Adult Health and Medical-Surgical Nursing
This domain tests assessment and management of common adult medical and surgical conditions, including deterioration, postoperative care, chronic disease and device management. Prioritisation is central.
Core rules and concepts
- ABCDE primary survey: airway, breathing, circulation, disability, exposure; use early-warning scores to escalate.
- Postoperative complications: atelectasis, haemorrhage, deep vein thrombosis, infection, paralytic ileus and wound dehiscence. Early ambulation and incentive spirometry reduce risk.
- Heart failure: left-sided failure causes pulmonary oedema with crackles, orthopnoea and frothy sputum; right-sided failure causes peripheral oedema, raised jugular venous pressure and hepatomegaly.
- COPD: titrate oxygen to 88–92% in patients at risk of carbon dioxide retention; teach pursed-lip breathing and smoking cessation.
- Diabetes emergencies: diabetic ketoacidosis shows glucose above 250 mg/dL, ketones and acidosis with Kussmaul breathing; hyperosmolar hyperglycaemic state shows very high glucose, high osmolality and no significant ketones.
- Chest drains: keep below chest level, never clamp without an order, and expect tidaling.
Worked example
A patient with COPD has SpO2 84%, confusion and a respiratory rate of 26/min. Give controlled oxygen to reach 88–92%, position upright, check blood gases and escalate. High-flow oxygen without a target risks worsening carbon dioxide retention and drowsiness.
Traps that cost marks
- Giving uncontrolled high-flow oxygen in COPD.
- Correcting sodium or glucose too rapidly.
- Forgetting to check potassium when treating diabetic ketoacidosis with insulin.
- Clamping a chest drain routinely.