any tips for med-surg. clinical? confidence boosters?

Daytonite, BSN, RN · Jan 10, 2006

well, it's hard to say because med/surg has such a diversified patient census. i would say, definitely, read up on diabetes and testing blood sugar because it seems to me that there are more and more patients admitted these days who have diabetes as a secondary diagnosis. you just have to be aware of how it works and affects patients. after that, i think the greatest population of patients on med/surg are the older folks. we tend to see our share of elderly ladies with urosepsis, so you might want to review the signs and symptoms of infection, inflammation and sepsis. older patients tend to get admitted with sepsis a lot because their systems are just not as honed to reading the symptoms of an infection before it goes septic. many require a lot of assistance with adls as well, so basic nursing care is usually necessary. most patients these days will have iv access, so bone up on how iv's work as most will have either continuous iv fluids running or a heparin/saline lock for antibiotics. you may see a good number of patients with dehydration as a primary problem for admission although something else will often turn out to be the real reason causing the dehydration. so, review the physical signs and symptoms of dehydration, the lab tests that will be ordered and how you can tell from lab tests that dehydration is present. you'll see a lot of pneumonia or respiratory problems, particularly at this time of the year.

with regard to surgical patients, you always need to be aware of what the general complications of surgery are. know why ambulation as soon as possible is necessary. learn how to coach a patient to deep breath and cough. practice listening to breath sounds. review sterile dressing changes. again, surgical inpatients tend to have a lot of iv's and antibiotics.

here is a link to a website on everything you ever wanted to know about sepsis.

http://www.survivingsepsis.com/index.html - surviving sepsis, a web site about sepsis, signs and symptoms, common sources of sepsis, septic shock and treatment. links at the left side of the page take you to the various pages of this site. includes links for more information on sepsis, some of which are extensive sites by drug manufactures on the treatment of sepsis.

Spatialized · Jan 10, 2006

:yeahthat:

in addition...

know your labs (or at least have a handy cheat sheet) and what they mean, for example, elevated BUN & Creatinine usually signal renal failure, how high they are shows how bad the failure is.

review you simple hematology stuff, H & H, platelets, WBCs, etc. to see how the pts. body is responding to what is going on with them.

review your diabetes stuff, at least 75% of the people on our med-surg floors have diabetes as an overt or underlying disease process.

skin, skin, skin. always remember to look for breakdown, even in pts. who have only been there a day or two, it can creep up on you very fast.

Besides the studying part, remember that you're there to learn. Take every opportunity to learn something new, or see something cool. When I started my externship last summer, everyone on the floor knew and would come get me to see new and different things that really increased my knowledge and hence my confidence, so keep your ears open for different procedures (saw a PICC go in at the bedside), dressing changes (changed a post-CABG open sternal wound), or anything you can get. Ask you preceptor for critiques at the end of the day, framing it as a way for you to learn and get better.

Best of Luck!

Cheers,

Tom