Medical-Surgical Nursing
made creator Wolters Kluwer Lippincott Williams & Wilkins
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The clinical treatments described and recommended in this publication are based on research and consultation with nursing, medical, and legal
authorities. To the best of our knowledge, these procedures reflect currently ac- cepted practice. Nevertheless, they can’t be considered absolute and
universal recommendations. For individual applications, all recommendations must be considered in light of the patient’s clinical condition and, before
administration of new or infrequently used drugs, in light of the latest package-insert information. The authors and publisher disclaim any responsibility
for any adverse ef- fects resulting from the suggested procedures, from any undetected errors, or from the reader’s misunderstanding of the text.
© 2012 by Lippincott Williams & Wilkins. All rights re- served. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means—electronic, mechanical, photocopy, recording, or otherwise—without prior written permission of
the publisher, except for brief quotations embodied in critical articles and reviews, and testing and evaluation materials provided by the publisher to
instructors whose schools have adopted its accompa- nying textbook. For information, write Lippincott Williams & Wilkins, 323 Norristown Road, Suite
200, Ambler, PA 19002-2756.
Printed in China
MSNIE3-010711
Library of Congress Cataloging-in- Publication Data Medical-surgical nursing made incredibly easy!. — 3rd ed.
p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1-60913-648-2 (alk. paper) ISBN-10: 1-60913-648-9 (alk. paper) 1. Surgical
nursing—Handbooks, manuals, etc. 2. Nursing—Handbooks, manuals, etc. I. Lippincott Williams & Wilkins.
[DNLM: 1. Nursing Care—methods—Handbooks. 2. Perioperative Nursing—methods— Handbooks. WY 49]
RT51.M436 2012 617'.0231—dc22 2011007519
ii
Contents
Contributors and consultants iv Foreword v
1 Medical-surgical nursing practice 1
2 Nursing process 13
3 Fluids and electrolytes 29
4 Perioperative care 55
5 Pain management 75
6 Neurologic disorders 95
7 Eye disorders 163
8 Ear, nose, and throat disorders 197
9 Cardiovascular disorders 229
10 Respiratory disorders 335
11 Gastrointestinal disorders 419
,12 Endocrine disorders 517
13 Renal and urologic disorders 571
14 Reproductive system disorders 635
15 Musculoskeletal disorders 677
16 Hematologic and lymphatic disorders 737
17 Immunologic disorders 777
18 Skin disorders 807
19 Cancer care 833
20 Obesity 867
21 Gerontologic care 887
22 End-of-life care 919
Appendices and index 935
NANDA-I taxonomy II by domain 936 Glossary 939 Selected references 941 Index 942
iii
This is a transformative time in information management and technology! Multi- tudes of resources are available—online,
digital books and, of course, the printed text. The sheer volume of resources can be overwhelming at times. The concept of
information overload dates back as early as 3rd or 4th century BCE and the Roman philosopher Seneca wrote that the
“abundance of books is a distraction.” So, with as many references available to today’s students and nurses, why choose
another medical-surgical text? The third edition of Medical-Surgical Nursing Made Incredibly Easy! is a must-have for
students, working nurses, and nurses returning to practice. Medical-surgical nursing is a complex and varied field with
many subspecialties practiced in an ever-expanding variety of settings. Our place is no longer just at the bedside.
Whatever your practice setting, this unique reference has it all in one convenient volume, complete with common
disorders, their etiology, pathophysiology, clinical manifestations, and updated diagnostics and treatments.
Content begins with the essentials of medical-surgical nursing and the nursing process, then covers basic concepts of care,
including fluids and electrolytes, acid- base balance, pain management, and perioperative nursing. Thirteen chapters
follow, covering common disorders organized by body systems. Additional chapters include cancer care, obesity,
gerontology care, and end-of-life care. New to the third edition is complete coverage of blood transfusion reactions,
including transfusion-related acute lung injury.
All content is presented in an easy-to-read format with bullet points highlighting important data. The disorders chapters
begin with a review of anatomy and physiol- ogy, history taking, and physical assessment; followed by diagnostic testing,
includ- ing patient preparation, monitoring, and teaching points; and lastly current NANDA nursing diagnoses. Common
disorders include etiology, pathophysiology, clinical manifestations, diagnostics, treatments, and nursing interventions that
include evidence-based practice recommendations.
Graphic icons quickly identify special features to enhance and reinforce the reader’s understanding of content:
A closer look provides illustrations and charts depicting anatomy, physiology, and complex pathways.
Education edge offers practical patient teaching tips.
What do I do? identifies steps to take in emergency situations.
Foreword
v
vi FOREWORD
Weighing the evidence includes updated evidence-based practice pointers to support nursing actions.
Memory jogger relies on helpful mnemonics to jar the memory and reinforce impor- tant concepts.
Quick quiz tests the reader’s understanding of material covered in the chapter.
Additional features include cartoon drawings to highlight important points and the use of full color throughout the text.
,Included with the text are online ancillary materials geared toward the student nurse, including: 1,000 NCLEX-style
questions in the latest format • NCLEX tutorials • Clinical simulation case studies • Test-taking strategies and study
techniques. •
Relevant content and exciting features presented in an extremely readable and enjoy- able format add up to a must-have
book for nurses, students, and faculty alike. Students will enjoy the friendly style of writing and can use the text as an
adjunct to classroom materials. Faculty may recommend it as a study aid to help clarify difficult concepts or as NCLEX
preparation. Practicing nurses can keep it at their fingertips for a review when caring for a patient with an unfamiliar
diagnosis or use it as a refresher. Regardless of your practice setting or background, Medical-Surgical Nursing Made
Incredibly Easy!, Third Edition, will prove to be a useful and fun way to learn or refresh your knowledge and
understanding of medical-surgical nursing, the practice field we all love.
Jane F. Marek, MSN, RN Clinical Specialist and Adult Nurse Practitioner Instructor of Nursing Frances Payne Bolton
School of Nursing Case Western Reserve University Cleveland, Ohio
1 Medical-surgical nursing practice
Just the facts
In this chapter, you’ll learn:
roles and functions of a medical-surgical nurse
definitions for the terms health and illness
the importance of health promotion in patient care.
A look at medical-surgical nursing
Medical-surgical nursing focuses on adult patients with acute or chronic illness and their responses to actual or potential
altera- tions in health. Medical-surgical nursing is one of many specialties in nursing, yet its scope is much broader than
such specialties as cardiovascular or orthopedic nursing. Thanks to the Academy
The Academy of Medical-Surgical Nurses was created in 1991 and now has more than 50 chapters across the United
States. Medical- surgical nurses assume diverse roles and responsibilities. They may work in any health care setting, but
most are employed by acute care facilities. What you need to know
Because they care for a wide range of patients in terms of age and illness, medical-surgical nurses need a broad knowledge
of the biological, psychological, and social sciences. In addition, because the typical medical- surgical patient is older than
age 65, a strong background in gerontology is required.
The typical med- surg patient is over age 65, so I need a strong background in gerontology.
MEDICAL-SURGICAL NURSING PRACTICE
2
Roles and functions
Recent changes in health care reflect changes in the populations requiring nursing care and a philosophical shift toward
health promotion rather than treatment of illness. The role of the medical-surgical nurse has broadened in response to these
changes. Medical-surgical nurses are caregivers, as always, but now they’re also educators, advocates, coordinators,
change agents, discharge planners, and researchers.
Caregiver Nurses have always been caregivers, but the activities this role encompasses changed dramatically in the
20th century. Increased education of nurses, expanded nursing research, and the consequent recognition that nurses are
autonomous and informed professionals have caused a shift from a dependent role to one of independence and
collaboration. (See Critical thinking: An essential skill.) A model of independence
Medical-surgical nurses conduct independent assess- ments and plan patient care based on their knowledge and skills.
They also collaborate with other members of the health care team to implement and evaluate that care.
Critical thinking: An essential skill
In the complex, rapidly changing health care environment, critical thinking is a skill necessary for providing safe,
, effec- tive nursing care. Critical thinking takes basic problem solving one step further by considering all related
factors, including the patient’s unique needs as well as any of the nurse’s thoughts and beliefs that may influence her
decision-making ability. Critical-thinking skills enable the nurse to take a step outside of the situation and look at the
whole picture more objectively.
Truth seekers Critical thinkers don't rely on tradition to provide all the answers. Instead,
they have the desire to seek truth and actively pursue answers to questions to obtain this complete picture. They’re
also open-minded and creative, and can draw from past clinical experience to come up with all possible alternatives
and then zero in on the best solution for the patient.
Practice for your practice Books, articles, and online courses are available to hone nurses’ critical-thinking skills.
When nurses engage in critical thinking, their patients have the best chances for success!
I’m so proud of my new work... I call her “The Critical Thinker.”
A LOOK AT MEDICAL-SURGICAL NURSING
3
Educator With greater emphasis on health promotion and illness preven- tion, the nurse’s role as educator has
become increasingly impor- tant. The nurse assesses learning needs, plans and implements teaching strategies to meet
those needs, and evaluates the effec- tiveness of the teaching. To be an effective educator, the nurse must be skilled at
interpersonal communication and familiar with principles of adult learning. The nurse must also consider the edu- cational,
cultural, and socioeconomic background of the patient when planning and providing patient teaching. Before you
go
Patient teaching is also a major part of discharge planning. Edu- cation of patients, family members, and caregivers has
greater importance because patients are discharged sooner, and often sicker, than before. Along with teaching come
responsibilities for making referrals, identifying community and personal resources, and arranging for necessary
equipment and supplies for home care.
Advocate The nurse’s first responsibility as an advocate is to ensure the health, welfare, and safety of the patient.
Being an advocate also means that the nurse makes every attempt to respect the patient’s decisions and to communicate
those wishes to the other members of the health care team. The nurse must accept a patient’s deci- sion, even if it differs
from the decision the nurse would make.
Coordinator All nurses practice leadership and manage time, people, resources, and the environment in which they
provide care. They carry out these tasks by directing, delegating, and coordinating activities. (See How to delegate safely,
page 4.) Call a huddle
All health care team members, including the nurse, provide patient care. Although the doctor is usually considered the
head of the team, the nurse plays an important role in coordinating the efforts of all team mem- bers to meet the patient’s
goals, and she may conduct team conferences to facilitate communication among team members.
The nurse plays an important role in coordinating the efforts of all health care team members.
MEDICAL-SURGICAL NURSING PRACTICE
4
How to delegate safely
Nurses must have a clear understanding of their responsibilities to ensure that delegat- ing is done safely and
successfully. Nurses must remember that although responsibility for a task has been delegated, accountability hasn’t.
When a nurse delegates a task, she should make sure that the person assigned the task understands what's
expected of her. The delegating nurse should also receive regular updates from that person, ask specific questions,
and evaluate the outcome.
Five “rights” The National Council of State Boards of Nursing identifies five “rights” of delegation that must be
satisfied by the delegating nurse:
Right task — The task being assigned or transferred must be within the scope of abilities and practice of the
individual receiving the responsibility.
Change agent As a change agent, the nurse works with the patient to address his health concerns, and with staff
members to address organizational and community concerns. This role demands a knowledge of change theory, which
provides a framework for understanding the dynamics of change, human responses to change, and strategies for effecting
change. Doing what’s right
