Physiological Adaptation
Physiological Adaptation
This domain tests the nurse's response to acute and chronic illness: respiratory, cardiac, metabolic, neurological, renal, and fluid and electrolyte problems. The exam expects ABC priorities, condition-specific monitoring, and recognition of complications.
Respiratory and cardiac
- Asthma: wheeze, accessory muscle use, prolonged expiration; give a short-acting beta-2 agonist (salbutamol), then corticosteroids. A silent chest is an ominous sign, not improvement.
- COPD: pursed-lip breathing, barrel chest; target oxygen saturation 88-92% to avoid hypercarbia.
- Heart failure: daily weight, fluid and sodium restriction, crackles, jugular venous distension, edema. For acute pulmonary edema, sit the client upright, give oxygen, administer prescribed diuretics, and monitor potassium.
Metabolic, neurological, and renal
- Diabetic ketoacidosis: hyperglycemia, ketones, Kussmaul breathing, dehydration. Priority is IV fluids, then insulin, with close potassium monitoring because insulin drives potassium into cells.
- Stroke: use FAST; document the last known well time; urgent CT; keep the client NPO until a swallow screen is done.
- Sepsis: infection plus altered vital signs and mental status; obtain lactate, give fluids and antibiotics within 1 hour.
- Hyperkalemia: peaked T waves and arrhythmia risk; calcium gluconate stabilizes the myocardium, insulin with glucose shifts potassium intracellularly, and dialysis may be needed.
Worked example
A client with type 1 diabetes has glucose of 28 mmol/L, ketones, deep rapid breathing, and dry mucous membranes. The PN recognizes DKA and prioritizes airway, breathing, and circulation. The PN starts IV normal saline as prescribed, monitors potassium before and during insulin infusion, checks glucose hourly, and watches for cerebral edema and hypokalemia.
Traps that cost marks
- Giving high-flow oxygen to a client with COPD without targeting 88-92%.
- Treating a silent chest as improvement in asthma.
- Giving insulin before fluids in DKA.
- Feeding a client after a stroke before a swallow screen.
- Missing that calcium gluconate does not lower potassium but protects the heart.