Medical-Surgical Nursing
Medical-surgical nursing carries the heaviest question weight in the PGIMER Nursing Officer paper. Items test whether you can link a clinical finding to pathophysiology, pick the priority action, and anticipate a drug-nursing interaction across cardiology, respiratory, neurology, renal, endocrine and orthopaedic units.
Prioritisation rules
- Airway, breathing, circulation, neurological deficit, exposure. Stridor outranks a fractured tibia.
- Unstable beats stable, acute beats chronic, actual beats potential, unexpected beats expected.
High-yield specifics
- Acute coronary syndrome: oxygen only if SpO₂ is below 90%; aspirin 300 mg chewed; nitrates withheld in inferior or right ventricular infarction and within 24–48 hours of sildenafil or tadalafil.
- COPD: controlled oxygen 1–2 L/min to a target SpO₂ of 88–92%, watching for drowsiness and rising PaCO₂.
- Ischaemic stroke: alteplase window up to 4.5 hours; blood pressure kept below 185/110 mmHg before lysis; swallow screen before any oral intake.
- Chronic kidney disease: monitor potassium, watch for pericardial rub and uraemic encephalopathy; restrict potassium and phosphate.
Worked example
A 58-year-old has chest pain, ST elevation in leads II, III and aVF, hypotension and clear lung fields. Those leads localise an inferior infarct, and hypotension with clear lungs suggests right ventricular involvement. The right ventricle is preload dependent, so give a careful fluid bolus, avoid nitroglycerin and morphine-induced venodilation, and prepare for primary PCI. Reasoning: vasodilators that help anterior infarcts can cause collapse here.
Traps that cost marks
Giving oxygen to every chest-pain patient, calling stable angina an emergency, and forgetting that right-sided leads (V4R) are needed to confirm right ventricular infarction.