Medical-surgical nursing
Medical-surgical nursing tests chronic disease monitoring, postoperative recovery and the recognition of complications. Questions usually give a set of observations or laboratory values and ask which finding is most concerning or what the nurse does first.
Chronic disease monitoring
- Heart failure: daily weight (report a gain over 1 kg in a day or 2.5 kg in a week), fluid balance, electrolytes, and BNP where used. Teach early warning signs.
- COPD: target oxygen saturation 88-92% in known CO2 retainers, using controlled oxygen and blood gases rather than high-flow oxygen by habit.
- Chronic kidney disease: monitor eGFR, potassium, bicarbonate and fluid status; adjust renally cleared drugs.
- Diabetes: individualised HbA1c target, usually around 7% for many adults; check feet and injection sites.
Postoperative priorities
Airway and breathing first, then pain, wound and drains, temperature, urine output, nausea, early mobilisation, VTE prophylaxis and return of bowel function. Typical timelines matter: afebrile within 48-72 hours, first flatus within 3-4 days after abdominal surgery.
Reference values worth knowing
Potassium 3.5-5.0 mmol/L, sodium 135-145 mmol/L, therapeutic INR 2-3 for atrial fibrillation and most VTE indications.
Worked example
Postoperative day 2 after hemicolectomy: HR 118/min, BP 100/60 mmHg, RR 26/min, temperature 38.6 C, SpO2 92% on air, urine 15 mL/h. Reasoning: tachycardia plus fever plus hypoxia plus oliguria points to a systemic complication (atelectasis, pneumonia, sepsis, anastomotic leak, pulmonary embolism) rather than isolated pain. The nurse applies ABCDE, sits the patient up, gives oxygen to target, obtains cultures and lactate as ordered, starts the sepsis pathway and escalates urgently. Attributing the tachycardia to pain alone is the classic error.
Traps that cost marks
Treating one abnormal observation in isolation; ignoring urine output; enteral feeding a patient with absent bowel sounds and a distended abdomen.