Medical-Surgical Nursing
Core concepts
Medical-surgical nursing tests assessment-to-intervention reasoning across body systems. Prioritize mastery of fluid and electrolyte balance (sodium, potassium, calcium, magnesium), acid-base interpretation (ABGs: pH, PaCO2, HCO3, and compensation), and perioperative care (pre-op teaching, post-op complications like atelectasis, DVT, hemorrhage, and infection). Know chronic disease management for diabetes (DKA vs. HHS, hypoglycemia protocol), heart failure (daily weights, fluid restriction, signs of exacerbation), COPD (pursed-lip breathing, low-flow oxygen), and renal disease (fistula care, potassium restriction). Wound care, ostomy management, and mobility/immobility complications (pressure injury, pneumonia, constipation) are recurring themes.
Traps in questions
Questions often test priority and delegation. Use ABCs and Maslow: airway and breathing before circulation, and unstable patients before stable ones. A classic trap is oxygen for COPD-remember hypoxic drive is largely a myth in practice; titrate to target saturation rather than withholding oxygen. Another trap: confusing DKA (ketosis, Kussmaul respirations, anion gap) with HHS (severe hyperglycemia, profound dehydration, minimal ketosis). Electrolyte traps include ignoring that potassium shifts with insulin and that hypokalemia causes dysrhythmias and ileus.
Rule of thumb
Assess, then intervene, then evaluate. When asked what to do first for a deteriorating patient, choose the assessment or the most life-threatening correction (ABCs) over comfort measures or documentation.
Worked example
A post-op patient becomes short of breath with a low-grade fever on day 2. Think atelectasis or pneumonia: encourage coughing and deep breathing, incentive spirometry, and ambulation; escalate if oxygenation drops.