Medical-Surgical Nursing: The Basics

Med/Surg is like the meat and potatoes of nursing, with Foundations being the dinner plate and Assessment being the mashed potatoes. It’s important to get a grasp of the general med/surg content, concentrating on:

  • pathophysiology of certain conditions and clinical manifestations
  • nursing interventions R/T the pathophys
  • related medications and treatment options
  • patient teaching

The Lewis textbook does a great job of organizing the content in a comprehensive and flowing manner. The chapters begin with basic pathophys related to a certain disease process followed by clinical manifestations. By now, much of the terminology used should be familiar post-Foundations. It’s important to differentiate specific clinical manifestations with a specific disease, because there are quite a few that overlap with other conditions. For example, nausea and vomiting may be a common symptom amongst several GI conditions, but a symptom like pain relieved by food is more specific to duodenal ulcers (as opposed to gastric ulcers).

Once you’re familiar with the clinical manifestations of the disease, relevant diagnoses and outcomes are important to address those symptoms. It’s also important to recognize what symptom that diagnosis addresses and if they match. For example, the diagnosis Ineffective airway clearance is more relevant to excess mucus in the airway as opposed to Ineffective breathing pattern which is more relevant to labored breathing. Remember, as nurses we don’t necessarily treat the disease, rather we treat the symptoms.

Following that, knowing the role of the nurse and responsibilities in the collaborative care is critical. A simple way to study for this is by linking the pathophy with the clinical manifestations and then link that to a specific nursing intervention. For example, a patient with COPD often displays dyspnea (difficulty breathing). The pathophysiology behind that is chronic inflammation of the airway and excess mucus. As a nurse, what are some interventions you can do? Let’s start with the obvious – oxygen. Assuming there is a standing order, the nurse would apply oxygen to the patient (FYI: patients with COPD should never be given oxygen more than 2-3 liters/minute as it may cause them to stop breathing!). Alright, so give the patient oxygen, what else is relevant? How about raising the head of the bed to allow for the lungs to expand? Often times a test question will ask for a priority intervention. In this case, what is the one action that the nurse can do immediately? It usually would be raising the head of the bed. Once envision in your mind yourself as the nurse caring for this patient, it may help facilitate the way you study for this course.

In addition, patient teaching is important. What does the patient need to know about self care before he or she is discharged? Using the above COPD example, I could teach the patient to take his/her medications regularly, turn/cough/deep breathe to facilitate lung clearance and pursed-lip breathing to prevent air trapping.

The exams for Med/Surg focus mainly on nursing care with some assessment and patient teaching. When reading the question, picture that patient in your mind. It’s important to differentiate real world from NCLEX world. Often times, these questions are in a setting where you have as much time as you have and can only do one thing in the room before leaving. Remember to identify positive from negative questions, as well as priority questions. What can the nurse do immediately? Before I call the doctor, what information have I gathered? If the question does not have any assessment findings/information in the root of the question, usually you would need to assess first.

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