What to Expect and How to Prepare – FRESHRN

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Hello to my fellow healthcare professionals and anyone interested in learning more about the world of med-surg nursing! In this post, we’ll discuss med-surg patients and the various procedures they may undergo during their stay. We’ll also touch on what kind of patients are on a med-surg floor, the typical patient ratio, and the use of patient acuity tools.

What Kind of Patients Are on a Med-Surg Floor?

Med-surg patients come from all walks of life and present with a wide range of medical conditions and surgical needs. The med-surg floor is often considered the backbone of the hospital, as it serves as a hub for diverse patient populations. You can expect to encounter patients with chronic medical conditions, those recovering from surgical procedures, and patients requiring acute care for various illnesses or injuries. This diversity requires med-surg nurses to be knowledgeable about numerous medical conditions and skilled in providing personalized care to each patient.

Generally speaking, some of the most common things you’ll see on a med-surg floor are:

  • Heart failure
  • Pneumonia
  • Gastrointestinal bleeding
  • Renal failure
  • Chronic obstructive pulmonary disease (COPD)
  • Urinary tract infections (UTI)
  • Sepsis
  • Pancreatitis
  • Deep vein thrombosis (DVT)
  • Altered mental status (AMS, often caused by infections!)
  • Bowel obstruction
  • Patients needing a general cardiac work-up for various reasons

If you can refresh yourself on these, you’ll be able to educate your patients better and troubleshoot common complications. (And if you don’t want want to waste time finding a solid explanation, and want one tailored specifically to your needs as a med-surg nurse, check out this resource I made that explains all of those!)

Med-Surg Patient Ratio

Additionally, the med-surg patient ratio refers to the number of patients assigned to each nurse on a med-surg floor. This ratio can vary depending on the hospital, the specific unit, and the acuity of patients. Generally, the patient ratio ranges from 1:4 to 1:6, although it can be higher or lower depending on the factors mentioned above. It is essential for healthcare facilities to maintain appropriate patient ratios to ensure that med-surg nurses can provide safe, high-quality care for their patients.

Med-surg patient acuity tools help determine the complexity of care required for individual patients. This helps ensure the workload is spread out fairly among staff members, as not every patient is created equal.

These tools take into account factors such as the patient’s medical condition, surgical history, and the level of care needed to manage their situation effectively. They often categorize patients under the following categories.

Stable

A stable med-surg patient would require vitals every 4 hours or less frequently. Frequent vital signs can really increase workload. They are often on room air, vitals are within defined parameters, are tolerating oral intake, normal blood glucose levels, and may have an IV attached for continuous or intermittent dosing. They should have less than a few drains (like JPs) and their pain is managed well.

Moderate Risk

Patients on alcohol withdrawal protocol (scoring low), with oxygen needs, a temperature, chest tubes to water seal, NG tubes, PCA, active vomiting, tube feeding, tachycardia.

Complex

Active delirium, alcohol withdrawal (scoring high), presence of a trach, blood transfusions, fluid boluses, chest tubes to suction, bolus feeding, pain requiring frequent management, complex discharge, isolation, complex wounds or ostomies, translator required.

High-Risk

Unstable vitals, chemo, copious unmanageable secretions, uncontrolled pain, unstable cardiac rhythm, chest tube with copious output, end of life, transfer to higher level of care, restraints.

A good acuity tool would also take factors into consideration that would impact a nurse’s workload, like presence of extensive wounds, needing a 1:1 sitter, frequent turns, total care, frequent toileting, and more. Essentially, the more complex, the higher the score. Everyone on the staff should get a few higher acuity (more labor-intensive) patients and a few patients that are easier to manage.

By using a med-surg patient acuity tool, healthcare providers can better allocate nursing resources, balance patient assignments, and maintain appropriate patient ratios.

Common Med-Surg Nursing Procedures

Med-surg nurses perform a wide range of nursing procedures to care for their patients. Here are some of the most common procedures carried out on a med-surg unit:

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Vital signs assessment

Med-surg nurses regularly monitor patients’ vital signs, including blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation. This helps to identify potential changes in the patient’s condition and guide appropriate interventions. Your CNA might obtain the vial signs, but as the RN you will be responsible for analyzing that data and responding appropriately.

Medication administration

Nurses on a med-surg unit administer various medications, including oral, intravenous, subcutaneous, and intramuscular routes. They must ensure the correct medication, dose, route, and timing while monitoring for potential side effects and interactions.

Wound care

Med-surg nurses provide care for patients with various types of wounds, including surgical incisions, pressure ulcers, and traumatic injuries. This involves cleaning and dressing the wound, assessing for signs of infection, and promoting healing.

Intravenous (IV) therapy

Establishing and maintaining IV access is a common task for med-surg nurses. They administer IV fluids, medications, and blood products, and monitor for potential complications, such as infiltration, phlebitis, or infection.

Foley catheter insertion and care

Nurses on a med-surg unit may insert and care for indwelling urinary catheters (Foley catheters). This involves maintaining sterility during insertion, securing the catheter, monitoring urine output, and preventing catheter-associated urinary tract infections (CAUTIs).

Telemetry monitoring

Nurses in the med-surg world will likely have many patients who require continuous cardiac monitoring. Therefore, nurses should be ready to manage these telemetry, interpret and respond appropriately, and troubleshoot.

Nasogastric (NG) tube and dobhoff tube placement and care

Med-surg nurses may insert and manage NG tubes for patients who require enteral nutrition or gastric decompression. This includes confirming proper placement, administering feedings or medications, and monitoring for complications.

Patient education

Med-surg nurses play a crucial role in educating patients and their families about their medical conditions, medications, treatments, and self-care strategies. This helps to promote patient engagement, adherence to treatment plans, and improved health outcomes.

Pain management

Nurses assess and manage patients’ pain using pharmacological and non-pharmacological interventions, such as administering pain medications, repositioning, and providing comfort measures.

Physical assessment

Med-surg nurses perform head-to-toe assessments to evaluate patients’ overall health, identify potential issues, and guide care planning.

Blood glucose monitoring and insulin administration

Nurses on a med-surg unit may monitor blood glucose levels and administer insulin for patients with diabetes or other conditions affecting glucose metabolism.

Care coordination and discharge planning

Med-surg nurses collaborate with interdisciplinary healthcare teams to coordinate patient care, develop individualized care plans, and prepare patients for discharge by arranging appropriate follow-up care and providing necessary resources.

These are just a few of the many nursing procedures performed by med-surg nurses. As they care for a diverse patient population, med-surg nurses must be skilled in various procedures and adapt their approach to meet the unique needs of each patient.

Preparing for Med-Surg Procedures

As a healthcare professional working with med-surg patients, it is crucial to be prepared for the various procedures that patients may undergo during their stay. Some essential steps to prepare include:

  1. Familiarize yourself with the most common med-surg procedures, mentioned above. I go over many of these skills in this resource.
  2. Stay up-to-date on the latest evidence-based practices and guidelines related to these procedures to ensure the best possible patient outcomes.
  3. Attend continuing education courses, workshops, or in-service training to hone your skills and expand your knowledge. Many of my online courses are applicable to med-surg nurses! Check out the latest catalog here.
  4. Develop strong communication and teamwork skills to collaborate effectively with other healthcare professionals in managing med-surg patients.
  5. Be prepared to educate and support patients and their families throughout the patient’s stay, explaining the rationale behind various procedures, addressing concerns, and promoting active participation in their care.

Final Thoughts For Med-Surg Nurses

Caring for med-surg patients is both challenging and rewarding, as it requires a broad knowledge base and the ability to adapt to the diverse needs of patients. By understanding the typical patient population on a med-surg floor, maintaining appropriate patient ratios, utilizing med-surg patient acuity tools, and being prepared for various procedures, healthcare professionals can provide excellent care and support for their med-surg patients. Embrace the learning opportunities and continue to grow in your practice, knowing that your efforts positively impact the lives of your patients.

More Resources for Med-Surg Nurses

Are you a new Med-Surg nurse?

Med-Surg Mindset from FreshRN is the ultimate resource for nurses new to this complex and dynamic acute care nursing specialty. Whether you are fresh out of nursing school or an experienced nurse starting out in med-surg for the first time, the learning curve is steep. With input from three experienced bedside nurses, this comprehensive course is all you need to learn all of the unspoken and must-know information to become a safe, confident, and successful medical-surgical nurse.

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