Class notes
NUR 101 Med Surg Notes
- Course
- NUR 101
- Institution
- Evergreen Valley College
Lecture notes for first half of first semester.
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Medsurg StudyguideWeek 1 - Health Promotion
Health: state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity
o Determinants of Health: factors that influence the health of individuals/groups and help explain why some
people experience poorer health than others
Behavior: influenced by his or her environment, education, and economic status
Positive: exercise routine, healthy diet
Negative: alcohol, smoking
Genetics: family history of disease
Negative: diabetes, heart diseases, sickle cell anemia
Social environment: personal relationships
Positive: supportive relationships
Negative: domestic violence, dating violence
Physical environment: availability & safety related to workplace, housing, neighborhood, transportation
Negative: pollution, environmental hazards
Medical care: millions in the US remain uninsured and have limited access to care
o Health status: a holistic concept that encompasses life expectancy as well as self-assessment of health, not just
the presence or absence of disease
For individuals, health status = sum of current health probs + coping resources (Ex: family, money…)
For a community, health status = combination of health measures for everyone living in the community.
Community health measures: birth and death rates, life expectancy, access to care, and
morbidity and mortality rates related to disease and injury.
o Disparities: differences in the incidence, prevalence, mortality rate, and burden of diseases among populations
Factors: ethnicity & race, gender, age, sexual orientation, location, income, disability status,
education/occupation, health literacy, health care provider’s attitude
Male more likely to have liver disease
Women more likely to have rheumatoid arthritis and receive lower quality of care
Younger people get less laboratory tests/screenings done
LGBTQ have higher rates of depression and less likely to seek care
People tend to seek providers from their same cultures
Rural rates have higher rates of depression, diseases, injury-related deaths
Explain the purpose and focus of Healthy People 2020.
o Purpose: provide science-based, 10-year national objectives for improving the health of all Americans
Vision: A society in which all people live long, healthy lives.
Mission:
Identify nationwide health improvement priorities.
Increase public awareness and understanding of the determinants of health, disease, and
disability the opportunities for progress.
Provide measurable objectives & goals that are applicable at the national, state, & local levels.
Engage multiple sectors to take actions to strengthen policies and improve practices that are
driven by the best available evidence and knowledge.
Identify critical research, evaluation, and data collection needs.
o Focus:
Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
Achieve health equity, eliminate disparities, and improve the health of all groups.
Create social and physical environments that promote good health for all.
, Promote quality of life, healthy development, and healthy behaviors across all life stages.
Discuss how access to care affects client outcomes.
o Access = timely use of personal health services to achieve the best health outcomes
Requires 3 distinct steps:
Gaining entry into the health care system (usually through insurance coverage)
Accessing a location where needed health care services are provided (geographic availability)
Finding a provider whom the patient trusts and can communicate with (personal relationship)
Access to health care impacts one's overall physical, social, and mental health status and quality of life.
Barriers to health services: high cost, inadequate or no insurance coverage, inavailability of services,
lack of culturally competent care
Barriers lead to: unmet health needs, delays in receiving appropriate care, inability to get preventive
services, financial burdens, preventable hospitalizations
o HMO: all care is coordinated through a primary care physician (PCP) of your choosing (Ex: Kaiser)
o PPO: you can visit any in-network physician or provider without needing referral from PCP; higher cost
o Medicare: federally funded health insurance program for 65 and older, disabled person, or people with end-
stage renal disease (ESRD)
4 parts: A = hospital, B = medical, C = Medicare Advantage, D = prescription drug plans
o Medicaid (Medi-Cal): state administered, need-based program
Medi-Cal is available for those enrolled in: SSI/SSP, CalWorks (AFDC), Refugee Assistance, Foster Care or
Adoption Assistance Program, In-Home Supportive Services (IHSS)
Other qualifications:
Low income (example: family of 4 cannot exceed annual income of $33,534)
Age: under 21, 65 or older
Blind or disabled or pregnant
In a skilled nursing or intermediate care home
On refugee status for a limited time, depending how long you have been in the United States
A parent or caretaker relative or a child under 21 if:
The child's parent is deceased or doesn't live with the child, or
The child's parent is incapacitated, or
The child's parent is under employed or unemployed
Have been screened/diagnosed for breast cancer or cervical cancer: BCCTP Program
Differentiate community-based nursing from community health and public health nursing.
o Public Health: promote & protect the health of populations using knowledge from nursing, social, and public
health sciences
Scope of practice: education, prevention of disease, promote community health and safety, caring for
entire populations, advocacy, activism (policy reform), assess/evaluate (monitor trends in outbreaks)
Responsibilities:
Assessing health trends to identify health risk factors specific to communities
Assigning priorities for health-related interventions in order to provide the greatest benefit
Advocacy with local, state and federal authorities in improving the access to health services in
underserved communities
Design and implement health education campaigns and activities for disease prevention
Provide info on local health programs and services that are available to improve access to care
Providing direct health care services to at-risk populations
Work alone or as part of the Interdisciplinary Team.
Often work for the gov’t (county/state/fed) in health depts., correctional facilities, worksites….
, Ex: if a disease outbreak occurs, public health nurse will evaluate the need & develop a program for an
immunization clinic.
o Community Health: serve the public in the nurse’s own environment to promote wellness & improve healthcare
Scope of practice: educating and developing intervention plans for individuals, families, or groups about
illness and disease prevention, safe health practices, nutrition, and wellness, among other topics.
Responsibilities:
Combines direct care & public health practices to target a population that may not have access
to health services.
Maximize the health status of individuals/families/groups/the community via direct approach.
Provide preventive care, immunizations, treat urgent illnesses, education, & medication refills.
Work within the community for a public entity such as school district or community health centers.
Ex: meet with young mothers to provide immunization info or teach a new diabetic how to give insulin
injections by practicing with an orange
o Community-based: include ambulatory care, transitional care, and long-term care
Offer patients the opportunity to live/recover in settings that maximize their independence and
preserve human dignity.
Transitional care: provide care in between the acute care & the home or a long-term care facility
Ex: acute rehab facility after head trauma or a spinal cord injury
Long-term care: care of patients for a period longer than 30 days
May be needed for those who are severely developmentally disabled, who are mentally
impaired, or who have physical deficits requiring continuous medical and nursing care (e.g.,
patients who are ventilator dependent or have Alzheimer’s disease).
Include skilled nursing facilities, assisted living facilities, and residential care facilities.
Identify factors that are influencing the shift of client care from hospitals to community-based and home settings.
o Special care needs of aging populations
o Homeless
o Cognition (dementia)
o Desires to age at home
o More surgical procedure are done out-patient & most of recovery is done at home
o Urgent Care (vs hospitalization due to economic impact)
o Mindful clients who want lower prices
Compare and contrast home health, rehab/skilled nursing and hospice settings and the role of nursing in each setting.
o Home Health: cost effective alternative for homebound adults who have health needs (intermittent or acute)
Designed to prevent or recover from illness.
Require physician orders and is reimbursed by Medicare.
Require caregiver for private duty care. Nurse does not help with ADL’s or continuous safety support.
Nurse’s role: monitor VS, ventilator care, trach care, ostomy/wound care, catheter care, meds
o Rehab and Skilled Nursing: Long Term Care Facilities (SNF/LTAC)
Precipitating factors: rapid & acute deterioration, caregiver unable to continue care, change/loss of
family support
Conflicts and fears: cost, anxiety and fears about care, Relocation Stress Syndrome
o Palliative Care: not a place, but a holistic form of care that focuses on reducing disease symptoms’ severity
Patients can receive curative and palliative treatments. Can be provided to both patients still receiving
aggressive treatment w/ hope of curing disease, as well as patients who are no longer on life-extending
treatment but preparing for death. When a cure seems unlikely, care transitions to palliative & hospice.
Goals: prevent & relieve suffering and to improve the quality of life for those with life limiting illnesses
Dying is a normal process. Relieve symptoms. Neither hasten nor prolong death.
, Variety of settings: home, long-term and acute care, mental health facilities, rehab centers, prisons
Team approach: physicians, nurses, patient, social workers, pharmacists, chaplains
To optimize the benefits of palliative care, it should be started soon after a person receives a diagnosis
of a life-limiting illness (cancer, heart failure, COPD, dementia, end-stage renal disease). No time limit.
o Hospice: specialized palliative care for terminally ill patients (less than 6 months to live) & families
Focus: symptom management, advance care planning, spiritual care, family support, palliative rather
than curative care, quality rather than quantity of life
Nurse’s priorities: manage pain and other symptoms, provide compassion, concern and support for the
dying, ensure dignity & quality of life, provide attentiveness to pt’s needs and resources
Models: hospital-based, home health, community or free-standing program; 24 hr/day, 7 days/wk
Services covered by: Medicare, Medicaid and many private insurances
Coverage often continues if patient is still alive past 6 months
Vulnerable populations: veterans, homeless, the poor, disabled, institutionalized
Variety of settings: the home, inpatient settings, acute & long-term care facilities, rehab centers
Criteria: patient must have a family caregiver to assist w/ hygiene when pt can no longer function alone
Nurse helps relieve symptoms and assist with ethical decision making and mourning. As death
nears, hospice team provides intense support. Follow-up after death to assist w/ bereavement.
Patient must desire the services and agree in writing that only hospice care (not curative care) can be
used to treat their illness. They can withdraw from the program at any time (if their condition
unexpectedly improves, etc.).
Describe the difference between primary, secondary and tertiary prevention/care and give examples.
o Chronic illnesses: permanent and often preventable; often has residual disabilities and rehab usually required
Account for 70% of deaths in the U.S.
4 modifiable risk factors: inactivity, excessive alcohol, tobacco, poor nutrition
o Primary prevention: prevent the occurrence of disease (before evidence of illness)
Remove risk factors, provide immunizations, prenatal care, use of condoms to prevent STDs, educate
about diet/exercise/healthy relationships/seat belts
o Secondary prevention: screening & early detection of a disease to prevent its progression
Intent: early detection & early treatment before disease is symptomatic
Screenings, hotlines (Ex: for leaving toxic relationship as soon as you realize it’s oxic)
o Tertiary prevention: focus is on people who have experienced disease or injury
Reduce complications (ex: beta blockers post MI), specialized clinics (Ex: heart failure clinics), support
groups (Ex: for victims of domestic violence), rehab
Identify and discuss how nurses utilize collaboration to promote client health.
o Health care team members:
Patient, nurse, social worker, counselor, dietician, pharmacist, physician, physician assistant
Occupational therapist (OT): may help patient with fine motor coordination, performing activities of
daily living, cognitive-perceptual skills, sensory testing
Physical therapist (PT): works with patients on improving strength and endurance, gait training, transfer
training, and developing a patient education program
Respiratory therapist (RT): may provide oxygen therapy in the home, give specialized respiratory
treatments, and teach the patient or caregiver about the proper use of respiratory equipment
Speech pathologist: focuses on treatment of speech defects/disorders
Pastoral care: offers spiritual support and guidance to patients and caregivers
o Exchanging knowledge & sharing responsibility to problem solve
o Make patient care decisions
o Coordinate care among members
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