Medical-Surgical Nursing (Adult Health)
Domain 3 - Medical-Surgical Nursing (Adult Health)
This domain tests systematic adult assessment and the recognition and management of common medical-surgical conditions, reflecting Fiji's disease burden: type 2 diabetes, hypertension, rheumatic heart disease, tuberculosis, dengue, leptospirosis and typhoid. Expect questions giving a set of observations and asking for the priority action, most likely complication, or correct interpretation.
Core rules
- Assess in order: airway, breathing, circulation, neurology, then expose and examine. Trends matter more than single values.
- Hypoglycaemia (below 4 mmol/L) causes sweating, tremor, hunger, confusion and can mimic stroke. If conscious, give 15–20 g oral glucose and repeat in 15 minutes; if unconscious, give IV dextrose or IM glucagon and recheck.
- Hyperglycaemia with ketones, Kussmaul breathing and dehydration suggests diabetic ketoacidosis - IV fluids, insulin infusion, and potassium monitoring and replacement.
- Heart failure: look for orthopnoea, basal crackles, raised jugular venous pressure, oedema and weight gain. Nurse upright, record daily weight and fluid balance, and check the apical pulse before digoxin - withhold and report if below 60/min.
- Post-operative complications by timing: haemorrhage (day 0), atelectasis and chest infection (days 1–3), wound infection (days 4–7), dehiscence (days 6–8), deep vein thrombosis at any time. Tachycardia, oliguria and cool peripheries precede the fall in blood pressure.
- Never give potassium chloride by IV bolus; dilute, infuse by pump, and monitor cardiac rhythm.
- Tuberculosis: sputum collection, airborne precautions, directly observed therapy, contact tracing.
Worked example
A man is six hours after open cholecystectomy: pulse 118, BP 100/64 (was 128/78), respirations 24, urine 15 mL/hour for three hours, cool clammy skin, dressing dry. Reasoning: tachycardia, narrowing pulse pressure, oliguria and vasoconstriction indicate compensated hypovolaemia; concealed bleeding is likely. Actions: urgent surgical review, lie flat with legs elevated, oxygen, large-bore IV access, bloods including group and crossmatch, vital signs every 15 minutes, inspect wound and drains, keep nil by mouth, prepare for theatre. Do not simply raise the drip rate and wait.
Traps
- Calling new confusion in an older adult 'dementia' instead of hypoxia, sepsis or hypoglycaemia.
- Documenting 'chest clear' without auscultating.
- Bolus potassium or insulin without monitoring.
- Withholding analgesia in case it masks signs.
- Missing rheumatic heart disease as a cause of heart failure in a young adult.