Medical-Surgical Nursing
Medical-Surgical Nursing
This domain tests assessment and management of adult medical and surgical conditions: cardiovascular, respiratory, endocrine, renal, gastrointestinal, musculoskeletal, fluid–electrolyte balance and perioperative care. Expect priority-setting and interpretation questions.
Core rules
- Myocardial infarction: MONA - morphine, oxygen only if hypoxic, nitrates and aspirin; troponin rises and ECG shows ST changes. Avoid nitrates in right ventricular infarction or hypotension.
- Hypoglycaemia is glucose below 70 mg/dL with sweating, tremor and confusion; give oral glucose if conscious, IV dextrose if not.
- Diabetic ketoacidosis: glucose above 250 mg/dL, ketones, pH below 7.30 and potassium shifts. HHS shows glucose above 600 mg/dL, high osmolality and minimal ketones.
- COPD: controlled low-flow oxygen 1–2 L/min targeting SpO2 88–92%; teach purse-lip breathing.
- Fluids: 0.9% NaCl is isotonic, 0.45% hypotonic, 3% hypertonic; watch for overload - crackles, raised JVP, weight gain.
- Post-operative atelectasis is the commonest pulmonary complication; deep breathing and early ambulation prevent it.
Worked example
ABG: pH 7.28, PaCO2 55 mmHg, HCO3 26 mEq/L. Low pH means acidaemia; high CO2 points to a respiratory cause; normal bicarbonate means no metabolic compensation yet. Answer: uncompensated respiratory acidosis.
Traps
- Regular insulin peaks in 2–3 hours; glargine has no peak and is never mixed.
- Insulin drives potassium into cells, so DKA potassium can fall during treatment.
- Do not give potassium IV push; always dilute and infuse.