Physiological Integrity: Physiological Adaptation
What this domain tests
Physiological Adaptation tests pathophysiology and management of acute and chronic illness: respiratory, cardiac, endocrine, renal, neurologic, fluid and electrolyte, shock, and emergencies. The exam asks what is happening and what the nurse does first.
Core rules
- Connect assessment findings to pathophysiology; treat the client, not the number.
- For DKA: assess airway, breathing, circulation, glucose, ketones, potassium, and hydration; begin isotonic fluid and insulin per protocol; monitor potassium because insulin drives it intracellularly.
- For heart failure: assess breath sounds, edema, weight, and oxygenation; position upright; administer prescribed diuretics and oxygen.
- For shock: identify type, support oxygenation and perfusion, and give prescribed fluids or vasopressors.
- Reassess after every intervention and document response.
Worked example
A client with type 1 diabetes has glucose 420 mg/dL, deep respirations, fruity breath, and abdominal pain. The nurse should suspect DKA, check ketones and potassium, start IV normal saline per order, prepare an insulin infusion, and monitor potassium and ECG. Reasoning: the findings reflect ketoacidosis and dehydration; insulin without fluid and potassium monitoring can worsen hypotension and hypokalemia.
Traps
- Giving insulin before assessing potassium in DKA.
- Treating a high glucose without looking for infection or dehydration.
- Assuming all breathlessness is anxiety.
- Missing subtle neurologic changes in a client with hypertension.