Physiological Integrity - Physiological Adaptation
What this domain tests
Managing a client whose physiology is already failing: shock, fluid and electrolyte imbalance, acid-base disorders, respiratory and cardiac emergencies, neurologic deterioration, endocrine crisis, burns, and sepsis. Prioritization is always ABC plus perfusion and neurologic status.
Concepts to own
Shock is inadequate tissue perfusion; early signs are tachycardia, tachypnea, restlessness, and narrowing pulse pressure, while hypotension is late. Septic shock needs cultures, broad-spectrum antibiotics, and fluid resuscitation quickly. Cardiogenic shock needs careful fluid restriction, not boluses. Heart failure teaching: daily weights, low sodium, report weight gain of 2 to 3 pounds in a day or 5 pounds in a week, and sit upright for dyspnea. Myocardial infarction: MONA-type priorities, aspirin unless contraindicated, watch for new murmur or sudden dyspnea. Stroke: note the time last known well, keep NPO until swallow screening, avoid hypoxia and hyperthermia. Increased intracranial pressure: elevate the head, keep the neck neutral, avoid hip flexion, and monitor level of consciousness as the earliest indicator.
Endocrine and metabolic
DKA: hyperglycemia, ketones, anion-gap acidosis, Kussmaul breathing, and total-body potassium depletion - replace fluids first, then insulin, and monitor potassium. HHS has higher glucose and osmolality with less ketosis. Addisonian crisis needs IV fluids and glucocorticoids; thyroid storm needs beta blockade and antithyroid drugs.
Traps
Treating hypotension as an early sign; withholding insulin in DKA until potassium is checked (know your protocol); giving free water to a client with SIADH or sodium to a client with heart failure without considering volume.
Worked rule
Interpret acid-base in three steps: pH, then CO2, then bicarbonate, then check compensation.