Physiological Adaptation Study Guide for the NCLEX-RN Exam

Page 3

Illness Management

Nursing care with regard to illness management often involves more than simply “providing care.” Comprehensive management will include the following tasks, which help patients better manage their own illness recovery.

Data Reporting

Certain pieces of patient data must be reported immediately to the patient’s managing practitioner. This may include adverse reactions and/or complications as discussed in previous review sections. It may also include the patient’s basic and essential needs and/or problems (physical, psychological, safety, etc.), any unexpected outcomes or responses, and any substantial change in status/condition.

All patient baseline data should be available and accessible for nurses and healthcare providers. This data helps support the critical thinking skills necessary to evaluate, interpret, and assess the continuous patient changes.

Pathophysiology Application

A deep understanding of the patient’s pathophysiology is crucial to helping them effectively during illness. This includes understanding all risk factors, etiologies, clinical signs and symptoms, and potential complications of specific conditions. Knowledge of pathophysiology helps to effectively create a care plan that prevents setbacks in a patient’s recovery process.

Patient Education

A crucial aspect of illness management is the ability to properly educate patients on the nature of their acute or chronic conditions. By doing so, patients gain empowerment and can make informed decisions about their health and care. Proper patient education starts with an analysis of the patient’s needs, deficiencies, and goals. The nurse must then design and implement the proper education activities based on this information. This process may also involve the patient’s family and/or caregivers. Be familiar with the most common components of this type of education.

In addition, be aware of implementing a plan for those with a lifelong or terminal condition. This will include education on self-care, modifiable risk factors, and available resources. For clients with acquired immune deficiency syndrome (AIDS), special education needs include reduction of risk potential for infection and spread of infection.


Understand that recovery from an illness involves both intrinsic and extrinsic factors. Some of these factors are innate to the patient (intrinsic) and others are not (extrinsic). Be mindful of both when planning interventions for recovery. Remember that the patient’s wellness comprises many aspects: biological, psychological, environmental, behavioral, sociocultural, and adequacy of healthcare (culturally competent, accessible, etc.) can and will impact recovery.

Gastric Lavage

Nurses may be responsible for performing gastric lavage if indicated. Common situations that require gastric lavage include drug overdose, poisoning, and gastrointestinal bleeding. Review the process in performing gastric lavage.

Continuity of Care

Nurses are the most important provider of continuity of care during the course of a patient’s illness or condition. Understand the proper ways to provide seamless, effective, and efficient care that meets your patient’s ongoing and changing needs. This may include education, coordination of care, identification of community resources, ongoing follow-up and continual reassessment and adjustment of the care plan.

This also extends to emergency care nurses who must help their patients understand important aspects of their condition, signs of problems, and how to properly follow up with continued care in the community.


Patients with impaired ventilation/oxygenation will require special nursing management. Be familiar with many of the indices measured by an arterial blood gas (SaO2, PaO2, PaCO2, pH, and HCO3), as well as components of pulmonary function testing, pulse oximetry, and spirometry. Understand that these patients will and often do require care from a multidisciplinary healthcare team.

Evaluation of Treatment

As with any other type of nursing care, nurses must provide continuous evaluation of the effectiveness of illness management. Assess each patient’s progress and achievements to ensure they are meeting the expected outcomes as outlined in their planned goals.

Medical Emergencies

Nurses play an integral part of patient care during a medical emergency. Minimally, knowledge of emergent patient care should include all of the following:

Application of Knowledge and Skills

When caring for a patient experiencing a medical emergency, nurses must know the most effective way to intervene. This will involve assessment of the patient in a rapid way and minute-to-minute interventions. Be aware that the patient’s status may change rapidly and unpredictably.


Knowledge of the patient’s pathophysiology is paramount in an emergent situation. It is essential to gather thorough details of the patient’s past medical history and current medical status to determine the most appropriate intervention. Conversely, knowing this information can also help to predict the possibility of inadvertently inducing a medical emergency during a treatment or procedure.

Nursing Procedures

Specific nursing procedures in medical emergencies will depend on the emergency that is being treated. Generally, procedures will be prioritized by ABCs (airway, breathing, and circulation). There are a number of medical conditions that can predispose a patient to a medical emergency that can involve the cardiovascular, respiratory, gastrointestinal, renal, central and peripheral nervous system, musculoskeletal, gynecological (including pregnancy), otorhinolaryngologic, ophthalmic, oral, and dental systems.

Psychomotor Skills

Nursing psychomotor skills vary during a medical emergency, depending on the patient’s needs. In general, nurses must know how to perform cardiopulmonary resuscitation, assess and clear a blocked airway, and perform the Heimlich maneuver, in order to (minimally) establish an airway and maintain breathing and circulation if clinically indicated.

Emergency Care

Other aspects of emergency care that nurses should be familiar with are respiratory support (bag-valve-mask, ventilator use, etc.), the use of an automated external defibrillator, advanced cardiac life support protocols and procedures (ACLS), as well as what steps to take in the event of an emergent wound disruption (evisceration and/or dehiscence).

Patient Education

Even though a medical emergency does not easily lend itself to patient education, nurses must do their best to reassure and inform patients of their current status, planned interventions, and any other critical information throughout the emergency situation.


Nurses will often be the first member of the medical team to notify a healthcare provider if a client is experiencing an unexpected response and/or an emergency situation. Unexpected responses may result in vital sign changes, changes in patient status, and reactions or severe side effects of medical therapies.


With any emergency treatment and/or intervention, nurses are responsible for evaluation and documentation of all events that occurred, including the patient’s response. This includes the establishment of an airway, the restoration of breathing, hemodynamic and peripheral pulses, and the re-establishment of the patient’s physiological stability.


It cannot be overstated how important a nurse’s understanding of pathophysiology is to the proper care and treatment of any patient with either an acute or chronic condition.


Nurses will need to be able to correlate all clinical signs, symptoms, diagnostic findings, potential risk factors, complications, and expected outcomes for any pathophysiologic disorder (acute and chronic) for all patients.

General Principles

The general principles of pathophysiology are:

  • the four stages of infection
  • the five signs of infection
  • the four phases of bacterial growth
  • the six stages of viral growth

Nurses should also be familiar with the phases of the inflammatory process as well as the phases of wound healing. Understand the innate and adaptive immune responses and when each occurs in the disease process. Also understand the principles of active and passive immunity.

Response to Therapies

For most patients, the response to therapy is predictable and expected. However, there are patients who may and do have unexpected responses to various therapies.

Patient Assessment

Be aware of the potential risks, complications, and adverse reactions of any intervention, procedure and/or therapy that is given to the patient. Be able to discern between inadvertent/accidental adverse responses (puncture of a vessel during a surgical intervention, retained surgical sponge, etc.) and undesirable yet common adverse events (catheter associated urinary tract infections, nosocomial infections, etc.) and assess patients for both. Clients with concern for altered mental status, stroke, or traumatic brain injury should be monitored for signs of increased intracranial pressure. Hemorrhage may also occur in the event of surgery, postpartum recovery, stroke, and trauma.


Be able to recognize the signs and symptoms of expected and unexpected complications. Understand the risk factors that make them more likely and how and when to appropriately intervene when caring for patients that have undergone a particular therapy, intervention, or procedure. This includes emergency care as well.


Complication recovery is very similar to recovery from a primary medical condition. If a complication does occur, understand and be able to provide the appropriate nursing care to promote your patient’s recovery. For example, a nurse would need to provide interventions, care, and assessment for the expected outcome following a catheter-associated urinary tract infection (CAUDI) as you would for an infection that is not associated with the use of a urinary catheter.

All Study Guides for the NCLEX-RN Exam are now available as downloadable PDFs