Medical-Surgical Nursing
This domain rewards pattern recognition across body systems. For each condition, know the pathophysiology in one line, the classic signs, the priority complication, and the key nursing action.
- Cardiac: Differentiate angina (relieved by rest/nitrates) from myocardial infarction (unrelieved, diaphoresis, nausea). In heart failure, teach daily weights, fluid/salt limits, and to report a 2–3 kg gain in a few days. Know digoxin toxicity signs (nausea, visual halos, bradycardia).
- Respiratory: Recognise early hypoxia (restlessness, confusion) before late signs (cyanosis). For COPD, low-flow oxygen with target saturations, not high-flow. Position for breathing: high Fowler's.
- Endocrine: Diabetic ketoacidosis (Kussmaul breathing, fruity breath, hyperglycaemia) versus hypoglycaemia (sweating, tremor, confusion) - treat hypoglycaemia immediately with fast-acting carbohydrate if conscious.
- Renal and fluid/electrolyte: Watch potassium in renal failure (peaked T waves) and post-operative fluid shifts.
- Neurological: Use FAST for stroke; time is brain. Keep the head midline and elevated for raised intracranial pressure.
Traps
- Distractors that are true statements but not the priority action.
- Confusing signs of hyper- with hypoglycaemia, or left- with right-sided heart failure (right: peripheral oedema, JVD; left: pulmonary oedema, dyspnoea).
- Choosing an intervention that requires a prescription when an independent nursing action is available.
Rule of thumb
For any deterioration, assess ABCs, position to protect the airway, apply oxygen if indicated, call for help early - escalate before you finish charting.