Medical-Surgical Nursing
The Medical–Surgical domain tests whether you can assess an adult systematically, spot deterioration early, and deliver the monitoring and interventions that accompany the conditions most often managed in Cambodian provincial and referral hospitals: dengue, tuberculosis, typhoid, stroke, diabetes, cirrhosis, COPD and post-operative care.
Structure every assessment
Use ABCDE (airway, breathing, circulation, disability, exposure) before a systems review. Record vital signs with the trend, not as isolated values. A rising respiratory rate and falling urine output usually precede a fall in blood pressure.
Frequent conditions
- Dengue: monitor haematocrit and platelets during the critical phase around days 4–6 of illness; a rising haematocrit with falling platelets signals plasma leakage and shock. Give isotonic crystalloid, and avoid NSAIDs and intramuscular injections.
- Stroke: keep the patient nil by mouth until swallowing is screened, monitor blood pressure and glucose, protect the airway, and mobilise early once stable.
- Post-operative: assess wound, drain output, bowel sounds, pain score and deep-breathing exercises to prevent atelectasis.
Worked example
A 24-year-old man on day 5 of fever has temperature 38.5 °C, heart rate 118, BP 100/60, cold extremities, and haematocrit rising from 42% to 50%. Reasoning: the rising haematocrit with tachycardia and a narrow pulse pressure indicates dengue with compensated shock. Action: start intravenous Ringer's lactate, measure hourly urine output and vital signs, repeat the haematocrit and escalate to the doctor. Paracetamol relieves fever but does not replace fluid resuscitation.
Traps
Giving aspirin or ibuprofen in dengue; ignoring a rising respiratory rate because oxygen saturation still reads 95%; recording one blood pressure without the trend; assuming a young adult cannot be in shock.