NSC 305 MEDICAL SURGICAL NURSING I

NSC 305MEDICAL SURGICAL NURSING IMODULE 2FUNDAMENTALS OF MEDICALSURGICAL NURSINGUnit 1Unit 2Unit 3Unit 4Unit 5Unit 6Unit 7Unit 8NutritionFluid and Electrolyte BalanceShockStressTemperature ControlPainSleepSkin care and wound careUNIT tivesMain Content3.1Nutrients in foods and in the body3.2Chemical composition of nutrients3.3The energy-yielding nutrients3.4Energy nutrients from foods3.5Energy in the body3.6Nutrition assessment3.7Nutrition assessment of individualsSummaryTutor-Marked Assignment1.0INTRODUCTIONThe picture of a nurse to an average person in the public is to providecare especially for the sick. Caring for patients is a core responsibility ofthe nurse. As nurses, our aim is to provide quality nursing care to ourpatients. This module will help you to have in-depth understanding ofthe bases of medical-surgical nursing and how to care for patients withcritical conditions: alteration in nutrition, fluid and electrolyte imbalanceand total care of patients with shock. It also reviews other conditionsrequiring intensive nursing focus. These include, stress, temperaturecontrol, pain, sleep, skin and wound care.Welcome to the world of nutrition. Although you may not always havebeen aware of it, nutrition has played a significant role in your life. Andit will continue to affect you in major ways, depending on the foods youselect. Every day, several times a day, you make food choices that34

NSC 305MODULE 3MODULE 3CARING FOR PATIENTS WITH SPECIALNEEDSUnit 1Unit 2Unit 3Unit 4Unit 5Unit 6Unit 7Care of the Client Having SurgeryCare of Patients Experiencing TraumaCare of Unconscious patientCare of Patients with BurnsCare of Patients with CancerCare of Patients Receiving Palliative CareLoss, Grief and End of Life CareUNIT 1CARE OF THE CLIENT HAVING tiveMain Content3.1Introduction to Surgery3.2Classification of Surgery3.3The surgical team3.4Phases of Perioperative Nursing care3.5Nursing Assessment of the Preoperative Patient3.5.1 The physical and psychological needs of surgicalpatients3.5.2 Physical and Psychological preparation of surgicalpatients3.5.3 Psychological preparation of patients3.5.4 Nursing Process for Preoperative Care.3.5.5 Intraoperative Care3.6Anesthesia3.6.1 Suture Materials3.6.2 Nursing Management3.6.3 Post Operative Period3.6.4 Transport of the Client3.6.5 Nursing Management3.7Prianesthesia (Recovery Room) Nursing Responsibilities3.7.1 Prevention of immediate PostoperativeComplications3.7.2 Post-Operative ComplicationsSummaryTutor-Marked Assignment

NSC 305MODULE 4MODULE 4Unit 1Unit 2Unit 3THE IMMUNE SYSTEM AND CARE OFPATIENTS WITH INFECTIOUSDISEASESCaring for Patients with InflammationCaring for Patients with Infectious DiseasesCaring for Patients with Altered Immune Main Content3.1Tissues and cells involved in inflammatory response3.2Categorization of inflammation3.3Pathophysiology of Inflammation3.4Systemic manifestations of inflammation3.5ManagementSummaryTutor-Marked Assignment1.0.INTRODUCTIONThe protective ability of the body to wade off all toxins and invadingforeign organisms is called immunity. To perform this vital life process,the immune system has been designed specially to cater for all essentialactivities involved in performing this function. The immune systemfunctions as the body’s defense mechanism against invasion andfacilitates a rapid reaction to the action of foreign bodies. The immunesystem is tasked with three distinct and interrelated duties.i.Defense of the body from external invaders (pathogens andtoxins).ii.Surveillance in identifying the body’s cells that have mutated andmay become or have already become neoplasms (tumors).iii. Maintain homeostasis by removing cellular detritus from thesystem to ensure uniformity of cells and function.With so much power over the functioning and viability of the body’scells, it is no coincidence that some of our worst diseases come about asa result of immune dysfunction.Immunity can be in two forms. These are; Innate immunity Acquired immunity285

NSC 305MEDICAL SURGICAL NURSING IInnate ImmunityThis is also called non-specific or natural immunity. This form ofimmunity results from general processes directed at specific diseaseorganism. It provides some form of rapid non-specific immunity and itis present at birth. Innate immunity can be immediate (occurring withinfour hours) or delayed (occurring between four to ninety six hours) afterexposure. This form of immunity includes the following:i.Phagocytosis of bacteria and other invaders by the white bloodcells and cells of the tissue macrophage system.ii.Destruction of swallowed organism by the acid secretion of thestomachiii.Resistance of the skin to invasion by organismsiv.Presence of certain chemicals in the blood that can attach toforeign organisms or toxins and destroy them. Examples of thesecompounds are; lysozymes, basic polypeptides, the complementcomplex and natural killer lymphocytes.Acquired ImmunityIt is also called adaptive or specific immunity. It is the body’s responseagainst individual invading organisms. It is caused by a special immunesystem that forms antibodies and/ or activated lymphocytes that attackand destroy the specific invading organism. This form of immunity isnot present at birth and develops either as a result of exposure orthrough an external source such as colostrum or injection ofimmunoglobulin. Acquired immunity confers great protection as foundin the process of immunization against certain infectious diseases.Acquired immunity can be of two types;a.Humoral or B-cell immunityb.Cell mediated immunitya.Humoral or B-cell immunityThe body develops circulating antibodies also called globulin moleculesin the blood plasma. These globulins are capable of attacking theinvading agent. These antibodies are produced by the B-lymphocytes inresponse to specific antibodies. The B-lymphocytes produces theglobulin while the macrophages of natural immunity and the T-celllymphocytes of the cellular immunity are involved in recognizingforeign substances and in producing antibodies.b.Cell mediated immunityIt is also known as T-cell immunity because the activated Lymphocytesare the T-lymphocytes. The T-cells exists with designated roles indefense against bacteria, viruses, fungi, parasite and malignant cells.The T-cells attack foreign bodies directly by producing antibodies.Cellular reactions emerge by the binding of an antigen to an antigen286

NSC 305MODULE 4receptor located on the surface of the T-cell. The T-cell then carriesantigenic messages to the lymph node where other T-cells are produced.NOTE: The adaptive immune system requires the innate immunesystem for initial activation. Once activated, however, much of itseffector mechanisms involve potentiating innate immune responses.Thus the innate system forms part of the adaptive system’s response andvice versa. The innate immune system can eliminate some threats byitself, but many invaders either overwhelm it or evade detection by it.In these cases, the adaptive immune system is required. It takes four toten days for the adaptive immune system to mount its first response.Once developed however, the adaptive immune system will retain someof its effector cells as memory cells. Upon subsequent exposures, theadaptive immune system can mount a response almost immediately. Thekey characteristics of both systems are recognition and effectormechanisms. Recognition mechanisms are the methods by whichvarious immune system cells recognize invading cells and toxins oraberrant host cells. Effector mechanisms are the methods by which theimmune system destroys and eliminates these threats.Inflammation is defined as the reaction of vascularized living tissue tolocal injury. It is a defensive reaction intended to neutralize, control oreliminate the offending agent and to prepare the site for repair.Inflammation can also serve to destroy, dilute or isolate the injuriousagent (microbes, toxins) and eliminate the necrotic cells and tissuesarising as a consequence to such injury while initiating a series of eventswhich leads as far as possible to the healing and reconstitution of thedamaged tissue.During repair, the injured tissue is replaced by: Regeneration of native parenchyma cells Filling of the defect by fibroblastic tissue or bothInflammation and repair are protective response, however they mayinduce harm e.g. anaphylactic reaction, rheumatoid arthritis,atherosclerosis or pericarditis.2.0OBJECTIVESAtthe end of this unit, you should be able to: define inflammationidentify the tissues involved in inflammationlist and describe the types of inflammationdescribe the pathophysiology of inflammationenumerate the systemic manifestations of inflammationmanage inflammation using the nursing process model287

NSC 305 MEDICAL SURGICAL NURSING Idescribe the immune system and list the major functions of thesystemlist and describe the types of immunityenumerate and describe the types of cells that performs immunefunctionsdescribe the functions of the lymphoid organs and chemicals.Review of Anatomy and Physiology of the Immune SystemA number of body cells are involved in immunity. The main cells of theimmune system are white blood cells collectively referred to asleukocytes. Like all blood cells, leukocytes originate from the bonemarrow. Stem cells (undifferentiated cells) in the marrow develop intothe various white blood cells. In addition to serving as the birthplace forleukocytes, the bone marrow also acts as a reservoir for mature cells thatmay be needed in the event of infection or blood loss. Although mostleukocytes originate in the bone marrow along with red blood cells,most spend very little time in the blood. Leukocytes spend most of theirtime in storage, in lymphoid tissues, or dispersed throughout the hosttissues. Leukocytes use blood mainly as a transport system to travel toareas of the body where they are needed.There are six families of leukocytes that have distinct roles in the body’sdefense. They are; Monocyte-macrophages Dendritic cells Mast cells Granulocytes Lymphocytes Natural killer cells.All the leukocytes except the lymphocytes are considered part of theinnate immune system. Lymphocytes are the only leukocytes associatedwith the adaptive immune system. All the leukocyte families originallycome from pluripotent hematopoeitic stem cells in the bone marrow.The pluripotent stem cell differentiates into common lymphoid andcommon myeloid progenitors. All lymphocytes as well as natural killercells are descended from the common lymphoid progenitor. Thecommon myeloid progenitor differentiates into monocyte, dendriticcells, granulocyte, erythrocyte, and platelet precursors.The leukocytes found in the blood and lymph tissues are typically notfully differentiated. As a case study, monocytes descend from thecommon myeloid progenitor. Monocytes circulate in the blood untilsummoned to the tissues. At this time, they exit the blood vesselsthrough specialized openings in the vessel wall and enter the tissue.Once in the tissue, monocytes differentiate yet again, maturing into288

NSC 305MODULE 4macrophages which usually live in the tissues until their death. Thus themacrophage is the monocyte’s final differentiation and the monocyte issimply a relatively inert circulation form of the cell. The exception is thegranulocytes which circulate in fully differentiated form. Proliferation isthe other concept necessary to understand some white blood cells.Although lymphocytes originate in the bone marrow from stem cells,they are also able to reproduce within lymph tissue. When activated,lymphocytes will proliferate (reproduce) first, then differentiate intotheir final functioning form. This allows the few cells that are able torespond to a given invader to reproduce quickly without a correspondingincrease in lymphocytes that are not needed for the present threat.Types of Cell1.Monocyte –MacrophagesThe immature stage is referred to as monocyte, while the fullydifferentiated stage is called a macrophage. Monocytes are continuouslymigrating to tissue and differentiating into tissue macrophages. Tissuemacrophages are called different names, depending on the tissue inwhich they have differentiated. Tissue macrophages in the nervoussystem are called microglial cells, while macrophages in the liver arecall Kupffer cells. Their functions are to monitor the surrounding tissuefor invaders and foreign antigen. They are sometimes referred to asmononuclear phagocytes.Macrophages are one of three phagocytic cells in the immune system.Having differentiated in tissues, macrophages are relatively immobile,monitoring the nearby tissue for invaders. Upon detecting an invader,macrophages attempt to engulf the invader in an amoeboid-like processcalled phagocytosis. Macrophages are antigen presenting cells (APCs)and act as one of the first responders in the immune response process.Once activated, a macrophage releases cytokines and chemokines whichenable the respective immune function.2.Dendritic cellsDendritic cells are star-shaped cells that are so called because theyresemble a neuron’s dendrites. The immature dendritic cells migrate totissues, particularly the skin, airway, spleen, and lymph nodes. Tissuedendritic cells that live in the skin are called Langerhans cells. (Skintissue macrophages are also called Langerhans cells.) Immature tissuedendritic cells are both phagocytic and macropinocytic; that is, they caningest large amounts of surrounding interstitial fluid. Tissue dendriticcells break down proteins and display the ingested antigens on their cellmembranes. At the end of their life cycle, they will migrate to lymphnodes and induce tolerance in lymphoctyes, because they do not haveco-stimulatory molecules in their immature stage. The signals formaturation are either direct contact with a pathogen or inflammatory289

NSC 305MEDICAL SURGICAL NURSING Icytokines. Pathogens are ingested when they are recognized by theircommon features as described above. Macropinocytosis allows thedendritic cell to ingest pathogens that have some mechanism to escapedetection by phagocytic receptors. As the products are degraded insidethe dendritic cell, it is able to recognize bacterial DNA, bacterial heatshock proteins, and viral double stranded RNA. Once activated, theydifferentiate into mature dendritic cells, develop co-stimulatorymolecules, and migrate to the lymph nodes to activate the lymphocytesthat migrate through the nodes.The dendritic cells are able to activate only the specific T lymphocytesthat are needed to respond to a given invader, whether it is a virus,bacteria, or fungus.The dendritic cell’s strength is also a key weakness exploited by severalviruses, such as HIV and measles. Instead of activating lymphocytes inlymph nodes against these viruses, the infected dendritic cell acts as atransportation system, allowing the virus to then infect the Tlymphocytes.Much of the extracellular debris that is ingested by dendritic cells isharmless, osften byproducts of dead body cells. Dendritic cells areessential in inducing and maintaining tolerance to these antigens,keeping the immune system from reacting to the body’s antigens. As Tlymphocytes exit the thymus gland, dendritic cells are responsible fordestroying cells that are reactive to self-antigens. This process isreferred to as central tolerance and removes the majority of self-reactiveT lymphocytes. Dendritic cells also induce peripheral tolerance,suppressing self-reactive lymphocytes that escaped central tolerance orcells that are reactive to antigens not expressed in the thymus.3.Mast cellsMast cells live near the skin and connective tissue of small blood vesselsand contain granules with stored chemicals. When activated, theyrelease substances within the granules (degranulate) that affect vascularpermeability, particularly histamine. Mast cells are thought to play animportant part in protecting mucosal surfaces from pathogens and helpthe inflammatory process to begin the process of healing damagedtissue, although they are primarily known for their role in IgE-mediatedallergic reactions.4.GranulocytesAlso known as polymorphonuclear leukocytes (PMNs). The granulesare lysosomes—vesicles filled with destructive enzymes. Theseenzymes are used to destroy invaders. Neutrophils are the mostnumerous granulocyte performing phagocytic function in the immune290

NSC 305MODULE 4system. Upon engulfing an invader, the granules are fused to the vesicleand the enzymes are released into vesicle, destroying the particle. Neutrophils are especially reactive to bacteria, as the number ofcirculating neutrophils greatly increases during bacterialinfections. Neutrophils are the first responders to chemotaxis,and are rarely found in healthy tissue. Neutrophils are relativelyfragile compared to macrophages. They can only ingest a fewbacteria before dying, while macrophages can ingest a hundredbacteria. Pus is mostly made up of bacteria and dead neutrophils.Because of their expendable nature, they appear in the blood inlarge numbers, with several times that number in reserve in thebone marrow. They are the most numerous granulocytes andoften the most numerous leukocyte. The other two classes ofgranulocyte cells are exocytic, meaning they produce their effectson outside cells as opposed to phagocytosed cells. Eosinophils are found in small quantities in the blood as most ofthem are distributed in the tissues. Their primary effectorfunction is

Medical Surgical Nursing (I) Medical Surgical Nursing (I) is the first of the four Medical Surgical Nursing courses in your degree programme. It is registrable at the first semester of the third year. The course shall improve on your previous knowledge to enhance better understanding of principles, concepts a