Medical-Surgical Nursing
What this domain tests
Adult assessment and management: cardiovascular, respiratory, endocrine, renal, neurological, gastrointestinal, oncology and perioperative care. NORCET favours priority action, monitoring and complication recognition.
Core rules
- Acute MI: 12-lead ECG within 10 minutes; aspirin chewed; troponin; oxygen only if SpO2 <90% or per local protocol; nitroglycerin is contraindicated with sildenafil or suspected right ventricular infarction.
- Heart failure: left failure causes dyspnea, orthopnea and pulmonary edema; right failure causes raised JVP, hepatomegaly and peripheral edema. Daily weight is more useful than intake-output alone.
- COPD: target SpO2 88–92% in patients at risk of CO2 retention; pursed-lip breathing prolongs expiration.
- DKA: hyperglycemia, ketones, anion-gap metabolic acidosis and Kussmaul breathing; give fluids and insulin, but check potassium before insulin if K is low.
- Stroke: thrombolysis window generally up to 4.5 hours; check glucose and keep nil by mouth until swallow screen.
- Postoperative: early ambulation, incentive spirometry, wound assessment and DVT prophylaxis.
Worked example
ABG: pH 7.30, PaCO2 50 mmHg, HCO3 26 mEq/L. pH is acidemic. PaCO2 is raised and explains the acidosis; HCO3 is normal, so there is no metabolic compensation. Interpretation: acute respiratory acidosis. If HCO3 were 30 with a normal pH, it would suggest compensated respiratory acidosis.
Traps
Calling any low pH 'metabolic acidosis' without checking PaCO2; giving high-flow oxygen to a CO2 retainer; forgetting potassium in DKA; giving nitroglycerin after a phosphodiesterase-5 inhibitor; and treating a high troponin as automatically diagnostic without clinical context.