MEDICAL SURGICAL AND PSYCHIATRIC
NURSING ASSESSMENT
PRODI NERS A 2021
GROUP 3 MEMBERS :
• AYU DYAH KUSUMADEWI WIDIARSA (019)
• NI KADEK SINTA MUTIARA DEWI (020)
• NI MADE NOLA SILPIA WARDANI(021)
• LUH PUTU MAS SARASWATI (022)
• KADEK MAHENDRA PRASETIA ADINATA (023)
• KETUT HERMAWAN (024)
• NI LUH GEDE DIPA LINDAYANI (025)
• I PUTU YOAN SUGIANTARA (026)
• KADEK MEGA ASRINI (027)
A. Medical Surgical Nursing Definition
• Medical-surgical nursing is a nursing specialty area concerned with
the care of adult patients in a broad range of settings. The Academy
of Medical-Surgical Nurses (AMSN) is a specialty nursing
organization dedicated to nurturing medical-surgical nurses as they
advance their careers.
• Today licensed medical-surgical nurses work in a variety of positions,
inpatient clinics, emergency departments, HMO's, administration,
out patient surgical centers, home health care, humanitarian relief
work, ambulatory surgical care, and skilled nursing homes.
B. Psychiatric Nursing Definition
• Psychiatric nursing or mental health nursing is the
appointed position of a nurse that specialises in mental
health, and cares for people of all ages experiencing
mental illnesses or distress. These include schizophrenia,
schizoaffective disorder, mood disorders, addiction,
anxiety disorders, personality disorders, eating
disorders, suicidal thoughts, psychosis, paranoia, and
self-harm.
C. Psychiatric Assessment in Med-Surg Patients
• Psychiatric disorders and related problems are common in
med-surg patients, and scenarios like this one occur every
day in acute-care hospitals. One source estimates that in
2007, 46% of the U.S. population experienced such mental-
health disorders as anxiety, impulse control, and substance
abuse. In 2006, psychosis was the third-highest-volume
diagnostic-related group (DRG). This DRG (430) includes
major personality disorders, such as schizophrenia,
catatonia, bipolar affective disorders, and paranoia.
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• People with psychosis or substance use disorders are at risk for the
same health problems as any other population subset. What’s more,
even patients without preexisting mental disorders may become
anxious and apprehensive when hospitalized, which may alter their
behavior. Consequently, aberrant social behaviors may increase in the
hospital setting.
• We don’t have to be a psych nurse to encounter patients experiencing
psychiatric emergencies. That’s why all nurses should have a basic
knowledge of psychiatric nursing, regardless of the setting they work in.
Identifying Psychiatric Emergencies
• On med-surg units, common psychiatric problems include psycho¬sis,
substance abuse and withdrawal, delirium, anxiety, aggression, bipolar
disorder, personality disorders, and suicidal behavior or ideation. To
ensure appropriate intervention, these problems need to be identified
early and their cause must be determined.
• Medication reconciliation can yield valuable clues. Generally,
psychiatric disorders are long-term problems with exacerbations and
remissions. Knowing if your patient’s current psychotic symptoms are
secondary to an ongoing psychiatric disorder can guide interventions.
General Goals of Care
These general care goals apply to all:
Assess the problem or potential problem early.
Maintain a safe environment.
Intervene appropriately using all available resources.
Ensure an appropriate follow-up plan, if needed.
Know that good communication and interpersonal skills are crucial
when dealing with patients experiencing psychiatric emergencies.
Substance Intoxication and Withdrawal
Acute alcohol withdrawal is common in med-surg patients
and must be treated. But be aware that some patients aren’t
truthful about their alcohol intake.
Alcohol withdrawal signs and symptoms include high blood
pressure, tachycardia, fever, hand tremors, insomnia, nausea
and vomiting, anxiety, generalized tonic-clonic seizures, and
transient visual, tactile, or auditory hallucinations.
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The primary care goal for patients in acute alcohol with drawal is to promote safe
withdrawal without injuries or medical complications. Nursing care includes:
monitoring vital signs
maintaining a quiet, calm environment
offering support and reassuring the patient he or she is safe
instituting fall precautions
addressing pain caused by medical-surgical conditions (and not withholding
analgesia)
promoting good hygiene
monitoring food and fluid intake
encouraging supportive family members and others to stay at the bedside
promoting use of relaxation techniques, such as soft music, controlled breathing,
and visualization.
Delirium
Many med-surg patients experience delirium secondary to stroke,intracranial tumors,trauma,
surgical complications, fever, infection, heart failure, substance toxicity or withdrawal, sedative
drugs, or excessive or deficient stimuli.
Whatever its cause, delirium may result in:
perceptual disturbances
Disorientation
Restlessness
reduced level of consciousness
disorganized thinking
decreased attention span
memory impairment
sleep disturbances.
Violent Behavior
Violent behavior may result from such problems as substance
intoxication, disordered or paranoid thinking and beliefs, and
anger. Violent patients are a threat to their own safety as well
as that of staff members, other patients, and visitors.
Generally, violent outbursts don’t occur suddenly without
warning. For example, agitated patients experience an inner
tension that may manifest as hyperactivity and behavioral
disorganization. So stay alert for violent tendencies.
Use of Restraints
Violent patients who pose an immediate danger to themselves or
others may need to be physically restrained for a brief period until
they can gain self-control. How-ever, patient injuries and litigation
risks associated with physical restraints are well documented, so
restraints should be avoided when¬ever possible. Use them only as
a last resort for the shortest time needed and in the least restrictive
manner possible—and only if you’ve been trained in the proper
application technique. The restrained patient should be monitored
closely and appropriate interventions followed.
Suicidal patients
Some med-surg patients have suicidal thoughts or exhibit suicidal
behavior. Patients may be hospitalized after a failed suicide
attempt, such as an intentional drug overdose, hanging, or a
nonfatal gunshot wound. Other med-surg patients may become
suicidal when hospitalized for other reasons. A 2007 Patient
Safety Goal of the Joint Commission was to identify patients with
suicidal ideation. Although that goal applies mainly to patients
being treated for mental illness in psychiatric settings, acute-care
general hospitals can adopt it to assess for this potential problem.
Special Skill Sets
If you work in a setting where many patients pose behavioral problems,
consider obtaining further education in psychiatric problems and crisis
management. For instance, emergency departments see more psychiatric
emergencies than other hospital areas. Patients in intensive care units
have a higher acuity and thus may require different approaches and
interventions in psychiatric emergencies. If you work on a pediatric unit,
you may require a specialized skill set to care for children and adolescents
with psychiatric or emotional problems. A maternity nurse may encounter
patients with severe postpartum psychiatric emergencies that call for
interventions encompassing the mother, newborn, and family.
Any Question???
Thank You
