08 Adult Medical-Surgical Nursing
A practical guide to recognizing deterioration, responding safely, and monitoring common adult medical-surgical conditions and treatments.
Recognizing and responding to change
Adult medical-surgical nursing focuses on recognizing changes in a patient’s condition, preventing harm, and responding promptly. Practical responsibilities include collecting and reporting assessment data, carrying out authorized care, monitoring responses, reinforcing teaching, and escalating concerns according to the care plan, facility policy, and scope of practice.
Do not delay urgent escalation while attempting to identify a diagnosis. A sudden change from baseline warrants escalation even when its cause is uncertain.
A safe response sequence
A useful approach to begins with the patient’s baseline and a focused assessment of airway, breathing, circulation, mental status, pain, vital signs, oxygenation, intake and output, and mobility.
Identify immediate threats. Airway obstruction, severe breathing difficulty, new chest pain, sudden neurologic changes, signs of shock, uncontrolled bleeding, or rapidly declining consciousness require immediate action and emergency escalation.
Act safely and promptly. Stay with an unstable patient, summon help, follow emergency protocols, and carry out authorized interventions. Reassess after each intervention.
Communicate clearly. Report the change, relevant history, assessment findings, actions taken, and response. Use structured handoff such as .
Document objectively. Record findings, times, notifications, instructions received, interventions, and outcomes. Never document care before it is performed.
Medication administration and monitoring
Use two patient identifiers and the medication-administration checks required by policy. Confirm allergies, indication, dose, route, timing, and relevant assessments; clarify an incomplete or unsafe order. Check parameters and relevant laboratory results when required.
Monitor for therapeutic effects and adverse reactions, and report concerns. Reconcile prescription, over-the-counter, and supplement use. Adjustments such as holding a medicine must follow an order or approved protocol.
Respiratory conditions
During worsening symptoms, assess work of breathing, speech, breath sounds, oxygenation, and response to prescribed reliever therapy. A patient who cannot speak normally, becomes confused or cyanotic, or has little air movement despite distress needs emergency escalation.
Teach correct inhaler technique and the difference between prescribed quick-relief and controller medicines. Inhaled corticosteroids are controllers, not immediate rescue medicines; patients should rinse and spit after use to reduce oral thrush. Follow the individual action plan.
can cause chronic airflow limitation, cough, shortness of breath, and acute flare-ups. Monitor breathing pattern, oxygenation, sputum, activity tolerance, and mental status; new confusion or increasing drowsiness can signal deterioration. Give oxygen as prescribed or under emergency protocol—do not withhold needed oxygen.
Support upright positioning, prescribed inhaled therapy, energy conservation, smoking cessation, and pulmonary rehabilitation when included in the care plan. Review inhaler technique and the patient’s flare-up plan.
may present with cough, fever or chills, shortness of breath, pleuritic chest pain, fatigue, or confusion. In older adults, new confusion or functional decline may be prominent. Monitor temperature, respiratory status, oxygenation, hydration, and response to prescribed treatment.
Encourage mobility, coughing and deep breathing as appropriate, oral care, and hand hygiene; use ordered precautions. Antibiotics treat bacterial infections, not viral .
Cardiovascular conditions
, including heart attack, is an emergency. Possible signs include chest pressure or discomfort, pain in the arm, jaw, back, or upper abdomen, shortness of breath, nausea, sweating, or lightheadedness. Symptoms may be less typical or subtle. Activate emergency response immediately for suspected ACS; do not wait to see whether symptoms resolve. Follow facility protocol, obtain and report observations promptly, and prepare for ordered testing and treatment.
may cause exertional or resting dyspnea, difficulty breathing when lying flat, cough, fatigue, edema, or rapid weight gain. Trend daily weights under consistent conditions, edema, lung sounds, oxygenation, intake and output, and activity tolerance. Report sudden worsening, especially resting dyspnea or increased swelling.
Medicines may include diuretics and other heart-failure therapies. Monitor blood pressure, renal function, and electrolytes as directed. Reinforce the prescribed medication, sodium, and fluid plan rather than giving a generic restriction.
Hypertension
Hypertension often has no symptoms, so reinforce adherence and follow-up rather than relying on how the patient feels. Measure blood pressure correctly, report unusually high or low readings with symptoms, and support the prescribed lifestyle and medication plan. Never advise stopping antihypertensive medication without consultation.
Endocrine conditions
requires monitoring of glucose, meal intake, medication timing, skin, and feet. Match insulin or other glucose-lowering medicines to the prescribed plan and coordinate meal-related doses with food availability.
A glucose below the patient’s target—often below —requires prompt treatment under protocol. If the patient is alert and can swallow safely, a common approach is of fast-acting carbohydrate, followed by a glucose recheck in minutes and repeat treatment if it remains low. If the patient is unconscious or cannot swallow safely, give nothing by mouth; summon urgent help and follow protocol for glucagon or IV dextrose.
High glucose with dehydration, vomiting, abdominal pain, fruity breath, deep or difficult breathing, or altered consciousness may indicate a hyperglycemic emergency such as diabetic ketoacidosis. Escalate urgently. Reinforce the individualized sick-day plan; patients should not independently stop prescribed insulin during illness without clinician guidance.
Thyroid disorders
Thyroid disorders can affect energy, temperature tolerance, bowel patterns, heart rate, and weight. Hypothyroidism may be associated with fatigue and cold intolerance; hyperthyroidism may cause heat intolerance, tremor, and a rapid heartbeat. Administer thyroid medicines as prescribed and reinforce consistent use and follow-up laboratory testing. New severe confusion, marked temperature abnormality, or pronounced cardiovascular symptoms require prompt evaluation.
Renal conditions
is a rapid decline in kidney function; chronic kidney disease (CKD) develops over time and may have few early symptoms. Monitor urine output, weight, edema, blood pressure, fluid balance, and ordered renal-function and electrolyte results. A sudden reduction in urine, new edema or breathlessness, or confusion warrants prompt reporting.
Review medication safety: some medicines, including NSAIDs, can worsen kidney injury, and medication dosing may need adjustment for impaired renal function. Reinforce only the patient-specific fluid, diet, and medication plan.
For a patient receiving dialysis, follow access-care instructions and report bleeding, redness, warmth, pain, or signs of infection. Protect the access arm as directed by policy; verify local instructions before blood pressure measurement or venipuncture.
Gastrointestinal conditions
commonly causes recurrent heartburn or regurgitation. Reinforce prescribed medicines and individualized measures such as avoiding personal triggers, not lying down soon after meals, and elevating the upper body during sleep when recommended. Persistent symptoms or difficulty swallowing require clinical follow-up.
may cause upper abdominal discomfort and can be related to infection or NSAID use. Report black, tarry stools; blood or coffee-ground material in vomit; sudden severe abdominal pain; dizziness; or fainting immediately, as these may indicate bleeding or another complication. Monitor vital signs and appearance, and follow emergency procedures if instability is suspected.
Medication risks and harm prevention
Monitor medication-specific risks and report concerning changes:
Diuretics: Monitor blood pressure, urine output, weight, renal function, and electrolytes as ordered; report dizziness, dehydration, or significant changes.
Anticoagulants and antiplatelet medicines: Watch for unusual bruising, bleeding, black stools, or blood in urine; use bleeding precautions and follow monitoring instructions.
Insulin and sulfonylureas: Watch for hypoglycemia, especially when meals are delayed or intake is poor.
Opioids and sedatives: Assess alertness and respiratory status; report excessive sedation or slowed breathing promptly.
Antibiotics: Check allergies, administer as prescribed, observe for reactions, and reinforce completing the prescribed course unless the prescriber changes it.
Prevent falls, pressure injuries, and infection with individualized mobility assistance, skin checks, hand hygiene, and appropriate precautions. Before oral intake, consider alertness and swallowing safety; use aspiration precautions as ordered.
Putting priorities together
Safe care depends on knowing the patient’s baseline, detecting trends, prioritizing airway, breathing, circulation, and neurologic changes, and acting within scope and protocol. Monitor the effects and risks of treatment, report red flags without delay, and reinforce individualized medication and self-care plans.