcutaneous tissue, visceral or somatic
structures) have ability to respond selectively to specific noxious
stimuli. Neurons are nociceptors. When they’re stimulated directly, a
# of compounds (serotonin, bradykinin, histamine, substance P &
prostaglandins) are released further activate more nociceptors.
• Transmission: 2nd process. Nociceptors have small-diameter axons either
A-delta or C fibers. Effective transduction generates electric signal (AP)
that’s transmitted in nerve fibers form periphery toward CNS.
• A-delta fibers: lightly myelinated & faster conducting.
o Detect thermal & mechanical injury
o Sensory perception activates a sharp & well localized & leads
to appropriately rapid protective response, reflex w/draw.
• C-fibers: unmyelinated or poorly myelinated slow conductors & respond
to mechanical, thermal & chemical stimuli.
o Activation after acute injury yield a poorly localized
(more widely distributed) typically aching or burning
pain.
o Produce more continuous pain.
• Perception:
