Alterations in Body Systems

Must-know rules

Isolation follows transmission: Airborne (N95 + negative pressure) for TB, measles, varicella. Droplet (surgical mask) for flu, meningitis. Contact (gown + gloves) for MRSA, C.
Seizures: Protect, don't restrain. Side-lying position. >5 min = status epilepticus → IV lorazepam STAT. Escalate: benzo → fosphenytoin → phenobarbital.
ICP: LOC = most sensitive indicator. HOB 30°, head midline, no Valsalva. Cushing's triad = herniation. Autonomic dysreflexia: sit up first → check catheter → remove stimulus.
OB emergencies: Previa = painless + bright red. Abruption = painful + dark red + rigid uterus. Mag sulfate for preeclampsia (antidote: calcium gluconate).
Shock types: Hypovolemic (↓volume → give fluids). Cardiogenic (pump failure → inotropes, NOT fluids). Septic (vasodilation → fluids + vasopressors).
DKA vs. HHS: DKA = ketones + acidosis + Kussmaul breathing. HHS = extreme glucose + no ketones + severe dehydration. Both: fluids first. DKA: hold insulin if K⁺ <3.3.
Thyroid/adrenal crises: Storm = everything fast (beta-blockers first). Myxedema = everything slow (IV levothyroxine).
AKI: Pre-renal (↓flow → BUN:Cr >20:1). Intrarenal (kidney damage). Post-renal (obstruction). Hepatic encephalopathy → lactulose (2–3 stools/day).

INFECTIOUS DISEASE MANAGEMENT & NEUROLOGICAL EMERGENCIES

INFECTIOUS DISEASE: TRANSMISSION-BASED PRECAUTIONS: Standard Precautions: ALWAYS, EVERY patient: • Hand hygiene before and after...

KEY INFECTIOUS DISEASES: RECOGNITION & RESPONSE: Tuberculosis (TB): • Transmission: airborne (cough, sneeze

SEIZURES: TYPES, MANAGEMENT & STATUS EPILEPTICUS: Seizure types: know the classification: • Generalized tonic-clonic (grand mal)

INCREASED ICP: RECOGNITION & EMERGENCY MANAGEMENT: Monro-Kellie Doctrine: • Skull = fixed volume • Brain (80%) + Blood (10%) + CSF...

NCLEX FAVORITE

Autonomic dysreflexia first action = sit the client UP. This uses gravity to drop BP while you search for the trigger.

DOJO RULE

Isolation precautions follow the pathogen, not the diagnosis. If you know HOW an organism spreads (airborne, droplet, contact), you'll always pick the right precaution

OBSTETRIC COMPLICATIONS & CARDIOVASCULAR-RESPIRATORY ALTERATIONS

PREECLAMPSIA & ECLAMPSIA: Preeclampsia: hypertensive disorder of pregnancy: • Develops after 20 weeks...

PLACENTA PREVIA vs. PLACENTAL ABRUPTION: Placenta Previa (placenta covers cervical os): • Hallmark: PAINLESS

ACUTE HEART FAILURE & PULMONARY EDEMA: Left-sided heart failure (backward = lungs): • LV can't pump forward → blood...

SHOCK: ALL TYPES AT A GLANCE: Hypovolemic (volume loss): • Cause: hemorrhage, burns

AMNIOTIC FLUID EMBOLISM & POSTPARTUM HEMORRHAGE: Amniotic Fluid Embolism (AFE): • Rare but catastrophic

SHOCK TYPE QUICK-ID

Cool + clammy + tachycardic + hypotensive: → hypovolemic or cardiogenic (check for crackles/JVD to...
Warm + flushed + tachycardic + hypotensive → early septic shock (distributive)
Warm + dry + bradycardic + hypotensive → neurogenic shock (loss of sympathetic tone)
Urticaria + stridor + hypotensive → anaphylaxis → EPINEPHRINE NOW
Hypotensive + JVD + muffled hearts or absent breath sounds → obstructive shock

NCLEX TIP

Placenta previa = PAINLESS. Abruption = PAINFUL. If a question describes bright red vaginal bleeding without pain

ENDOCRINE, RENAL & GI ALTERATIONS · RADIATION THERAPY & RECOVERY

DKA vs. HHS: THE ENDOCRINE EMERGENCIES: Diabetic Ketoacidosis (DKA): • Who: Type 1 (usually), sometimes Type 2 • Cause

THYROID STORM & MYXEDEMA COMA · ADDISONIAN CRISIS: Thyroid Storm (thyrotoxic crisis): • Extreme hyperthyroidism

DOJO RULE

In DKA, the potassium is a lie. Serum K⁺ looks high because acidosis pushes K⁺ out of cells. But total body K⁺ is depleted from osmotic diuresis.

FINAL DOJO RULE

Body systems don't fail in isolation: they fail in cascades. The septic client develops AKI. The eclamptic client develops DIC. The DKA client's potassium crashes with insulin.

Memory hooks

Sit Up, Find It, Fix It Sit up Sit the client up · Find Look for the trigger · Fix Remove the trigger · Meds BP still high

Fill, Squeeze, Squeeze Hypovolemic Fill the tank · Cardiogenic Help the pump · Septic Squeeze the vessels

Mag Toxic: Calcium Back Reflexes Check deep tendon reflexes · RR RR under 12 · Urine Urine under 30 mL · Antidote Calcium gluconate at the