Introduction: Physiological Adaptation – NCLEX-RN®

00:01 This is the fourth and final category in physiological integrity.

00:06 And most people report this as being the most challenging of the four categories.

00:11 Now it's worth 11 to 17% of your overall exam.

00:16 Let's go back to the definition of what NCSBN calls this.

00:19 They say it's managing and providing care for clients with acute, chronic or life threatening physical health conditions.

00:27 So this content is likely what you experienced in your advanced med surg class or whether you call it an acute and chronic illness class, whatever your school called it. This is going to be the type of content that you'll be tested on here.

00:40 So this probably won't surprise you about the things we're going to talk about.

00:43 But let me give you a rather lengthy list, because I know this is an area that students struggle with. This is some of my favorite content, but I'm kind of a pathos nerd.

00:54 So let me give you some ideas and some strategies and things that you can take a look at. Remember when you're doing practice questions here, if you don't remember this content or you feel like you need to review it, we have hundreds of videos for you on most of these topics, so be sure to check those out if you want.

01:10 Just a quick review.

01:12 So let's get rolling. You've got invasive procedures.

01:15 Those would be things like a central line, a thoracentesis, or even a bronchoscopy.

01:19 But I want you to keep in mind is if someone has an -esis, a thoracentesis, even diuresis, or a paracentesis, that this means you're moving fluid in a thoracentesis.

01:33 You're taking it out of my chest wall, right? In a paracentesis, you're removing fluid from their abdomen.

01:39 Why do I keep saying -esis? Because I want you to remember, when you're withdrawing fluid, it can cause additional fluid volume shifting.

01:48 The worst case scenario for your patient would be boom, a drop in blood pressure.

01:54 So always be sure to watch that patient's blood pressure extra closely when they've had any type of ACS or fluid removal.

02:04 Now, thinking about things with babies, something as simple as phototherapy that we would use for hyper bilirubin anemia.

02:11 What about clients on a ventilator? Yes, I can tell you that this is a possibility.

02:17 You could get a question about a patient on a ventilator.

02:20 So they want to be sure that you know how to be safe taking care for these types of patients. Now, there's all kinds of equipment and devices, right, for drainage.

02:29 We've got surgical wound drains, chest tubes to suction, negative pressure, wound therapy.

02:34 We've got all kinds of options for you to choose from there.

02:37 You'll also take care of people receiving peritoneal dialysis.

02:41 Remember, that is major fluid shifting, whether it's peritoneal dialysis or hemodialysis. You want to watch those patients vital signs very closely.

02:52 Now back to our ventilator, friend.

02:53 Suctioning is another thing that you would do for the patient, whether they're on a ventilator or if you're just doing straight suctioning without the patient being intubated. Think of this next portion of physiological adaptation is taking care of wounds and dressings.

03:10 So basic wound care, dressing changes, ostomy care, and educating the patient about ostomy care and tracks and enteral feedings.

03:19 Also pulmonary hygiene, chest physiotherapy, incentive spirometry.

03:23 You're doing post-operative care.

03:25 And what are you watching closely for there? What about fluid and electrolyte imbalances? When are those most likely to occur? Also, monitoring and maintaining arterial lines could fall into this category.

03:38 This portion addresses clients who need additional monitoring.

03:41 Maybe it's a client with a pacing device or on a telemetry unit.

03:45 It could be somebody who has alterations in hemodynamics for whatever reason.

03:49 They might have poor tissue perfusion, they might have hemostasis or clots or any type of acute or chronic condition is a possibility in physiological adaptation.

04:01 Now the handout has a list of even more things that are possible in physiological adaptation, but really it's just about anything that could be an acute or chronic condition or a procedure.

04:12 They all fall into this category.

04:15 Don't get discouraged here.

04:17 Just use the good judgment you've developed in nursing school.

04:20 Be aware of signs of hemodynamic instability.

04:24 Make sure the airway is clear.

04:26 They're breathing normally.

04:27 They've got good circulation, especially about perfusion.

04:30 Have they developed any clots? Those are just kind of the basic overall rules to look at these questions from that lens and you'll be able to make the safest answer selection for the patient you're dealing with.