Page 1 Basic Care and Comfort Study Guide for the NCLEX-PN® exam
How to Prepare for the Basic Care and Comfort Questions on the NCLEX-PN® Test
There are many basic patient needs that you’ll be responsible for ensuring during your work as an LPN. From movement to hygiene to bodily functions, part of your job will be to be sure all goes as smoothly as possible and monitor patients for any difficulties in these areas. The NCLEX-PN® test uses about 7% to 13% of its questions to this area of nursing. The outline below should help you know what to study, but if you still have questions, be sure to seek additional information.
Mobility/Immobility and Body Use
Patients are often bedridden as opposed to ambulatory. Given the potential negative effects of prolonged immobility, it is important to pay close attention to patients’ mobility needs.
When caring for the patient, the first step is to assess their current condition as it relates to mobility. This is crucial in determining a patient’s appropriate treatment and risk for falls.
Start with the patient’s motor skills, including strength. This can start with bedside tests such as sitting and shaking hands and progress to observed ambulation. When assessing a patient’s gait and ambulation needs, special attention should always be paid to his or her risk for falls.
When patients are bedridden, they are at risk for venous insufficiency, as the blood that usually flows through the lower extremities when walking can become static. Pay attention to swelling or dark discoloration in the lower legs and comply with orders for elastic stocking and/or sequential compression devices (SCDs) to increase blood flow in the lower legs.
A patient with a chronic disorder that impacts his or her mobility will have different physical and psychosocial needs than a patient in an acute situation that has made them immobile. Further, a patient who was not expecting to be rendered immobile may need additional reinforcement more than a patient who had prepared for immobility and may have been educated earlier in the process.
The PN is responsible for reinforcing the education provided to the patient, such as how to perform active and passive range of motion, strengthening, and/or isometric exercises. It is important that the patient follows the provided teaching to maintain mobility. Further, when observing the patient, the PN should ensure the patient maintains correct body alignment so that the exercises are most effective.
For patients that are able to ambulate, the PN can assist with transfers and walking. For some patients, adaptive equipment may be necessary, and the PN should be trained on how to use these devices. For patients that are immobile and/or bedridden, the PN can assist with repositioning at least every 2 hours and with range of motion exercises in the bed.
Maintain Skin Integrity
Patients that are immobile are at high risk for skin breakdown, and the PN can assist with monitoring skin integrity and prevention of skin breakdown. The most effective way to prevent skin breakdown is repositioning. Frequent skin assessments and meticulous skin care is also important in assessing for skin breakdown in the early stages. Pressure relieving devices should be used as appropriate.
Some patients may need a variety of assistive devices, such as a cane, walker, or crutches to assist with ambulation or devices to assist with feeding or communication.
Understand and Teach Proper Use
When assisting a patient ambulate with assistive devices like a cane or walker, the PN must ensure that these devices are being used properly and must reinforce patient teaching. Canes, walkers, or crutches must be the appropriate height for the patient and proper use should avoid placing pressure on the patient’s body.
Care for Patient
Patients with difficulty eating may use a parenteral tube, and the PN will assist with parenteral feedings along with site care of the feeding tube. For patients with communication barriers, the PN should be familiar with telecommunication devices, touch pads, and communication boards so that the PN can converse with the patient and reinforce patient teaching.
Non-pharmacological Comfort Interventions
The effectiveness of non-pharmacological comfort interventions is often overlooked, but the PN can assist with these measures. They may include imagery, massage, repositioning, or other physical interventions.
The vast majority of patients in inpatient or outpatient settings will have some level of pain that needs treatment. While pharmacologic treatment is often necessary, there are non-pharmacological interventions that the PN can assist with to ensure that patient is as comfortable as possible.
Assess Pain Level
Pain is a subjective experience and will differ from one patient to another. To best assess a patient’s pain level, there are a number of standardized scales, both verbal and non-verbal. Most commonly, the patient will express their pain level and pain goal on a scale of 1–10; however, non-verbal signs of pain may include grimacing and restlessness.
Provide Pain Therapy
There are many additional treatments for pain aside from pharmacological treatments. For example, patients may benefit from imagery, massage, or repositioning to provide comfort. As with any pain therapy, always be monitoring the patient’s response or lack thereof. And when caring for a patient with inflammation or swelling, consider heat/cold treatments or limb elevation to decrease the swelling and discomfort.
General Comfort and Palliative Care
For some patients, the treatment goal will not be to get rid of pain but make the patient as comfortable as possible. In palliative care, the focus is not on treating the underlying cause of the pain but providing a measure of comfort care. When caring for a palliative care patient, it is extremely important to respect the patient’s choices and assist as needed.
Assess Patient Needs for Care
When caring for a palliative care patient, it is important to constantly assess the patient’s pain level and his or her need for intervention. The PN should assist in planning comfort interventions as needed and reinforce teaching on these care interventions.
Comfort and palliative care interventions will primarily include pharmacological and nonpharmacological comfort interventions. The PN should assist with treatment as appropriate and constantly monitor the outcome and patient response, paying close attention to the patient’s pain level.
There are additional considerations for the PN to be aware of, as these may be part of your patient care.
Visually or Hearing-Impaired Patients
The PN will often encounter visually impaired or hearing-impaired patients. There are different assistive devices to assist with communication, like telecommunication devices and communication boards. The PN should also be cognizant of how these impairments may require modifications to activities like ambulating.
Using Alternative and Complementary Therapy
Some patients may be interested in alternative and complementary therapies. The PN should be respectful of alternative measures the patient may explore. The PN can also suggest common complementary therapies such as music therapy that may improve the patient’s experience.
When the PN is caring for a patient in the inpatient or outpatient setting, the patient will likely be under some level of added stress related to the hospitalization or treatment. The PN can assist with and reinforce teaching on stress management techniques, such as relaxation exercises, physical exercises, and meditation.
Nutrition and Oral Hydration
The PN will often assist with nutrition and hydration. As many patients are bedridden and out of their normal routine, it is extremely important to monitor nutrition and hydration status throughout care.
The PN can assist with patient’s nutritional needs during care. This will include monitoring the patient’s status, helping the patient with eating, and teaching the patient the importance of nutrition. Many patients may also have different dietary and/or cultural preferences, such as a need for a special diet (high protein, kosher diet, calorie restriction, sodium restriction).
One of the first steps in addressing a patient’s nutritional needs is monitoring his or her input and output. There are many obvious forms of intake and output, but the PN should also be aware of some non-obvious forms such as IV fluids, sweat, or emesis. Also, the patient’s disease or illness may have an impact on nutritional needs or ability to eat or drink.
Help and Teach
Some patients may need assistance eating and drinking, which can be provided by a PN. The PN should also promote independence in eating when appropriate. There are a number of assistive devices that the PN can suggest to help the patient eat independently. Further, the PN should reinforce client teaching on any dietary or nutritional needs based on the patient’s diagnosis. These might include such dietary restrictions as “high protein” or “calorie restriction.”
When assisting with or monitoring a patient eating, the PN should pay attention to any signs or symptoms of eating difficulties. The patient may be unaware of an inability to chew properly or swallow, which can become extremely dangerous. If the patient does have eating difficulties, he or she should not eat without being monitored.
Monitor Ability to Eat and Drink
When monitoring a patient while drinking, the PN should check the patient’s ability to swallow to assess the risk of aspiration (see below). When the patient is eating, the PN should be monitoring the patient’s ability to chew as unchewed food could become a choking hazard.
Potential for Aspiration
Patients with both acute and chronic conditions can be at risk for aspiration, which is food or liquid entering the trachea. Patients with swallowing difficulties along with sedated patients are at risk for aspiration during eating or drinking. Patients with feeding tubes should constantly be monitored and assessed, as the tube placement could change, placing the patient at risk.
Patients with eating difficulties may benefit from an enteral tube. When feeding patients using an enteral tube, the PN should check for correct tube placement and patency prior to feeding to ensure the tube feeding contents are administered correctly. This is frequently done by administering air into the feeding tube and listening for gastric bubbling with a stethoscope.
In conjunction with monitoring and caring for a patient’s nutritional input, the patient’s elimination and associated impairments is of high importance.
Identify Impairment Risk
When caring for a patient, identifying risks for impaired elimination and early action can prevent negative outcomes. One easily preventable elimination impairment risk is related to hydration. Patients should be encouraged to stay hydrated to prevent dehydration and constipation. Patients are also commonly given medications like opiods that decrease gastric motility, which can also lead to or exacerbate constipation.
Patients may be on a bowel or bladder management protocol, and the PN should assist as needed. This may include caring for patients with a urinary catheter, ostomy bag, or rectal tube. These devices are often in the perineum, which requires meticulous skin care to prevent skin breakdown and/or infection.
One of the early signs of decreased gastric motility is diminished bowel sounds. The PN can auscultate for bowel sounds using a stethoscope. If bowel sounds are absent or decreased, the PN should inform other members of the care team so that the appropriate interventions are taken.
The PN may be asked to provide irrigation of various orifices. Wound irrigation should be performed with the appropriate solution to assist with healing. Bladder irrigation will be performed using a catheter. Additionally, ear, eye, or nose irrigation may be indicated for some injuries.
Patients who are incontinent require meticulous skin care as the perineum is at high risk for skin breakdown. When caring for an incontinent patient, they should be washed frequently to ensure the area is clean and dry. Further, barrier creams and ointments may be used to protect the skin.
Many hospitalized patients feel a loss of control, and one of the basic needs they can usually continue independently or with assistance is their personal hygiene.
Assist with Hygiene
The PN can be instrumental in assisting with patient hygiene. The PN should first assess the patients and determine their usual personal hygiene habits and routines. As many hospitalized patients have impairments, the PN should reinforce teaching on required adaptations for performing activities of daily living, such as use of a shower chair or handrails.
Patients that have an enteral tube will need site care in addition to their routine personal hygiene activities. The skin should be assessed for breakdown and/or infection around the insertion site on a regular basis. When bathing the patient, special care should be taken to ensure the tube does not become dislodged or misplaced.
In some areas of care, such as hospice, postmortem care may be a common activity that a PN will assist with. During postmortem care, the PN can assist the team with bathing and grooming of the body to prepare for family viewing or transport or assist with documentation needs.
Rest and Sleep
Most, if not all, patients in an inpatient or outpatient setting are at risk for interrupted rest and sleep, which can have a negative impact on the healing processes.
To promote optimal rest and sleep, the patient should be assessed, and the PN can identify the patient’s usual rest and sleep patterns: ability to nap during the day, ideal bedtime, sleep rituals, or measures that may increase sleep quality. The PN can use the patient’s preferences to determine how and when to interact with the patient.
Promote Rest and Sleep
Given that patients are disturbed or interrupted multiple times during the day and night for vital signs monitoring or medication administration, it is important to promote adequate rest and sleep whenever possible. The patient care activities should be scheduled to promote adequate rest and sleep as opposed to multiple interruptions. Further, the PN can provide measures to promote sleep and rest as appropriate.