Medical-Surgical Nursing and Adult Health
Assessment first, always
Adult health items reward a systematic ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure). Know adult norms: pulse 60–100/min, respirations 12–20/min, BP below 120/80 mmHg, temperature 36.5–37.5 °C, SpO₂ 95% or above, urine output at least 0.5 mL/kg/hour.
Body systems and the numbers examiners test
Fluids and electrolytes: sodium 135–145, potassium 3.5–5.0, chloride 95–107, bicarbonate 22–26 mmol/L; know the signs of hypokalaemia (weakness, ileus, dysrhythmia) and hyperkalaemia (peaked T waves). Acid–base: respiratory disorders change CO₂, metabolic disorders change bicarbonate, and compensation moves the other value in the same direction as the primary disorder. Diabetes: DKA gives ketosis, Kussmaul breathing and abdominal pain; hyperosmolar hyperglycaemic state gives profound dehydration and high osmolality without significant ketones. Stroke: use FAST. Burns: the Parkland formula. Shock: recognize tachycardia, cool clammy skin, falling urine output and confusion early.
Traps
Treat hypoglycaemia before hunting for a cause; never give oral fluids to an unconscious patient. Confusing left- and right-sided heart failure signs. Forgetting that analgesia and early mobilisation prevent post-operative complications. Misreading a low haemoglobin as the only sign of bleeding - look at pulse and BP first.
Worked example
Parkland formula: 4 mL × body weight (kg) × %TBSA, half in the first 8 hours from the time of the burn, the remainder over 16 hours. For 60 kg with 30% TBSA: 4 × 60 × 30 = 7200 mL in 24 hours - 3600 mL in 8 hours, then 3600 mL in 16 hours. Titrate to urine output of 0.5–1 mL/kg/hour.