Physiological Integrity
What it covers
Basic care and comfort (mobility, nutrition, elimination, sleep, pain), pharmacological and parenteral therapies, fluid/electrolyte and acid–base balance, reduction of risk, and physiological adaptation (managing acute and chronic illness).
Labs and acid–base
Memorize core values: pH 7.35–7.45, PaCO2 35–45, HCO3 22–26, K 3.5–5.0, Na 135–145, Ca 8.6–10.2, BUN 10–20, creatinine 0.6–1.2. For acid–base, check pH first (acidemia versus alkalemia), then decide whether CO2 (respiratory) or HCO3 (metabolic) explains it, then judge compensation. High potassium is the arrhythmia risk; low potassium potentiates digoxin toxicity.
Pharmacology rules of thumb
Know the class, the serious adverse effect, and the monitoring parameter for high-yield drugs: digoxin (apical pulse before the dose; toxicity - nausea, visual changes, bradycardia), warfarin (INR), heparin (aPTT and platelets), insulin (hypoglycemia signs), opioids (respiratory depression, naloxone), aminoglycosides (peak and trough levels, ototoxicity, nephrotoxicity), loop diuretics (potassium). Question unclear orders and always use the rights of medication administration plus two patient identifiers.
Fluid and electrolytes
Hypertonic solutions pull fluid into the vasculature; hypotonic solutions shift it into cells. Watch for overload (crackles, jugular venous distention, weight gain) versus dehydration (tachycardia, low urine output, poor skin turgor). For a suspected transfusion reaction, stop the infusion, keep the line open with saline, and recheck the blood unit and type against the order.
Physiological adaptation traps
Distinguish hypoglycemia (sweating, tremor, confusion - give glucose) from hyperglycemia (polyuria, thirst, Kussmaul respirations). Infection in an older adult may present as new confusion without fever.
Worked example
pH 7.28, PaCO2 50, HCO3 24: acidemia with a high CO2 and a normal bicarbonate - uncompensated respiratory acidosis.