Medical-Surgical Nursing

Medical-Surgical Nursing is a comprehensive and engaging resource for nursing students, equipping them with the essential knowledge and skills required to provide high-quality care. Building on the foundational knowledge and skills acquired in previous nursing courses, this textbook expands students’ learning with concepts in medical-surgical nursing. The offering provides the background to ensure that nursing students are well-versed in both the science and art of nursing, capable of critical thinking, clinical judgment, and compassionate care.

Medical-Surgical Nursing encompasses a broad range of patient-care situations, from managing chronic conditions to providing postoperative care. The material includes concise explanations to facilitate understanding, as well as rich reviews of pathophysiology, ensuring students grasp essential concepts without becoming overwhelmed. Beyond theoretical knowledge, the text emphasizes the development of practical skills and competencies, and incorporates evidence-based best practices into each of its 38 chapters.

Senior Contributing Authors
- Christy Bowen, Chamberlain University
- Bridget Carey, Holy Family University
- Jessica Palozie, University of Connecticut
- Maren Reinholdt, University of Rochester School of Nursing

Preface

Unit 1 Introduction and Foundations of Medical-Surgical Nursing

Chapter 1 Professional Medical-Surgical Nursing
o Introduction
o 1.1 Professional Nursing Practice
o 1.2 Intercollaborative Care
o 1.3 Health Policy and Ethical Considerations
o 1.4 Evidence-Based Practice
o 1.5 Health-Care Delivery Systems
o 1.6 Systems-Based Practice
o 1.7 Technology and Informatics
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 2 Culturally Competent Care
o Introduction
o 2.1 Concepts in Culture
o 2.2 Cultural Assessment
o 2.3 Health Equity and Disparities
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 3 Health Promotion and Patient Education
o Introduction
o 3.1 Health Promotion and Wellness
o 3.2 Strategies for Improving Healthy Habits
o 3.3 Challenges Throughout the Lifespan
o 3.4 Purpose of Health Education and Patient Teaching
o 3.5 Strategies for Optimal Patient Education
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Unit 2 Critical Thinking in Nursing Practice

Chapter 4 Clinical Judgment in the Nursing Process
o Introduction
o 4.1 Critical Thinking and the Nursing Process
o 4.2 Clinical Judgment Measurement Model Overview
o 4.3 Recognizing and Analyzing Cues
o 4.4 Prioritizing Hypotheses, Generating Solutions, and Taking Action
o 4.5 Evaluating Outcomes
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 5 Ethical Decision Making
o Introduction
o 5.1 Clinical Judgment and Ethical Dilemmas
o 5.2 Patient Care and Safety
o 5.3 Ethical Patient Education
o 5.4 Ethical Challenges in Scope of Practice
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Unit 3 General Assessment Considerations

Chapter 6 Comprehensive Health Assessment and Physical Examination
o Introduction
o 6.1 Critical Thinking in Assessment
o 6.2 Effective Communication in the Nurse-Patient Relationship
o 6.3 Health History
o 6.4 Bedside Physical Assessment in Medical-Surgical Nursing
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 7 Pain Assessment and Management
o Introduction
o 7.1 Concepts and Causes of Pain
o 7.2 Pain Assessment
o 7.3 Pharmacological Pain Management
o 7.4 Nonpharmacological Pain Management
o 7.5 Substance Use Disorder
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 8 Stress and Stress-Related Disorders
o Introduction
o 8.1 Homeostasis, Stress, and Adaptation
o 8.2 Causes and Types of Stress
o 8.3 Stress and Disease
o 8.4 Physiological Response
o 8.5 Psychological Response
o 8.6 Inflammation: Cellular Response to Stress
o 8.7 Role of Stress in Family Health
o 8.8 Pharmacotherapy and Complementary and Alternative Medicine
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 9 Management of Chronic Illness
o Introduction
o 9.1 Chronic Disease and Illness (Prevalence and Etiology)
o 9.2 Comorbid Chronic Diseases
o 9.3 Chronic Illness and Disability
o 9.4 Access and Barriers to Health Care
o 9.5 Prevention of Chronic Disease
o 9.6 The Chronic Care Model
o 9.7 Care of the Chronically Ill Patient
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Unit 4 Nursing Management and Considerations

Chapter 10 Fluid, Electrolyte, and Acid-Base Imbalances
o Introduction
o 10.1 Maintaining Homeostasis
o 10.2 Fluid Disturbances and Replacement
o 10.3 Electrolyte Imbalance
o 10.4 Acid-Base Imbalance
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 11 Gas Exchange, Airway Management, and Respiratory System Disorders
o Introduction
o 11.1 Concepts of Oxygenation and Perfusion
o 11.2 Upper and Lower Respiratory Assessment
o 11.3 Disorders of the Upper Respiratory System: Bronchiectasis
o 11.4 Disorders of the Lower Respiratory System: Asthma
o 11.5 Disorders of the Lower Respiratory System: Chronic Obstructive Pulmonary Disease
o 11.6 Disorders of the Lower Respiratory System: Pneumothorax
o 11.7 Disorders of the Lower Respiratory System: Pneumonia and Aspiration
o 11.8 Disorders of the Lower Respiratory System: Tuberculosis
o 11.9 Disorders of the Lower Respiratory System: Cystic Fibrosis
o 11.10 Effects of Smoking, Vaping, and Environmental Triggers of the Respiratory System
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 Critical-Thinking Questions about Case Studies
 Competency-Based Assessments
o References

Chapter 12 Cardiovascular System
o Introduction
o 12.1 Cardiovascular Overview
o 12.2 Dysrhythmia
o 12.3 Heart Failure
o 12.4 Hypertension
o 12.5 Myocardial Infarction
o 12.6 Vascular Disorders
o 12.7 Peripheral Vascular Disease
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 Critical-Thinking Questions about Case Studies
 Competency-Based Assessments
o References

Chapter 13 Musculoskeletal System
o Introduction
o 13.1 Osteoporosis and Osteopenia
o 13.2 Osteoarthritis
o 13.3 Bone Fractures
o 13.4 Muscular Dystrophy
o 13.5 Connective Tissue Disease
o 13.6 Soft Tissue Injuries
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 14 Integumentary System
o Introduction
o 14.1 Integumentary Disorders
o 14.2 Burns
o 14.3 Dermatologic Conditions
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 15 Cerebrovascular System
o Introduction
o 15.1 The Cerebrovascular System and Cerebral Vascular Accidents
o 15.2 Ischemic Stroke
o 15.3 Hemorrhagic Stroke
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 Competency-Based Assessments
o References

Chapter 16 Hematopoietic Disorders and Regulation
o Introduction
o 16.1 Anemias
o 16.2 Hereditary Disorders
o 16.3 Polycythemia
o 16.4 Thrombocytopenia
o 16.5 Neutropenia
o 16.6 Thrombotic Disorder
o 16.7 Blood Products and Transfusion Principles
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 17 Nervous System and Chronic Diseases of the Nervous System
o Introduction
o 17.1 Intracranial Pressure Changes
o 17.2 Acute Disorders of the Nervous System
o 17.3 Chronic Disorders of the Nervous System
o 17.4 Major Neurocognitive Disorder and Neurodegenerative Diseases
o 17.5 Seizures
o 17.6 Polyneuropathy
o 17.7 Chronic Pain Disorders
o 17.8 Spinal Disorders
o 17.9 Neurological Injuries
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 18 Sensory Organs
o Introduction
o 18.1 Disorders of the Eye
o 18.2 Disorders of the Ear
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 19 Gastrointestinal System and Disorders
o Introduction
o 19.1 Nutritional Disorders
o 19.2 Disorders of the Oral Cavity
o 19.3 Parenteral and Enteral Nutrition
o 19.4 Disorders of the Upper GI System
o 19.5 Disorders of the Lower GI System
o 19.6 Hepatic and Biliary Disorders
o 19.7 Ostomy Care
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 20 Genitourinary and Reproductive Systems
o Introduction
o 20.1 Brief Review of Genitourinary and Reproductive Anatomy and Physiology
o 20.2 Sexually Transmitted Infections
o 20.3 Male-Specific Disorders of the Reproductive Tract
o 20.4 Disorders of the Prostate
o 20.5 Female-Specific Disorders of the Reproductive Tract
o 20.6 Disorders of the Breast
o 20.7 Renal Function and Chronic Kidney Disease
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 21 Endocrine System and Endocrine System Disorders
o Introduction
o 21.1 Review of Endocrine Anatomy and Physiology
o 21.2 Diabetes Mellitus
o 21.3 Thyroid and Parathyroid Disorders
o 21.4 Pituitary Disorders
o 21.5 Adrenal Disorders
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 22 Infection and Infectious Diseases
o Introduction
o 22.1 Infectious Process
o 22.2 Viral and Fungal Infections
o 22.3 Antibiotic Resistance
o 22.4 Preventing Secondary Infections
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 23 Shock and Sepsis
o Introduction
o 23.1 Shock Overview
o 23.2 Hypovolemic Shock
o 23.3 Septic Shock
o 23.4 Neurogenic Shock
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 24 Management of Patients with Allergic Disorders
o Introduction
o 24.1 Allergic Response
o 24.2 Allergic Rhinitis
o 24.3 Types of Dermatitis
o 24.4 Urticaria and Angioneurotic Edema
o 24.5 Allergy to Food
o 24.6 Allergy to Latex
o 24.7 Anaphylaxis
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Unit 5 Care of the Surgical Patient

Chapter 25 Preoperative Care
o Introduction
o 25.1 Preadmission Assessment and Education
o 25.2 Preoperative Nursing Priorities
o 25.3 Preoperative Nursing Care Plan
o 25.4 Special Preoperative Considerations
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 Critical-Thinking Questions about Case Studies
 Competency-Based Assessments
o References

Chapter 26 Intraoperative Care
o Introduction
o 26.1 Overview of the Surgical Experience
o 26.2 Intraoperative Considerations
o 26.3 Intraoperative Nursing Management
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 Critical-Thinking Questions about Case Studies
 Competency-Based Assessments
o References

Chapter 27 Postoperative Care
o Introduction
o 27.1 Postanesthesia Recovery and Care
o 27.2 Postoperative Pain Management
o 27.3 Hospitalized Postoperative Patient
o 27.4 Postoperative Nursing Care Plan
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 Critical-Thinking Questions about Case Studies
 Competency-Based Assessments
o References

Chapter 28 Inflammation and Healing
o Introduction
o 28.1 Cellular Response and Adaptation in Wound Healing
o 28.2 Wound Healing Process
o 28.3 Pressure Injury
o 28.4 Debridement
o 28.5 Wound Care and Dressing
o 28.6 Medical Management
o 28.7 Nursing Management and Care Plan
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 29 Immunological Function
o Introduction
o 29.1 Immune Response
o 29.2 Autoimmunity
o 29.3 Immunodeficiency
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Unit 6 Special Considerations and Concepts

Chapter 30 Genetics
o Introduction
o 30.1 Genetic Disorders
o 30.2 Patterns of Inheritance and Mutations
o 30.3 Testing and Detection
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 31 Cancer
o Introduction
o 31.1 Oncological Disorders
o 31.2 Detection and Prevention of Cancer
o 31.3 Care of the Patient with Cancer
o 31.4 Survivorship
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 32 Palliative Care
o Introduction
o 32.1 Palliation
o 32.2 End-of-Life Care
o 32.3 Assessment
o 32.4 Psychosocial Support
o 32.5 Special Considerations
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 33 Emergency Care
o Introduction
o 33.1 Triage and Assessment
o 33.2 Types of Emergency Care
o 33.3 Managing Risk Exposure
o 33.4 Forensic Nursing
o 33.5 Transferring from the Emergency Department
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 34 Disaster and Recovery
o Introduction
o 34.1 Environmental Disasters
o 34.2 Biological and Technological Disasters
o 34.3 Epidemics and Pandemics
o 34.4 Community Response to Disaster
o 34.5 Hospital Preparedness for Disasters
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 35 Nursing Care of the Critically Ill Patient
o Introduction
o 35.1 Assessment and Management of the Critically Ill Patient
o 35.2 Cardiovascular Concerns
o 35.3 Respiratory Concerns
o 35.4 Neurological Concerns
o 35.5 Gastrointestinal Concerns
o 35.6 Renal Concerns
o 35.7 Integumentary Concerns
o 35.8 Musculoskeletal Concerns
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Chapter 36 Home Health Nursing and Rehabilitation
o Introduction
o 36.1 Home Health Care
o 36.2 Rehabilitative Care
o 36.3 Additional Care Settings in the Community
o 36.4 Transition and Continuity of Care
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
o References

Chapter 37 Trends in Health-Care Technology
o Introduction
o 37.1 Telemedicine and Artificial Intelligence
o 37.2 Health Informatics
o 37.3 Influences on Delivery of Health Care
o Summary
o Key Terms
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 What Should the Nurse Do?
 Competency-Based Assessments
o References

Unit 7 Putting It All Together

Chapter 38 Unfolding Case Study and NCLEX Preparation
o Introduction
o 38.1 Unfolding Case Study Dissection
o 38.2 NCLEX Preparation
o Summary
Assessments
 Review Questions
 Check Your Understanding Questions
 Reflection Questions
 Competency-Based Assessments

Appendix A Diagnostic Studies and Interpretation
Appendix B Major Fluid and Electrolyte Imbalances