Medical-Surgical Nursing
Medical-Surgical Nursing is the largest clinical domain of this paper: assessment, monitoring, drug therapy and perioperative care for adult medical and surgical conditions.
Core rules
- Oxygen must be humidified at high flow; in COPD titrate to a target SpO₂ of 88–92% rather than withholding oxygen when the patient is hypoxic.
- Acute myocardial infarction: morphine, oxygen if hypoxic, nitrates, aspirin 300 mg chewed. Nitrates are contraindicated within 24–48 hours of sildenafil and in hypotension.
- Left heart failure gives pulmonary oedema, orthopnoea and basal crackles; right heart failure gives raised JVP, hepatomegaly and pedal oedema.
- Hypoglycaemia below 70 mg/dL: sweating, tremor, confusion. Give 15 g fast-acting oral carbohydrate if conscious; intravenous 25% dextrose if unconscious. Never give oral fluid to an unconscious patient.
- Post-operative care follows airway, vital signs, wound, drains, urine output, pain, early ambulation and thromboprophylaxis.
- A 1 kg change in body weight approximates 1 litre of fluid.
Worked example
A 58-year-old has central chest pain with ST elevation and a blood pressure of 100/60 mmHg. Aspirin and oxygen are given, but sublingual GTN is withheld. Reasoning: nitrates reduce preload and will worsen existing hypotension; the safe rule is not to give nitrates when systolic pressure is below about 90–100 mmHg.
Traps that cost marks
- Reversing left and right heart failure signs.
- Giving oral glucose to a drowsy hypoglycaemic patient.
- Forgetting that morphine can depress respiration and must be titrated.