Nursing: Priority, Safety and Applied Care
Nursing (domain focus)
The Nursing paper for OSSSC Staff Nurse is applied rather than purely factual: questions place you in a ward, PHC or delivery room and ask what you would do first, what is safe, or which finding matters most. High-yield areas are the nursing process, vital signs, medication administration, asepsis, fluid balance, immunisation and maternal-newborn care.
Core rules
- The nursing process runs Assessment → Nursing diagnosis → Planning → Implementation → Evaluation. Assessment always precedes intervention.
- Prioritise by ABC: Airway, Breathing, Circulation, then Disability and Exposure. A drowsy patient with noisy breathing needs airway opening before analgesia or documentation.
- Medication rights: right patient, drug, dose, route, time and documentation; confirm identity using two identifiers, and double-check high-alert drugs such as insulin and potassium.
- Standard precautions apply to every patient: hand hygiene before and after contact, gloves for body fluids, and sterile technique for invasive procedures.
- Childhood diarrhoea: ORS after every loose stool and zinc for 10–14 days; antibiotics are not routine.
Worked example
A 60-year-old returns from surgery drowsy, with stridor and SpO₂ 88%. Four orders await: pain score, antibiotics, oxygen, dressing change. Reasoning: stridor indicates upper-airway obstruction and hypoxaemia; airway and breathing outrank pain and infection. Reposition, call for help, prepare suction and oxygen, then reassess. Only after stabilisation do you complete the pain assessment and scheduled care.
Traps
Giving oral ORS to an unconscious child; using alcohol rub when hands are visibly soiled; recording a temperature without noting the site; confusing paediatric normal ranges with adult ones; and choosing “complete the antibiotic” over immediate airway support in an emergency.