Medical-Surgical Nursing
The Medical-Surgical Nursing domain tests your ability to manage adults with common medical and surgical conditions, prioritise competing needs and recognise deterioration early. Egyptian items often use locally prevalent chronic disease - hepatitis C cirrhosis, rheumatic heart disease, diabetes, chronic kidney disease and COPD - so link pathophysiology to the action you choose.
Prioritisation frameworks
Use ABC (airway, breathing, circulation) before Maslow, and unstable before stable, acute before chronic. Ask which finding will harm the patient first: a new oxygen saturation of 86% outranks chronic pain scored 8/10.
Fluid and electrolyte red flags
- Hyperkalaemia: peaked T waves, widened QRS, weakness. Protect the myocardium first with IV calcium gluconate, then shift potassium intracellularly (insulin with dextrose, nebulised salbutamol) and remove it (dialysis, binders).
- Hypokalaemia: U waves, ileus, arrhythmia. Replace by slow IV infusion, never a bolus.
- Hyponatraemia: confusion and seizures when severe; correct slowly (no more than 8–10 mmol/L per 24 hours) to avoid osmotic demyelination.
- Third-spacing after major surgery: tachycardia, oliguria and falling BP despite oedema.
Perioperative essentials
Pre-op: consent, fasting, site marking, allergy and anticoagulant review. Post-op: airway, opioid-related respiratory depression, wound, urine output of at least 0.5 mL/kg/h, early ambulation, VTE prophylaxis. Sudden calf pain with breathlessness after hip surgery suggests DVT with pulmonary embolism - give oxygen, monitor and escalate.
Chronic disease anchors
Diabetes: hypoglycaemia (sweating, tremor, confusion) is treated with 15–20 g fast-acting carbohydrate if the patient is conscious. Heart failure: weigh daily, report a 2 kg gain in three days, sit upright, avoid NSAIDs. Cirrhosis: watch for ascites, hepatic encephalopathy (treated with lactulose) and variceal bleeding.
Worked example
A man with CKD stage 4 has potassium 6.9 mmol/L, a widened QRS and BP 100/60 mmHg. What comes first? Reasoning: the ECG change means the heart is at risk of ventricular fibrillation. Give IV calcium gluconate first for membrane stabilisation, then an insulin–dextrose infusion, then arrange urgent dialysis. A potassium binder alone is wrong because it works over hours; documenting and rechecking in an hour are unsafe delays.
Traps that cost marks
- Treating the number rather than the patient's stability.
- Bolusing potassium chloride intravenously.
- Confusing DKA (ketones, acidosis, potassium often normal or high) with hyperosmolar hyperglycaemic state.
- Forgetting anticoagulant reversal before surgery.