Medical-Surgical and Chronic Care Nursing
Core concepts
Chronic care emphasizes self-management, adherence, exacerbation prevention, and complication screening. Know core management for heart failure (daily weights, fluid and sodium limits, signs of decompensation), diabetes (A1C targets, hypoglycemia recognition, sick-day rules), COPD (pursed-lip breathing, oxygen targets, action plans), chronic kidney disease (potassium, phosphorus, fluid balance), and hypertension. Postoperative care focuses on airway, breathing, circulation, pain, mobility, and infection surveillance.
Traps in questions
Questions reward early recognition of deterioration over waiting for a provider. Watch for subtle signs: a 2 kg weight gain in a week signals fluid retention before dyspnea appears; new confusion may signal infection or electrolyte imbalance. Another trap is choosing an intervention that is contraindicated, such as high-flow oxygen in a CO2 retainer without target ranges, or fluid boluses in decompensated heart failure.
Worked example
A patient with heart failure reports increased shortness of breath and a 3 kg weight gain over five days. Rule of thumb: this is volume overload; assess lung sounds, oxygenation, and edema, place upright, and escalate for diuretic adjustment. Do not treat it as expected aging or anxiety.
Study strategy
For each chronic condition, list the one early warning sign, the one monitoring parameter, and the one contraindicated action.