Physiological Adaptation Study Guide for the NCLEX-PN Exam

General Information

The NCLEX-PN® test allots about 7% to 13% of its questions to the area of physiological adaptation, covering things like changes in body systems, electrolyte imbalances, and medical emergencies. There’s a lot to know, so use the outline below to help you prepare. And if you still have questions, be sure to consult other resources for more information.

Alterations in Body Systems

Knowledge

When caring for clients, the LPN must be knowledgeable not only of the client’s current disease process but also the basic physiological changes that may impact the client’s status.

Signs and Symptoms

The LPN should be able to identify the signs and symptoms of the following common issues that may present themselves in caring for both inpatient and outpatient clients. These items may be ancillary to the focal disease process being treated, and they may cause unnecessary complications if not recognized early.

Infection

All clients are at risk of infection, whether a nosocomial infection while in the hospital or an infection of a healing incision after surgery. The LPN should note any temperature changes, swelling, redness, mental confusion, or foul-smelling urine. as these may be signs of an infection.

Hypoglycemia or Hyperglycemia

Both LPNs and clients should be aware of signs of hypo- and hyperglycemia. If a client is sweaty, clammy, and/or confused, he or she may be hypoglycemic and require a simple carbohydrate snack to increase blood pressure. On the other hand, a client with increased thirst and appetite along with frequent urination may be hyperglycemic and require insulin.

Acute or Chronic Illness

When assessing a client, the LPN should be aware of known illnesses and suspected or potential illnesses. These may be acute or chronic, and the LPN will need to identify their related signs and symptoms.

Fluid or Electrolyte Imbalance

Many clients are at risk for fluid and/or electrolyte imbalance. This may be a lack of or excess of fluids or electrolytes, and the signs and symptoms of this imbalance will depend upon what item is in minimal quantities versus excessive quantities.

Standards and General Principles

There are widely accepted standards and general principles that the LPN will need to refer to while caring for clients.

Cardiac Monitoring

Clients may have occasional or continuous cardiac monitoring. The LPN should be able to recognize and report basic abnormalities on a client cardiac monitor strip (ECG/EKG). Occurrences such as an arrhythmia or a block may require an intervention.

The Disease Process

Depending on the disease process for which the client is being treated, the LPN should consider the general principles of the disease process when providing care. For example, the disease may impact the client’s injury and repair process, immunity, or cellular structure.

Pathophysiology

Pathophysiology looks at the changes in the body as a result of a disease. The LPN should apply knowledge of basic pathophysiology when monitoring the client for alterations in the body systems that may be affected.

Care

Routine client care will likely involve some of the tasks below. It is imperative that the LPN be familiar with these devices, equipment, and tasks.

Devices and Equipment

The LPN may encounter clients that have or are using certain devices and/or pieces of equipment. There are considerations for these that may require additional care or monitoring. The LPN should be able to provide care for these clients and, if encountering a device or piece of equipment that is unfamiliar, ask the care team for assistance.

Drainage Devices

A client that has air or fluid in the lungs may have a chest tube in place. Care should be taken to ensure this does not become dislodged. Post-surgical clients may have a wound drain, and the LPN may be responsible for removing this drain at the appropriate time and should follow protocol.

Tracheostomy

A client may require a tracheostomy either temporarily or permanently to assist with respiratory functions. Care should be taken to ensure the airway stays patent, the dressing is maintained, and infections are prevented.

Ostomy

Clients may also have a type of ostomy for various alterations in elimination. These include, but are not limited to, a colostomy, ileostomy, or urostomy. The LPN should be able to provide care to these clients and reinforce teaching on ostomy care.

Ventilator

Clients who are unable to breathe independently will likely require a ventilator. Care should be taken to ensure the ventilator remains connected. Further, actions should be taken to prevent infections such as ventilator-associated pneumonia (VAP).

Pacemaker

Clients who have a history of cardiac alterations may require a pacemaker. The LPN should be able to perform a check of the pacemaker and reinforce education about the signs of pacemaker malfunction.

Other Care

Additionally, the LPN’s responsibility may include providing care to correcting other alterations in the client’s body system. These may include physiologic signs to measure and monitor or wounds to care for. The LPN should follow the facility’s policies and procedures for monitoring and interventions.

Temperature

As part of routine care and monitoring, the client’s temperature will be taken. When the client’s temperature is outside of the normal or desired range, the LPN may be asked to provide cooling or warming measures to restore the client to a normal temperature.

Peritoneal Dialysis

The LPN may encounter clients undergoing peritoneal dialysis. Peritoneal dialysis is an alternative to hemodialysis. A catheter is placed in the abdomen, and the peritoneum serves as a filter to remove waste products from the blood in cases of kidney failure.

Increased Intracranial Pressure

Clients who have had head trauma may have or be at risk for increased intracranial pressure. Increased intracranial pressure can be life-threatening and can impair cerebral perfusion and cause hypoxia and compression of the cerebral arteries.

Seizure

The LPN may be asked to care for a client who has experienced a seizure or experiences seizures on a regular basis. Not all seizures are predictable. The priority for these clients is to ensure the client’s safety during and after a seizure.

Pregnancy, Labor, and Delivery

When caring for a pregnant client, there are a number of considerations to ensure the health and safety of the client. Further, when the client is in labor, the LPN should be on alert for signs of eclampsia, precipitous labor, and/or hemorrhage.

Wound Care

Clients who have experienced trauma or have undergone surgery may have wounds that the LPN will need to care for. There are various wound care protocols depending on the type of wound. Further, the LPN may be asked to perform dressing changes.

Post-Surgery

In some departments, the LPN will be caring for a client after a surgical procedure. The immediate surgical recovery typically takes place in the PACU (post-anesthesia care unit) or an ICU (intensive care unit). The client’s needs for monitoring and care will be dependent on the type of procedure and type of anesthesia used.

Sutures and Staples

Clients with a surgical wound will likely have sutures or staples to assist in appropriate healing and closure. After the skin edges are healing appropriately, the LPN may be asked to remove these sutures or staples. The LPN should take care to monitor for any signs of wound infection.

Respiration

One of the most important physiologic processes to monitor is the client’s respiratory status. When needed, the LPN should intervene to improve this status. This may include breathing treatments, suctioning, and/or repositioning.

Fluid and Electrolyte Balance

Clients may be at risk for a fluid and/or electrolyte imbalance. The LPN should provide interventions to restore fluid and/or electrolyte balance and monitor the client’s response to these interventions. The type of intervention will depend on what fluid or electrolyte is out of range.

Other Responsibilities

In addition to the interventions above, the LPN may have other responsibilities to ensure the best and most appropriate care is delivered to clients.

Education

While the LPN may not be primarily responsible for providing client education, he or she should reinforce this education regarding the client’s care and condition. It is important to monitor the client’s willingness to receive this education and preferred method of communication or teaching. Some clients may benefit from written education while others may need verbal instruction or active reinforcement.

Notification

When noticing a change in the client’s status, the LPN should not hesitate to notify the primary healthcare provider of this change. The LPN can also consult with other members of the care team when there is concern over the client’s status. It is usually better to err on the side of caution when a status change is suspected, as the signs may be more subtle in early stages.

Documentation

A common mantra is, “If it’s not documented, it didn’t happen.” The LPN should follow the facility’s protocol for documentation and ensure that the interventions taken and the response to those interventions are properly documented. Documentation should be factual information regarding the client’s care. For example, the status of a pacemaker or chest tube should be noted on the chart so that other care team members are aware of the client’s status.