Medical-Surgical Nursing
Medical-Surgical Nursing carries the largest clinical weight: recognising deterioration, prioritising care and matching interventions to common adult conditions such as myocardial infarction, COPD, diabetes, stroke, chronic kidney disease and fractures.
Assessment and prioritisation
Use ABCDE: airway, breathing, circulation, disability, exposure. Unstable patients are seen before stable ones; actual problems before potential ones; acute before chronic. A falling level of consciousness, stridor, chest pain with sweating, or a systolic BP below 90 mmHg demands immediate action.
Condition-specific essentials
- Acute MI: aspirin 300 mg chewed, oxygen only if SpO2 below 94%, ECG within 10 minutes, morphine for pain; nitrates are avoided in right ventricular infarction and within 24–48 hours of sildenafil.
- Hypoglycaemia: glucose 15–20 g orally if conscious, IV dextrose if not; recheck in 15 minutes.
- COPD: controlled oxygen to a target saturation of 88–92% in those at risk of CO2 retention.
- Stroke: note time of onset, keep nil by mouth, CT to exclude haemorrhage before thrombolysis.
- CKD: monitor potassium and fluid balance; avoid potassium-sparing drugs and NSAIDs.
Worked example
Three patients call: one with crushing chest pain and sweating, one with a casted leg and itching, one requesting a laxative. First is the chest pain: airway and breathing are not yet compromised but circulation is at risk, and ECG and aspirin are time-critical. The itchy cast needs skin and circulation checks next; the laxative can wait.
Traps
Do not give oxygen routinely to every breathless patient; target saturation matters. Never label chest pain as indigestion without an ECG. Distinguish hypoglycaemia (sweating, tremor, confusion) from hyperglycaemia (thirst, polyuria, dehydration).