Medical Surgical Nursing

This document discusses the concept of medical surgical nursing and its importance in providing quality healthcare. It covers topics such as patient considerations, nursing assessments, care plans, and patient education. The document also emphasizes the need for teamwork and collaboration in providing holistic care to patients.

Running head: MEDICAL SURGICAL NURSING
Medical Surgical Nursing
Name of the Student
Name of the University
Author’s Note:

1MEDICAL SURGICAL NURSING
Task 1: Consideration of the patient
‘Clinical Reasoning Cycle’ is a systematic structure which guides the nursing professionals to
develop care plans for the receiving patient so that utmost quality of health care service can be
provided to that respective patient as well as to meet the health care required by the patient
(Dalton, Gee & Levett-Jones, 2015). First step of this clinical reasoning cycle is to consider the
patient and collect visual, verbal and observable cue from the patient in order to understand
and consider the patient situation (Hunter & Arthur, 2016). This step also aids the nurses and
health care professionals to provide holistic care service to the patient. In this case study, I will
be discussing the condition and situation of Miss Violet Paterson and in this section the
patient’s situation will be considered according to the first step of the ‘Clinical Reasoning Cycle’.
Miss Violet Paterson is a 77 year old single woman who was admitted to the hospital ward with
AMI or Acute Myocardial Infarction. Present condition of Miss Paterson is now stable as her
Acute Myocardial Infarction is under control. From Miss Paterson’s medical history, it has been
observed that Miss Paterson is suffering from primary hypertension along with longstanding
osteoarthritis. At the time of admittance, she has reported that her arthritic pain has been
increased significantly over the last few months. In addition, her daily activities have been
hampered significantly due to her blood pressure problem as well as osteoarthritis. This
situation has been worsened further due to the fact that she lives in a third floor apartment and
Miss Paterson’s apartment building has no lift. Climbing up and down of the three flights of
stairs has also exacerbated the problem of arthritic pain. This condition has significantly
handicapped her situation to perform the activities needed for daily life and she had to perform
all the activities as she lives alone. She has also stated that she has no extended family and her
only companion is her cat named ‘Molly’. These condition might make Miss Paterson socially
excluded and may imbalance her mental stability.
Task 2: Nursing assessment
The next part of the holistic approach for Miss Paterson would be to identify and provide
nursing assessment (Koivisto et al., 2016). In order to do that, I need to go through the ‘Clinical
Reasoning Cycle’ for the provision of her care structure. From the information above, it can be

2MEDICAL SURGICAL NURSING
seen that Miss Paterson has admitted due to Acute Myocardial Infarction. Hence, the first
assessment for Miss Paterson would be to conduct an Electrocardiogram or ECG test as studies
have reported that ECG is able to detect the further damaged done to the myocardium. Recent
evidenced based researches have reported that an ECG test should be performed in every thirty
minutes for the initial four hours of the patient presented with Acute Myocardial Infarction
(Mythili & Malathi, 2015). ECG works by detecting the electric pulses generated by the muscles
and impaired heart muscle cannot generate electrical impulses and thus an ECG test is effective
in detection of the damage done by Myocardial Infarction. Hence, the conduction of an ECG
test is the first and foremost assessment for the patient with Acute Myocardial Infarction. In
addition to the ECG test, another test which can be performed is ‘Blood Test’ for Miss Paterson.
During the Myocardial Infarction protein and fat particles get released from the heart muscle
which can be detected through the blood test. Therefore, blood test is another indicator to
know the condition of the patient’s heart (Mythili & Malathi, 2015). In a nutshell, the first
nursing assessment for Miss Paterson would be to conduct an ECG test every 30 minutes for
the initial four hours along with blood test.
The patient, Miss Paterson is long suffering form the condition of osteoarthritis and her related
arthritic pain has increased for the last few months. Hence, by the aid of the ‘Clinical Reasoning
Cycle’ the next assessment for Miss Paterson would be to identify the pain level and provide
proper care plan to reduce her pain at the earnest as the arthritic pain can be a additional
burden for an 77 years old woman suffering from Acute Myocardial Infarction. For identification
of the pain, a pain assessment tool can be utilized. In this pain assessment tool the patient will
be asked to convey her pain in a scale of 0 to 10 where 0 denotes the absence of pain and 10
denotes extreme unbearable pain (Keane, 2013). According to her report, she is in considerable
pain as it is hampering her daily activities and this pain also increases her risk of fall while
performing daily necessities. Therefore, an additional assessment will be the patient’s fall risk
assessment. The FRAT tool can be implemented by the nurses for fall risk assessment of the
patient. This FRAT tool has three parts and they are fall risk status, risk factor check list and
action plan respectively (Nawaz et al., 2015). Hence, the second nursing assessment for Miss
Paterson would be identification and remission of pain as well as fall risk assessment.

3MEDICAL SURGICAL NURSING
Vitals signs like blood pressure, body temperature, respiratory rate, saturated oxygen level and
heart rate are indicative of the conditions of the body and it is extremely important in case of
determining the patients current condition. For one instance, blood pressure, respiratory rate
and saturated oxygen level can be an indication for the patient current heart condition (Bruijns
et al., 2013). Therefore, third assessment for Miss Paterson would be to regular checkup of her
vital conditions preferably in four hour interval.
Task 3: Care plan
Nurses require to identify and diagnose issues related to the patient health problem and
prioritize them in order to provide better care for the suffering patient. In case of Miss
Paterson, three such diagnosis has been identified and these nursing diagnosis related to the
patient is briefly described in the sections below along with their rationale.
In case of Miss Paterson, the first Nursing diagnosis is that she will be in risk for ineffective
tissue perfusion. With regard to that first nursing intervention is that the patient should be
inspected for cyanosis, pallor, mottling, clammy and cool skin. The nurse should also observe
the strength of the peripheral pulse. The reason behind this systematic vasoconstriction might
occur due to reduced cardiac output which might be evidenced by the reduced pulses and skin
perfusion (Ponikowski & Jankowska, 2015). Second intervention is that the patient should be
monitored for respirations as well as breathing mechanism. The rationale behind this that
ischemic pain and cardiac pump failure might precipitate respiratory distress whereas sudden
onset of dyspnea might indicate pulmonary complications. Another nursing intervention for this
nursing diagnosis is that the patient should be investigated for sudden or continued alteration
in her mentation. This intervention will be applied as cardiac output is directly proportional to
the cerebral perfusion and it might influence the acid – base variations or electrolyte balance in
the body (Ponikowski & Jankowska, 2015).
The second nursing diagnosis for Miss Paterson is that she will be in risk of decreased cardiac
output. For this diagnosis, three nursing interventions has been proposed. First nursing
intervention is that the patient’s blood pressure will be monitored continuously and blood
pressure in both arms will be compared in lying, sitting and standing position. Hypotension in

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the patient might occur due to the hypo perfusion of the myocardium, vagal stimulation, and
ventricular dysfunction. On the other hand, hypertension might happen due to the anxiety,
pain, preexisting vascular problems, and/or catecholamine release (Dai et al, 2015). Second
nursing intervention is that the patient will be monitored for heart rhythm and rate. Rhythm
and rate of the heart react to medicines, activities and complications. Dysrhythms can affect
heart function or increase ischemic damage, particularly premature ventricular contractions or
progressive heart blocks. Atrial flutters may be acute or chronic with coronary or valve arteries
and may be pathological or not. Third nursing intervention is that the patient’s cardiac output
will be measured as well as other functional parameters. A thoratic electric bioimperance (TEB)
technique can be used for non - invasive measurement of cardiac index, preload, afterload,
contractility and cardiac work (Mabote, Wong & Cleland, 2014).
The third nursing diagnosis for Miss Paterson is that she will be in the risk of acute pain. Similar
like the previous two diagnosis, three intervention will be provided for this diagnosis as well.
The first intervention is that the patient will be monitored for the characteristics of pain by
noticing the verbal and non- verbal cues of the patients. The rationale behind this intervention
is that most acute Myocardial Infarction patients seem ill, disturbed and in pain.
The respiration may cause the pain and related anxiety to increase; the release of
catecholamines caused by stress generally increases the heart rate and blood pressure. The
next intervention for this nursing diagnosis is that the patient’s vital signs will be checked after
and before narcotic medication. The reason behind this intervention is that narcotic
administration may lead to hypotension and respiratory depression. These problems can lead
to more ventricular failure and may increase myocardial damage. The third nursing intervention
is that the patient’s medical history will be consulted for angina or similar disorders and the
rationale behind this intervention is that time delay in the reporting of pain prevents relief from
pain and may necessitate increased medicine in an attempt to relieve pain. Moreover, extreme
pain can cause shock by inducing the nervous system sympathetically, causing further harm and
intervening in pain relief and diagnostics.

5MEDICAL SURGICAL NURSING
In a nutshell, the three nursing diagnosis of Miss Paterson will be risk for ineffective tissue
perfusion, risk of decreased cardiac output and risk of acute pain.
Task 4: Patient education
Studies have suggested that patient’s conditions in case of severe diseases exacerbated most of
the time due to lack knowledge about the condition and its prevention and precautionary
measures (Scholl et al., 2014). There patient education is part of the holistic care that should be
provided by the nurses. In this scenario, the patient, Miss Paterson is admitted with Acute
Myocardial Infarction and hence should be educated about the life style and diet modifications
which are needed related to the heart disorders like Acute Myocardial Infarction. This is also
true in case of blood pressure as Miss Paterson is also suffering from long standing
hypertension. The patient should avoid fatty and salty food and her diet should be rich with
fruits and vegetables. Smoking should also be prohibited from smoking and her alcohol
consumption should be moderated (Piepoli et al., 2016). Furthermore, the patient should be
encouraged to have physical activities and due to the physical condition of Miss Paterson, she
would be suggested for brisk walking for 30 minutes. In addition, the patient is also suffering
from osteoarthritis. Hence, the patient, Miss Paterson need to be educated on the effect weight
gain has on osteoarthritis. Extra weight will only aggravate her conditions and hence, she will be
suggested to keep her weight in control (Kroon et al., 2014). Furthermore, Miss Paterson will be
educated on the assistive device she might need for her ease and comfort to perform daily life
activities.
Task 5: Team Work
Recent evidenced based studies have suggested the effectiveness of multi- disciplinary
approach to provide a holistic treatment to the patient before their discharge from the hospital
as well as prepare them from the life after discharge (Kress et al., 2015). Miss Paterson can be
beneficial from various other services which can be provided by the allied team of the hospital.
Miss Paterson is suffering from long standing arthritic pain for the condition of osteoarthritis;
hence visiting a physiotherapist might help her with her pain. She might also be benefitted by
joining the community cardiac rehabilitation programme. Before the discharge, Miss Paterson

6MEDICAL SURGICAL NURSING
will be referred to the hospital’s resident dietician who will prepare diet chart for the patient to
follow in the upcoming months. It has also been observed that the patient lives alone and has
no extended family. Seclusion is one of the primary reasons for mental illness (Lloyd, King &
Machingura, 2014). Therefore, Miss Paterson will be encouraged join a social community
pragramme weekly as well as a routine check up to the psychotherapist. Furthermore, a social
worker will be allotted to her who will be communicating and checking up on her in regular
basis.

7MEDICAL SURGICAL NURSING
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