Contents
- 0.1 Introduction to Surgery and Surgical Nursing II
- 0.2 1. Musculoskeletal System Conditions
- 0.3 2. Endocrine System Conditions
- 0.4 3. Integumentary System Conditions
- 0.5 4. Nervous System Conditions
- 0.6 5. Genito-Urinary System Conditions
- 0.7 6. Diseases and Abnormalities of the Eye, Ear, Nose, and Throat
- 1 For more study materials and lessons, please visit asonyagh.com.
- 2 REad Also: Handout on Advanced Nursing II (RGN 211) for Nursing Students
Introduction to Surgery and Surgical Nursing II
Surgery and Surgical Nursing II focuses on equipping nursing students with the knowledge and skills to manage patients with a wide range of surgical conditions, including those affecting the musculoskeletal, endocrine, integumentary, nervous, and genito-urinary systems. Nurses play a vital role in providing care before, during, and after surgery, ensuring that patients receive comprehensive care tailored to their specific conditions.
This handout will explore the key surgical conditions in each of these systems and offer practical guidelines for nursing care. It is aligned with the Ghana Nurses and Midwifery Council (NMC) Curriculum and provides students with the foundation needed to manage complex surgical cases.
1. Musculoskeletal System Conditions
The musculoskeletal system includes bones, muscles, ligaments, and tendons, all of which can be affected by trauma, infections, or congenital disorders. Nurses must be proficient in assessing, diagnosing, and managing various conditions that affect the musculoskeletal system.
a. Fractures, Dislocations, and Tumors of the Bones
- Fractures: A break or crack in a bone, often caused by trauma or underlying bone disease (e.g., osteoporosis).
- Types of Fractures:
- Simple (Closed) Fracture: The bone is broken, but the skin is intact.
- Compound (Open) Fracture: The bone is broken, and the skin is also damaged, increasing the risk of infection.
- Nursing Responsibilities:
- Immobilize the Fracture: Use splints or casts to prevent further injury.
- Monitor for Complications: Look out for signs of infection (in compound fractures) and assess for circulation issues (e.g., compartment syndrome).
- Types of Fractures:
- Dislocations: Occur when bones are forced out of their normal positions at a joint, often resulting in severe pain and joint instability.
- Nursing Responsibilities:
- Assist with the reduction of dislocated joints (usually done by a physician).
- Provide pain relief and immobilize the joint after reduction.
- Nursing Responsibilities:
- Tumors of the Bones: Abnormal growths in the bone tissue that can be benign (non-cancerous) or malignant (cancerous).
- Nursing Responsibilities:
- Monitor for signs of bone weakening and fractures.
- Support the patient through diagnostic tests (e.g., X-rays, biopsies) and treatment (e.g., surgery, chemotherapy).
- Nursing Responsibilities:
b. Osteogenesis Imperfecta
- A genetic disorder characterized by fragile bones that break easily, often with minimal or no trauma.
- Nursing Responsibilities:
- Provide gentle handling and support to prevent fractures.
- Educate the family on bone-strengthening exercises and proper nutrition (e.g., calcium and vitamin D intake).
- Nursing Responsibilities:
c. Disorders of the Spine: Kyphosis, Lordosis, Scoliosis
- Kyphosis: Excessive outward curvature of the spine, leading to a hunchback appearance.
- Lordosis: Excessive inward curvature of the lower spine, often causing back pain.
- Scoliosis: A lateral (sideways) curvature of the spine, often diagnosed in childhood or adolescence.
- Nursing Responsibilities:
- Assist with bracing or surgical correction, depending on the severity of the condition.
- Provide post-operative care for spinal surgeries, including pain management and monitoring for complications.
- Nursing Responsibilities:
d. Osteomyelitis, Osteitis, Pyomyositis
- Osteomyelitis: Infection of the bone, often caused by bacteria such as Staphylococcus aureus.
- Nursing Responsibilities:
- Administer antibiotics as prescribed and monitor for signs of infection (e.g., fever, swelling).
- Assist with surgical drainage if necessary.
- Nursing Responsibilities:
- Osteitis: Inflammation of the bone, often resulting from infection or injury.
- Pyomyositis: A bacterial infection of the skeletal muscles, often caused by Staphylococcus aureus.
- Nursing Responsibilities:
- Administer antibiotics and monitor the patient for abscess formation, which may require drainage.
- Nursing Responsibilities:
2. Endocrine System Conditions
The endocrine system consists of glands that secrete hormones regulating various bodily functions. Disorders of these glands can lead to imbalances in metabolism, growth, and reproduction.
a. Pancreas
- Diabetes Mellitus: A condition where the body cannot regulate blood sugar levels due to insufficient insulin production (type 1) or insulin resistance (type 2).
- Nursing Responsibilities:
- Monitor blood glucose levels and administer insulin or oral hypoglycemic agents as prescribed.
- Educate patients on dietary management and the importance of exercise.
- Nursing Responsibilities:
b. Gonads
- Disorders of the ovaries or testes can lead to hormonal imbalances affecting reproductive health and development.
- Nursing Responsibilities:
- Assist with hormone therapy or surgery for conditions such as ovarian cysts or testicular cancer.
- Nursing Responsibilities:
c. Thyroid, Pituitary, Hypothalamus, and Parathyroid
- Thyroid Disorders (e.g., Hyperthyroidism, Hypothyroidism): These conditions result from overactive or underactive thyroid glands.
- Nursing Responsibilities:
- Monitor vital signs, particularly heart rate and temperature, as thyroid disorders can affect metabolism.
- Administer thyroid medications and educate the patient on proper dosage and side effects.
- Nursing Responsibilities:
- Pituitary and Hypothalamus Disorders: These conditions can affect growth, sexual development, and metabolism.
- Nursing Responsibilities:
- Assist with hormone replacement therapy and monitor for side effects.
- Nursing Responsibilities:
- Parathyroid Disorders: These glands regulate calcium levels in the body, and disorders can lead to hypercalcemia or hypocalcemia.
- Nursing Responsibilities:
- Monitor serum calcium levels and provide appropriate interventions (e.g., calcium supplements, surgery).
- Nursing Responsibilities:
3. Integumentary System Conditions
The integumentary system includes the skin, hair, nails, and glands. Nurses are responsible for managing conditions affecting this system, especially those involving burns, wounds, and infections.
a. Burns and Scalds
- Burns: Damage to the skin and underlying tissues caused by heat, chemicals, or electricity.
- Types of Burns:
- First-Degree Burns: Affect the outer layer of the skin (epidermis), causing redness and pain.
- Second-Degree Burns: Affect both the epidermis and dermis, leading to blisters and severe pain.
- Third-Degree Burns: Penetrate all skin layers and may affect underlying tissues, causing numbness due to nerve damage.
- Nursing Responsibilities:
- Administer pain relief and prevent infection by using sterile dressings.
- Monitor fluid balance and prevent dehydration in patients with severe burns.
- Types of Burns:
b. Growths and Abscesses
- Skin Growths: Can be benign (e.g., warts) or malignant (e.g., melanoma).
- Abscesses: Pockets of pus caused by bacterial infections.
- Nursing Responsibilities:
- Assist with incision and drainage of abscesses.
- Administer antibiotics and monitor for signs of systemic infection.
- Nursing Responsibilities:
4. Nervous System Conditions
The nervous system is responsible for transmitting signals between different parts of the body. Surgical conditions affecting this system require careful management due to the complexity and sensitivity of the brain and spinal cord.
a. Head Injuries
- Traumatic Brain Injuries (TBIs): Caused by a blow to the head, leading to symptoms such as loss of consciousness, confusion, and memory loss.
- Nursing Responsibilities:
- Monitor the patient’s level of consciousness using the Glasgow Coma Scale (GCS).
- Manage intracranial pressure and provide supportive care.
- Nursing Responsibilities:
b. Cerebral Abscess
- A collection of pus in the brain due to bacterial infection.
- Nursing Responsibilities:
- Administer antibiotics and monitor for neurological symptoms (e.g., seizures, headaches).
- Assist with surgical drainage if necessary.
- Nursing Responsibilities:
c. Spinal Injuries
- Injuries to the spine can result in paralysis, loss of sensation, or chronic pain.
- Nursing Responsibilities:
- Provide immobilization of the spine using braces or traction.
- Monitor for complications such as pressure ulcers and deep vein thrombosis (DVT).
- Nursing Responsibilities:
d. Tuberculosis of the Spine
- Also known as Pott’s disease, this condition occurs when tuberculosis bacteria infect the vertebrae, leading to spinal deformities and pain.
- Nursing Responsibilities:
- Administer anti-tuberculosis medications and monitor for spinal complications.
- Provide support for pain management and mobility.
- Nursing Responsibilities:
5. Genito-Urinary System Conditions
The genito-urinary system includes the kidneys, bladder, and reproductive organs. Surgical conditions in this system can be life-threatening if not managed properly.
a. Calculi and Strictures
- Calculi (Kidney Stones): Solid masses that form in the kidneys from crystallized substances in the urine.
- Nursing Responsibilities:
- Administer pain relief and fluids to help pass the stones.
- Monitor for signs of infection or blockage.
- Nursing Responsibilities:
- Strictures: Narrowing of the urethra or other parts of the urinary tract, often due to scarring from injury or infection.
- Nursing Responsibilities:
- Assist with catheterization or surgery to relieve the blockage.
- Nursing Responsibilities:
b. Tumors of the Prostate Gland
- Prostate Tumors: These include benign prostatic hyperplasia (BPH) and prostate cancer.
- Benign Prostatic Hyperplasia (BPH): A non-cancerous enlargement of the prostate gland, common in older men, leading to urinary difficulties.
- Prostate Cancer: A malignant tumor of the prostate, often requiring surgical removal or radiation therapy.
- Nursing Responsibilities:
- Monitor for symptoms such as difficulty urinating, blood in urine, or pain during urination.
- Assist with diagnostic procedures such as a Prostate-Specific Antigen (PSA) test or biopsy.
- Provide post-operative care for prostate surgeries, including pain management and catheter care.
c. Phimosis and Paraphimosis
- Phimosis: A condition where the foreskin of the penis is too tight to be retracted over the glans.
- Paraphimosis: Occurs when the retracted foreskin becomes trapped behind the glans, leading to swelling and pain.
- Nursing Responsibilities:
- Educate patients and caregivers on proper hygiene.
- Assist with circumcision or manual reduction of paraphimosis.
- Nursing Responsibilities:
d. Testicular Torsion and Varicocele
- Testicular Torsion: A medical emergency where the testicle twists, cutting off its blood supply.
- Nursing Responsibilities:
- Recognize the symptoms of sudden, severe testicular pain and swelling.
- Prepare the patient for emergency surgery to untwist the testicle and restore blood flow.
- Nursing Responsibilities:
- Varicocele: An enlargement of the veins within the scrotum, often leading to pain or fertility issues.
- Nursing Responsibilities:
- Assist with diagnostic procedures like ultrasound.
- Educate patients on surgical options to correct the varicocele.
- Nursing Responsibilities:
e. Epididymo-Orchitis, Balanitis
- Epididymo-Orchitis: Inflammation of the epididymis and testicle, often due to bacterial infection or sexually transmitted infections (STIs).
- Nursing Responsibilities:
- Administer antibiotics and educate patients about STI prevention.
- Provide supportive care, including scrotal elevation and pain relief.
- Nursing Responsibilities:
- Balanitis: Inflammation of the glans penis, often caused by poor hygiene, infection, or allergic reactions.
- Nursing Responsibilities:
- Educate patients on proper genital hygiene.
- Administer topical or oral medications as prescribed.
- Nursing Responsibilities:
f. Urolithiasis (Kidney Stones) and Strictures
- Urolithiasis: The presence of stones in the urinary system, causing severe pain, nausea, vomiting, and possible urinary obstruction.
- Nursing Responsibilities:
- Provide pain relief (e.g., NSAIDs or opioids) and increase fluid intake to help pass stones.
- Monitor for complications like urinary tract infections or hydronephrosis (swelling of the kidney due to urine buildup).
- Nursing Responsibilities:
- Strictures: Narrowing of the urethra or urinary tract due to injury, infection, or surgery.
- Nursing Responsibilities:
- Assist with surgical procedures to dilate or remove strictures.
- Provide catheter care and patient education on self-catheterization if necessary.
- Nursing Responsibilities:
g. Genito-Urinary Tumors and Female Genito-Urinary Tumors
- Genito-Urinary Tumors: Include cancers of the bladder, kidneys, and reproductive organs (e.g., ovarian, uterine, cervical cancer).
- Nursing Responsibilities:
- Monitor patients for symptoms such as hematuria (blood in urine), pelvic pain, or abnormal bleeding.
- Provide post-operative care and emotional support to patients undergoing surgery for tumor removal.
- Nursing Responsibilities:
- Female Genito-Urinary Tumors and Fistulae: Conditions like obstetric fistulae (abnormal connections between the bladder, rectum, and vagina) often result from childbirth complications.
- Nursing Responsibilities:
- Assist with surgical repair of fistulae.
- Provide post-operative care, including wound care and patient education on hygiene and follow-up visits.
- Nursing Responsibilities:
6. Diseases and Abnormalities of the Eye, Ear, Nose, and Throat
Conditions affecting the eye, ear, nose, and throat (ENT) are common in surgical nursing. Nurses must be able to recognize the symptoms, assist with diagnosis and treatment, and provide comprehensive post-operative care.
a. Eye Conditions
- Cataracts: A clouding of the lens of the eye, leading to blurred vision and, eventually, blindness.
- Nursing Responsibilities:
- Prepare patients for cataract surgery (phacoemulsification) by educating them on the procedure.
- Provide post-operative care, including eye drops and instructions on avoiding strenuous activity to prevent pressure on the eye.
- Nursing Responsibilities:
- Glaucoma: A group of eye conditions that damage the optic nerve, often due to high intraocular pressure.
- Nursing Responsibilities:
- Administer eye drops to lower intraocular pressure.
- Educate patients on the importance of regular eye exams to prevent vision loss.
- Nursing Responsibilities:
- Pterygium: A benign growth of tissue on the conjunctiva that may extend over the cornea.
- Nursing Responsibilities:
- Educate patients on using sunglasses to prevent irritation from UV exposure.
- Assist with surgical removal if the pterygium affects vision.
- Nursing Responsibilities:
- Chalazion: A small cyst in the eyelid caused by a blocked oil gland.
- Nursing Responsibilities:
- Provide warm compresses to promote drainage.
- Assist with surgical removal if the chalazion persists.
- Nursing Responsibilities:
- Trachoma: A bacterial infection of the eye that can lead to scarring and blindness if untreated.
- Nursing Responsibilities:
- Administer antibiotics and educate the community on hygiene practices to prevent the spread of trachoma.
- Nursing Responsibilities:
- Foreign Bodies in the Eye:
- Nursing Responsibilities:
- Gently irrigate the eye to remove foreign objects.
- Assist in further medical intervention if the foreign body is embedded.
- Nursing Responsibilities:
b. Ear Conditions
- Mastoiditis: An infection of the mastoid bone behind the ear, often a complication of untreated middle ear infections.
- Nursing Responsibilities:
- Administer antibiotics and monitor for signs of infection spread (e.g., fever, swelling behind the ear).
- Assist with surgical drainage or mastoidectomy if necessary.
- Nursing Responsibilities:
- Excessive Ear Wax (Cerumen Impaction): Buildup of ear wax that can cause hearing loss or discomfort.
- Nursing Responsibilities:
- Use ear drops to soften wax and irrigate the ear to remove the buildup.
- Educate patients on proper ear hygiene and the dangers of using cotton swabs in the ear canal.
- Nursing Responsibilities:
- Foreign Bodies in the Ear:
- Nursing Responsibilities:
- Carefully remove the foreign object using irrigation or forceps.
- Refer to an ENT specialist if the object is deeply lodged or causes damage.
- Nursing Responsibilities:
c. Nose Conditions
- Sinusitis: Inflammation of the sinuses, often caused by infection or allergies.
- Nursing Responsibilities:
- Administer decongestants and antibiotics as prescribed.
- Educate patients on steam inhalation and saline nasal sprays to relieve symptoms.
- Nursing Responsibilities:
- Deviated Septum: A misalignment of the nasal septum, often causing difficulty breathing through the nose.
- Nursing Responsibilities:
- Prepare patients for septoplasty if surgical correction is required.
- Provide post-operative care, including nasal packing and monitoring for bleeding.
- Nursing Responsibilities:
- Nasal Polyps: Non-cancerous growths in the lining of the nasal passages that can obstruct airflow.
- Nursing Responsibilities:
- Administer corticosteroid nasal sprays to shrink the polyps.
- Assist with surgical removal if polyps cause significant breathing problems.
- Nursing Responsibilities:
- Foreign Bodies in the Nose:
- Nursing Responsibilities:
- Carefully remove foreign objects using forceps or suction.
- Monitor for signs of infection or trauma to the nasal tissue.
- Nursing Responsibilities:
d. Throat Conditions
- Tonsillitis: Inflammation of the tonsils, often caused by viral or bacterial infection.
- Nursing Responsibilities:
- Administer antibiotics for bacterial infections and provide pain relief (e.g., throat lozenges, analgesics).
- Educate patients on rest, hydration, and maintaining good oral hygiene.
- Nursing Responsibilities:
- Peritonsillar Abscess: A collection of pus around the tonsils, often following untreated tonsillitis.
- Nursing Responsibilities:
- Assist with incision and drainage of the abscess.
- Monitor for airway obstruction and ensure the patient’s airway remains clear.
- Nursing Responsibilities:
This Surgery and Surgical Nursing II (RGN 317) Handout provides a detailed and comprehensive guide to managing patients with surgical conditions affecting the musculoskeletal, endocrine, integumentary, nervous, and genito-urinary systems. The handout also covers conditions of the eye, ear, nose, and throat, emphasizing the critical role that nurses play in the pre-operative, intra-operative, and post-operative care of these patients.
For more study materials and lessons, please visit asonyagh.com.
REad Also: Handout on Advanced Nursing II (RGN 211) for Nursing Students