🏥 New Lesson 22
Medical-Surgical Nursing Overview
Acute and chronic conditions, post-op care, common adult illnesses, systems-based nursing approach.
Systems Approach
Medical-Surgical Systems-Based Approach
🏥
Med-Surg is the largest portion of LPN education — and the largest portion of NCLEX-PN. The key is to organize what you know BY BODY SYSTEM and always ask: what is failing, what is compensating, and what does the nurse do?
| System | Priority Assessment | Common Nursing Interventions |
|---|---|---|
| Cardiac | VS, O2 sat, pain, edema, jugular veins | O2, IV access, ECG, medications, fluid management |
| Respiratory | RR, SpO2, breath sounds, work of breathing | Position, O2, breathing exercises, airway clearance |
| Neurological | LOC, pupils, FAST, GCS, movement | Safety, neuro checks, seizure precautions |
| Renal | I&O, weight, edema, BUN/creatinine | Fluid/diet restrictions, dialysis care, medication adjustment |
| GI | Bowel sounds, abdomen assessment, stool | NPO if acute, tube feeding if indicated, stoma care |
| Endocrine | Blood glucose, vital signs, mental status | Glucose monitoring, insulin, electrolyte replacement |
Common Conditions
High-Yield Common Med-Surg Conditions
| Condition | Priority Sign | Priority Nursing Action |
|---|---|---|
| Sepsis | Fever/hypothermia + tachy + altered LOC | Blood cultures BEFORE antibiotics, IV fluids, O2 |
| DVT | Unilateral leg pain, warmth, swelling | Do NOT massage. Anticoagulation, monitor for PE |
| Pulmonary Embolism | Sudden SOB, chest pain, tachycardia | O2, IV access, anticoagulation, notify immediately |
| Hypertensive Crisis | BP >180/120 + end-organ symptoms | IV antihypertensives, neuro checks, limit activity |
| Acute Abdomen | Rigid abdomen, rebound tenderness, absent BS | NPO, IV access, analgesics, surgical consult |
| Bowel Obstruction | Absent BS, distension, obstipation | NPO, NG tube, IV fluids, assess for surgical need |
| ARDS | Refractory hypoxia, bilateral infiltrates | Prone positioning, mechanical ventilation support |
Post-Op Essentials
Post-Operative Essentials
1️⃣
First post-op priority: ABCs — Airway, Breathing, Circulation. Always before pain assessment, incision check, or anything else.
| Post-Op Timeline | Priority Concern | Nursing Focus |
|---|---|---|
| 0–24 hours | Atelectasis (most common early fever) | Deep breathing, incentive spirometry, early mobility |
| 24–72 hours | UTI, wound complication beginning | Catheter care, incision assessment, fluid balance |
| 72 hours – 5 days | Wound infection (SSI) | Daily wound assessment, temperature monitoring |
| 5–7 days | DVT, pulmonary embolism risk | Ambulation, SCD devices, anticoagulation |
⚠️
Post-op fever mnemonic (5 Ws): Wind (atelectasis) → Water (UTI) → Wound (infection) → Walking (DVT) → Wonder drugs (drug fever). Time determines most likely cause.
Chronic Disease Management
Chronic Disease Management Principles
| Chronic Condition | Patient Teaching Priority | Key Monitoring |
|---|---|---|
| Heart Failure | Daily weight (2 lb gain = call provider), fluid restriction, sodium restriction | Daily weight, edema, dyspnea, I&O |
| COPD | Pursed-lip breathing, energy conservation, smoking cessation, rescue inhaler use | SpO2, RR, ABGs, use of accessory muscles |
| Diabetes (Type 2) | Consistent diet, glucose monitoring, foot care, sick-day rules, medication adherence | Fasting glucose, A1C, foot assessment, renal function |
| Hypertension | DASH diet, sodium restriction, medication adherence, home BP monitoring | BP logs, medication effects, end-organ signs |
| CKD | Dietary restrictions (K+, phosphorus, protein, fluid), medication adjustments | BUN, creatinine, GFR, electrolytes, weight |
📖 Study Notes
🏥
Med-Surg study strategy: Learn by SYSTEM, not by disease name. Once you know what a failing cardiac system looks like (decreased perfusion, fluid backup, low CO), you can handle any specific cardiac disease.
💡
Post-op 5 Ws: Wind (0–24 hr), Water (24–72 hr), Wound (3–5 days), Walking (5–7 days), Wonder drugs (any time). Timing identifies the most likely complication.
⭐
Sepsis early signs: Temperature change (fever OR hypothermia), increased HR, increased RR, and altered mental status. Sepsis = 3 of these + suspected infection source.