Internal Medicine Nursing (Adult Medical Nursing)
This domain tests safe management of common adult medical conditions and their acute complications: heart failure, COPD, diabetes, renal failure, electrolyte disorders, anemia, and infection, including atypical presentations in older adults.
Core rules
- Begin every deterioration with ABCDE and a full set of vital signs; interpret trends rather than a single value.
- In COPD, titrate oxygen to 88–92% and check blood gas if the patient is drowsy or acidotic; uncontrolled high-flow oxygen can worsen hypercapnia.
- Heart failure: daily weight, strict fluid balance, and assessment of orthopnea, crackles, edema, and renal function before adding fluids.
- Hypoglycemia is an emergency: check glucose, give fast-acting carbohydrate or IV glucose, recheck, then provide complex carbohydrate.
- Renal failure: review potassium, creatinine, and all renally cleared drugs; treat hyperkalemia with ECG monitoring.
- Anemia and infection may present as falls, confusion, or functional decline in older adults.
Worked example
A 72-year-old with COPD arrives confused, respiratory rate 28, SpO2 84% on room air. Do not give high-flow oxygen or attribute the confusion to dementia. Start controlled oxygen to a target of 88–92%, obtain an arterial blood gas, and treat the exacerbation with inhaled bronchodilators, systemic corticosteroids, and antibiotics if criteria are met. Reassess work of breathing and consider non-invasive ventilation if acidosis persists. Reason: the patient is at risk of acute hypercapnic respiratory failure, and over-oxygenation can suppress hypoxic drive and worsen CO2 retention.
Traps
- Assuming “more oxygen is always better” in COPD.
- Missing a silent myocardial infarction in a diabetic or older patient.
- Blaming confusion on age instead of checking glucose, oxygen, infection, and drugs.