Medical and Surgical Nursing Basics: Perioperative Care and Observation
What this domain tests
Basic care of common medical and surgical conditions, pre- and post-operative care, wound care, and fluid balance.
Core rules and concepts
- Pre-operative: consent, fasting, baseline observations, remove jewellery/dentures, mark the site, check allergies.
- Post-operative: airway, breathing, circulation, pain, wound, drains, urine output, and early mobilisation.
- Wound healing: keep clean, change dressing using aseptic technique, note discharge, redness, swelling, and pain.
- Fluid balance: record intake and output; report urine output <0.5 mL/kg/hour for adults as oliguria.
- Deep vein thrombosis prevention: leg exercises, compression stockings, hydration, and early ambulation.
Worked example
On post-operative day 1 a patient has pulse 118/min, BP 96/60 mmHg, urine output 15 mL/hour, and dry mucous membranes. Reasoning: tachycardia, hypotension, low urine output, and dry mucosa suggest hypovolaemia, possibly from bleeding or inadequate intake. The nurse should check the wound and drains, report immediately, and prepare for fluid replacement. Do not simply document and wait.
Traps that cost marks
- Assuming all post-operative fever is infection on day 1; atelectasis is common.
- Measuring drain output without noting colour and amount.
- Giving oral fluids immediately after major surgery without an order.
- Ignoring urine output because BP is "only slightly low".