Preface

Customization

Medical-Surgical Nursing is licensed under a Creative Commons Attribution 4.0 International (CC BY) license, which means that you can distribute, remix, and build upon the content, as long as you provide attribution to OpenStax and its content contributors.

Because our books are openly licensed, you are free to use the entire book or select only the sections that are most relevant to the needs of your course. Feel free to remix the content by assigning your students certain chapters and sections in your syllabus, in the order that you prefer. You can even provide a direct link in your syllabus to the sections in the web view of your book.

Instructors also have the option of creating a customized version of their OpenStax book. Visit the Instructor Resources section of your book page on OpenStax.org for more information.

Art Attribution

In Medical-Surgical Nursing, art contains attribution to its title, creator or rights holder, host platform, and license within the caption. Because the art is openly licensed, anyone may reuse the art as long as they provide the same attribution to its original source.

Errata

All OpenStax textbooks undergo a rigorous review process. However, like any professional-grade textbook, errors sometimes occur. In addition, the wide range of evidence, standards, practices, data, and legal circumstances in nursing change frequently, and portions of the text may become out of date. Since our books are web-based, we can make updates periodically when deemed pedagogically necessary. If you have a correction to suggest, submit it through the link on your book page on OpenStax.org. Subject matter experts review all errata suggestions. OpenStax is committed to remaining transparent about all updates, so you will also find a list of past and pending errata changes on your book page on OpenStax.org.

Format

You can access this textbook for free in web view or PDF through OpenStax.org, and for a low cost in print. The web view is the recommended format because it is the most accessible—including being WCAG 2.2 AA compliant—and most current. Print versions are available for individual purchase, or they may be ordered through your campus bookstore.

Summary

With more than half of all nursing students eventually working in medical and surgical environments, it is imperative that students build a solid foundation of knowledge, critical thinking skills, and patient-centered care practices to excel in these diverse settings. Medical-Surgical Nursing is designed to be a comprehensive guide for nursing students, equipping them with the essential knowledge and skills required to provide high-quality care. The ever-evolving field of health care demands that nurses be 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 post-operative care. The text balances concise explanations to facilitate understanding with rich reviews of pathophysiology, ensuring students grasp essential concepts without becoming overwhelmed. As a result, students come away with a deep understanding of the underlying mechanisms of diseases. Medical-Surgical Nursing integrates current best practices into each chapter. By staying informed about the latest advancements in medical-surgical nursing, students can deliver the highest quality care to patients. Beyond theoretical knowledge, the text emphasizes the development of practical skills and competencies. After reading Medical-Surgical Nursing, students will be better prepared to use their clinical judgment and critical thinking skills in a fast-paced environment.

Pedagogical Foundation

Medical-Surgical Nursing utilizes a blend of constructivism and experiential learning as its pedagogical framework. The text incorporates visual tools such as diagrams, flowcharts, and infographics to help students internalize complex information and create long-term understanding. Building on the foundational knowledge and skills acquired in previous nursing courses, this textbook expands students’ learning with advanced concepts in medical-surgical nursing.

By encouraging students to apply their knowledge through real-world scenarios, case studies, and hands-on exercises, the textbook fosters experiential learning that enhances critical thinking and clinical decision-making skills. This approach not only prepares students for the complexities of medical-surgical nursing but also empowers them to provide high-quality, evidence-based care to their patients.

Organizational Framework

The table of contents for Medical-Surgical Nursing presents content in 38 chapters, organized into 7 thematic units.

• Unit 1 establishes the foundational principles of medical-surgical nursing, covering professional practice, inter-collaborative care, health policy, evidence-based practice, and the integration of technology in health care. It also addresses culturally competent care and health promotion strategies.
• Unit 2 focuses on the critical thinking skills essential for nursing by exploring the nursing process, clinical judgment, and ethical decision-making. It provides frameworks for recognizing, analyzing, and prioritizing patient care needs.
• Unit 3 covers comprehensive health assessments and the management of pain, stress, and chronic illness. It emphasizes holistic patient evaluations and the development of effective communication skills.
• Unit 4 details the management of various physiological conditions, such as fluid and electrolyte balance, respiratory and cardiovascular care, musculoskeletal and integumentary health, and more. It provides practical guidelines for patient care management.
• Unit 5 guides students through the surgical experience, from preoperative to postoperative care. It highlights critical roles in ensuring patient safety, managing pain, and promoting healing and recovery.
• Unit 6 addresses specialized topics such as genetics, oncology, palliative care, emergency care, and disaster response. It prepares nurses to handle specific conditions and scenarios with confidence and competence.
• Unit 7 offers practical applications through unfolding case studies and NCLEX preparation. These sections enable students to integrate their knowledge and apply it in real-world clinical situations, fostering the transition from student to professional nurse.

Nursing Features

To further enhance learning, Medical-Surgical Nursing includes the following features:

• Clinical Judgment Measurement Model boxes guide students through the application of the Clinical Judgment Measurement Model. The content explores the critical thinking and decision-making processes necessary to navigate patient care at different points in the process, from recognizing cues to evaluating outcomes.
• Clinical Safety and Procedures (QSEN) align with the Quality and Safety Education for Nursing competencies by providing detailed explanations of safety protocols and procedures specific to medical-surgical nursing. This feature emphasizes the importance of patient safety and quality care and offers checklists, step-by-step, or tips on various safety practices.
• Cultural Context boxes explore the impact of cultural factors on nursing procedures and practices. Some features describe care provided in other countries, while other features discuss cultural considerations for patients in the United States. Cultural Context boxes encourage students to approach each patient individually, respecting their culture and values.
• Life-Stage Context features describe topics that are affected by a patient’s age. Age-related topics allow the students to critically think about what influences certain conditions and the specific considerations needed for patients at different life stages.
• Link to Learning features provide a very brief introduction to online resources—videos, interactives, collections, maps, and other engaging resources that are pertinent to students’ exploration of the topic at hand.
• Interdisciplinary Point of Care features highlight the collaborative nature of modern health care by identifying the plan of care from various disciplines, including physical therapy, occupational therapy, social work, nutrition, pharmacy, case management, and respiratory therapy. These features help students appreciate the interdisciplinary approach to patient care, emphasizing the importance of teamwork in achieving optimal patient outcomes.
• Read the EHR boxes present students with real electronic health record (EHR) data, such as lab results, progress notes, or vital signs, for a specific patient. Each feature includes critical-thinking questions that challenge students to analyze the data, identify concerning information, determine expected findings, and question any anomalies. This exercise helps students develop the skills necessary for effective EHR utilization in clinical practice.
• Real RN Stories feature firsthand accounts from registered nurses in the field. These stories help students make connections to topics on a deeper level.
• Unfolding Case Studies present a hypothetical client scenario that unfolds in three parts across chapters, with each subsequent part presenting new information on the same client, to help foster clinical judgment. In each part of an unfolding case feature, the scenario is followed by two questions that require students to apply their knowledge of evidence-based care and allow them to practice with questions that mimic the style of Next-Gen NCLEX. The answers to these questions, with explanations, are included in the Answer Key for students at the end of the book.

Pedagogical Features

To support student learning, Medical-Surgical Nursing includes the following standard elements:

• Learning Outcomes: Every chapter section begins with a set of clear and concise student learning outcomes. These outcomes are designed to help the instructor decide what content to include or assign and can guide students on what they can expect to learn and be assessed on.
• Assessments: A variety of assessments allow instructors to confirm core conceptual learning, elicit brief explanations that demonstrate student understanding, and offer more in-depth assignments that enable learners to dive more deeply into a topic or history-study skill.
  • Review Questions test for conceptual apprehension of key concepts.
  • Check Your Understanding Questions require students to explain concepts in their own words.
  • Reflection Questions and Competency-Based Assessment Questions dive deeply into the material to support longer reflection, group discussion, or written assignments.
  • What Should the Nurse Do? and Critical Thinking About Case Study Questions assess students’ clinical judgment skills using case-based scenarios. Students review either a single case or an unfolding case that reveals information gradually. In response to their observations of the patient, students must decide how to navigate the Clinical Judgment Measurement Model process. This approach challenges them to apply theoretical knowledge to practical situations, determining the most appropriate interventions based on the patient’s specific circumstances.
• Answers to Questions in the Book: The assessments are intended for homework assignments or classroom discussion; thus, student-facing answers are not provided in the book. Answers and sample answers are provided in the Instructor Answer Guide for instructors to share with students at their discretion, as is standard for such resources.
• Chapter Summary: Chapter summaries assist both students and instructors by outlining the primary subtopics addressed within the chapter.
• Key Terms: Key terms are presented in bold text and are followed by an explanation in context. Definitions of key terms are also listed in the end-of-chapter glossary.
• References: References are listed at the end of each chapter.

Senior Contributing Authors

Senior contributing authors (left to right): Christy Bowen, Bridget Carey, Jessica Palozie, Maren M. Reinholdt

Christy Bowen, Chamberlain University. Dr. Christy Bowen DNP, RN serves as the Dean of Academic Affairs for Chamberlain University’s BSN-Online. Dr. Bowen holds an ASN from Excelsior University, a BSN in Nursing and MSN in Nursing Education with a focus in Curriculum Development and Revision from Western Governor’s University, and a Doctor in Nursing Practice in Nursing Leadership and Management from Capella University. Dr. Bowen has been a nurse for more than 20 years and is certified in the specialty of Critical Care nursing, and Wound Care. In her clinical practice she held roles such as Department Chair, Unit Educator, and Lead Nurse. In her Academia role, she has served as Lead Instructor, Curriculum Chair, Program Coordinator, Program Director, and Associate Dean of Faculty. Dr. Bowen has taught courses throughout all levels of nursing education such as associate, bachelor, master, and doctoral level programs. She enjoys teaching both clinical and didactic learning for nursing students. Dr. Bowen served as a key member of the curriculum team to develop a Concept-Based Curricula as part of the Texas Nursing Concept-Based Curriculum (TxNCBC) project; develop a standardized concept-based curriculum for the state of Texas. She has led over 50 Workshops as part of the Implementation and Customization service for schools across the US transitioning to Concept-based Nursing. She developed over 20 Board of Nursing Continuing Education (CE) Certified Workshops and presented as Keynote speaker for all workshops to Universities and Colleges across the US. Throughout Dr Bowens career she has received many prestigious awards including Nurse of the Year, Clinical Nurse Leader of the Year, Employee of the Year, Top Requested Nursing Education Consultant (NEC), Phi Theta Kapa Faculty Member of the Year, and Presidential Award Outstanding Faculty Service.

Bridget Carey MSN, RN, CWCN, LNC is an esteemed nurse leader and educator with over 15 years of clinical and academic experience. She holds a Bachelor of Science in Nursing (BSN) from Gwynedd Mercy University, a Master of Science in Nursing (MSN) with a focus on Nursing Education and Curriculum Development from Western Governor's University, and is a Board Certified Wound Care Nurse via graduate of the Rutgers School of Nursing's Wound Ostomy and Continence program. Bridget served as didactic and clinical adjunct faculty for the BSN-Express program at Holy Family University. Bridget is a published Medical Writer and Legal Nurse Consultant with a passion for advancing the field through evidence-based practice, innovative teaching methods, and elevating patient stories to foster systemic improvements. With experience as an active clinician and working across the continuum of health care, Bridget continues to weld the art and science of nursing by serving patients and providers from the classroom to bedside and boardrooms. She has reviewed and authored nursing curricula and clinical practice support with Wolters Kluwer/Lippincott, EBSCO and Dynamic Health, The Journal of Visualized Experiments (JOVE), HealthStream and Relias. She has authored, reviewed, and published several Continued Education courses for health-care providers, including a Wound Care 101 course with Texas Tech University.

Jessica Palozie, University of Connecticut. Dr. Jessica Palozie DNP, APRN, ACNP-BC, CNE has been an educator and practicing clinician for over a decade, specializing in acute care nursing with a focus on BSN and APRN students. As an Assistant Clinical Professor, she is deeply committed to the teaching philosophies of Benner and Bandura, tailoring education to meet the unique learning needs of her students. Dr. Palozie emphasizes the importance of leading by example and instilling confidence in student nurses, fostering both skills and knowledge essential for navigating today's complex health-care environment. A graduate of the University of Connecticut’s Doctor of Nursing Practice (DNP) program, Dr. Palozie’s academic journey also includes a Master of Science in Nursing (MSN) from UConn, a Post Master’s Certificate in Nursing Education from the University of Hartford, and a Bachelor of Science in Nursing (BSN) from Hartwick College. Her clinical interests include cardiology, women’s health with a focus on infertility, and the integration of evidence-based practice (EBP) into clinical thinking. Dr. Palozie’s research explores the adoption of EBP beliefs and attitudes among associate-prepared nurses, with a vision to increase the utilization of EBP guidelines in clinical practice. Dr. Palozie’s dedication to education and research has been recognized through several prestigious awards, including the April 2018 Merit Faculty Award for her innovative integration of historical Hartford landmarks into nursing education and the October 2018 21st Century Grant for curriculum development. Her contributions continue to shape the future of nursing education and practice.

Maren M. Reinholdt, University of Rochester School of Nursing. Maren M. Reinholdt PhD, MSN, RN, CNE is an experienced educator of traditional, second degree/accelerated, and masters pre-licensure nursing students. She holds a BSN from Johns Hopkins University, a MSN in Nursing Education from Gonzaga University, a PhD in Nursing from Indiana University of Pennsylvania, and a BA in English, Theatre, and Secondary Education from Albright College. She has spent most of her time in clinical care in adult inpatient neurology and neurosurgery. She has coordinated and taught in-person and online in the didactic, laboratory, simulation, and clinical settings for Adult Health/Medical-Surgical Nursing, Child Health, Pathophysiology and Pharmacology, and Writing for Nursing courses. Dr. Reinholdt is a member of NLN, is a Certified Nurse Educator®, and a member of Sigma, International. Heather Moore, Xavier University.

Contributing Authors

Valerie Baker, Gannon University
Mary Anne Bera
Beverly Brown, Professional Consultants Without Walls
Catherine Cantrell, Higher Learning Technologies
Lindsay L. Draper, University of North Carolina Greensboro
Alissa Hershberger, University of Central Missouri
Stefanie Hoffman, Chamberlain University
Lori Greenhill, Christ Community Health Services
Tracey Long, Roseman University
Amanda Marten
Brandy McGhee, Marshall University
Taylor Mullin, The Ohio State University
Kate Roche, Dartmouth Hitchcock Medical Center

Reviewers

Taranee Albert, Northwestern Medicine
Kelly Coloff
Barbara Dewhirst, UPMC Passavant
Diane Glowacki, Clinical Nurse Specialist
Leigh Goldstein, The University of Texas at Austin
Susan Griffitts
Victoria Haynes, MidAmerica Nazarene University
Melissa Hollis, Baylor University
Veronica Hughes, Concordia University Texas
Christopher Jackson, South College
Monica Johnson, University of Holy Cross
Melissa Massey, Chamberlain University
Jenna Mendoza
Alexandra Patten, Columbia University
Jenna Reyes, Azusa Pacific University
Ansu Sebastian, Chamberlain University
Julie Thomison, Baylor University
Leigh A. Waldron, Western Governors University
Natasha Wylie, Boehringer Ingelheim
Joan Yankalunas, Lehigh Valley Health Network

Student and Instructor Resources

We have compiled additional resources for both students and instructors, including Getting Started Guides, an instructor’s answer guide, test bank, and image slides. Instructor resources require a verified instructor account, which you can apply for when you log in or create your account on OpenStax.org. Take advantage of these resources to supplement your OpenStax book.

Instructor’s answer guide. Each component of the instructor’s guide is designed to provide maximum guidance for delivering the content in an interesting and dynamic manner.

Test bank. With more than 1,100 assessments, instructors can customize tests to support a variety of course objectives. The test bank includes review questions (multiple-choice, identification, fill-in-the-blank, true/false), short answer questions, and long answer questions to assess students on a variety of levels. The test bank is available in Word format.

PowerPoint lecture slides. The PowerPoint slides provide learning objectives, images and descriptions, feature focuses, and discussion questions as a starting place for instructors to build their lectures.

Academic Integrity

Academic integrity builds trust, understanding, equity, and genuine learning. While students may encounter significant challenges in their courses and their lives, doing their own work and maintaining a high degree of authenticity will result in meaningful outcomes that will extend far beyond their college career. Faculty, administrators, resource providers, and students should work together to maintain a fair and positive experience.

We realize that students benefit when academic integrity ground rules are established early in the course. To that end, OpenStax has created an interactive to aid with academic integrity discussions in your course.

Visit our academic integrity slider. Click and drag icons along the continuum to align these practices with your institution and course policies. You may then include the graphic on your syllabus, present it in your first course meeting, or create a handout for students. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

At OpenStax we are also developing resources supporting authentic learning experiences and assessment. Please visit this book’s page for updates. For an in-depth review of academic integrity strategies, we highly recommend visiting the International Center of Academic Integrity (ICAI) website at https://academicintegrity.org/.

Community Hubs

OpenStax partners with the Institute for the Study of Knowledge Management in Education (ISKME) to offer Community Hubs on OER Commons—a platform for instructors to share community-created resources that support OpenStax books, free of charge. Through our Community Hubs, instructors can upload their own materials or download resources to use in their own courses, including additional ancillaries, teaching material, multimedia, and relevant course content. We encourage instructors to join the hubs for the subjects most relevant to your teaching and research as an opportunity both to enrich your courses and to engage with other faculty. To reach the Community Hubs, visit www.oercommons.org/hubs/openstax.

Technology partners

As allies in making high-quality learning materials accessible, our technology partners offer optional low-cost tools that are integrated with OpenStax books. To access the technology options for your text, visit your book page on OpenStax.org.

Special Thanks

The Division of Digital Learning at the Texas Higher Education Coordinating Board (THECB) has a history of dedicated research initiatives, services, and programs that have advanced open education in Texas by providing support, advocacy, and resources to Texas institutions in their OER efforts. The Division maintains a diverse OER portfolio including OERTX, a digital library and community space for open education work. The leadership and collaboration of the Division of Digital Learning staff made the OER Nursing Essentials (ONE) project possible, throughout research, planning, and development phases of the eight-textbook series.

This work was supported in whole or in part by the THECB. The opinions and conclusions expressed in this document are those of the author(s) and do not necessarily represent the opinions or policies of the THECB.