Page 1 Basic Care and Comfort Study Guide for the NCLEX-PN® Exam
There are many basic client 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 clients for any difficulties in these areas. The NCLEX-PN® test uses about 7% to 13% of the questions to address 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
Clients are often bedridden as opposed to ambulatory. Given the potential negative effects of prolonged immobility, it is important to pay close attention to each client’s mobility needs.
Assess the Client
When caring for clients, the first step is to assess their current condition as it relates to mobility. This is crucial in determining a client’s appropriate treatment and his or her risk for falls and risk for injury.
When assessing a client’s mobility, the nurse should first start with the client’s motor skills. Common motor skills to assess includestrength, balance, and coordination. The nurse’s assessment can start with bedside tests such as sitting and shaking hands and progress to observed ambulation. When assessing a client’s gait and ambulation needs, special attention should always be paid to his or her risk for falling.
When clients 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 stockings and/or sequential compression devices (SCDs) to increase blood flow in the lower legs.
A client with a chronic disorder that impacts his or her mobility will have different physical and psychosocial needs than a client in an acute situation that has made them immobile. Further, a client who was not expecting to be rendered immobile may need additional reinforcement more than a client who had prepared for immobility and may have been educated earlier in the process.
The LPN is responsible for reinforcing the education provided to the client, such as how to perform active and passive range of motion, strengthening, and/or isometric exercises. It is important that the client follows the provided teaching to maintain mobility. Further, when observing the client, the LPN should ensure the client maintains correct body alignment so that the exercises are most effective. Use of proper ergonomic principles when moving also helps to prevent unnecessary injury.
For clients that are able to ambulate, the LPN can assist with transfers and walking. For some clients, adaptive equipment may be necessary, and the LPN should be trained on how to use these devices. For clients that are immobile and/or bedridden, the LPN can assist with repositioning at least every 2 hours and help the client practice active and passive range of motion exercises in the bed.
Maintain Skin Integrity
Clients that are immobile are at high risk for skin breakdown, and the LPN 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 are also important in assessing for skin breakdown in the early stages. Pressure relieving devices, such as gel pillows and positioning wedges, should be used as appropriate.
Some clients 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 client ambulate with assistive devices like a cane or walker, the LPN must ensure that these devices are being used properly and must reinforce client teaching. Canes, walkers, or crutches must be the appropriate height for the client and proper use should avoid placing pressure on the client’s body.
Care for the Client
Clients with difficulty eating may use a parenteral tube, and the LPN will assist with parenteral feedings along with caring for the site of the feeding tube. For clients with communication barriers, the LPN should be familiar with telecommunication devices, touch pads, and communication boards so that the LPN can converse with the client and reinforce client teaching.
Non-Pharmacological Comfort Interventions
The effectiveness of non-pharmacological comfort interventions is often overlooked, but the LPN can assist with these measures. They may include imagery, massage, repositioning, or other physical interventions.
The vast majority of clients 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 LPN can assist with to ensure that the client is as comfortable as possible.
Assess Pain Level
Pain is a subjective experience and will differ from one client to another. To best assess a client’s pain level, there are a number of standardized scales, both verbal and non-verbal. Most commonly, the client will express their pain level and pain goal on a numbers scale, rating their pain on a level from 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, clients may benefit from imagery, massage, or repositioning to provide comfort. As with any pain therapy, always monitor the client’s response or lack thereof. And when caring for a client with inflammation or swelling, consider heat/cold treatments or limb elevation to decrease the swelling and discomfort.
General Comfort and Palliative Care
For some clients, the treatment goal will not be to get rid of pain but make the client 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 client, it is extremely important to respect the client’s choices and assist as needed.
Assess the Clients’ Needs for Care
When caring for a palliative care client, it is important to constantly assess the client’s pain level and his or her need for intervention. The LPN 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 LPN should assist with treatment as appropriate and constantly monitor the outcome and client response, paying close attention to the client’s pain level.
There are additional considerations for the LPN to be aware of to meet the clients’ needs.
Visually or Hearing Impaired Clients
The LPN will often encounter visually impaired or hearing impaired clients. There are different assistive devices to assist with communication, like telecommunication devices and communication boards. Clients with visual impairment should have access to their corrective lenses and be provided with written materials that are printed in a font and size that is readable to them. The LPN should also be cognizant of how these impairments may require modifications to activities like ambulating.
Using Alternative and Complementary Therapy
Some clients may be interested in alternative and complementary therapies. The LPN should be respectful of alternative measures the client may explore. The LPN can also suggest common complementary therapies such as music therapy that may improve the client’s experience.
When the LPN is caring for a client in the inpatient or outpatient setting, the client will likely be under some level of added stress related to the hospitalization or treatment. The LPN can assist with and reinforce teaching on stress management techniques, such as relaxation exercises, physical exercises, and meditation.
Nutrition and Oral Hydration
The LPN will often assist with nutrition and hydration. As many clients are bedridden and out of their normal routine, it is extremely important to monitor nutrition and hydration status throughout care.
The LPN can assist with clients’ nutritional needs during care. This will include monitoring the client’s status, helping the client with eating, and teaching the client the importance of nutrition. Many clients 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).
Monitor the Client
One of the first steps in addressing a client’s nutritional needs is monitoring his or her input and output. There are many obvious forms of intake and output, but the LPN should also be aware of some non-obvious forms such as IV fluids, sweat, or emesis. Also, the client’s disease or illness may have an impact on nutritional needs or the ability to eat or drink.
Help and Teach
Some clients may need assistance eating and drinking, which can be provided by an LPN. The LPN should also promote independence in eating when appropriate. There are a number of assistive devices that the LPN can suggest to help the client eat independently. Further, the LPN should reinforce client teaching on any dietary or nutritional needs based on the client’s diagnosis. These might include such dietary restrictions as “high protein” or “calorie restriction.”
When assisting with or monitoring a client eating, the LPN should pay attention to any signs or symptoms of eating difficulties. The client may be unaware of an inability to chew properly or swallow, which can become extremely dangerous. If the client does have eating difficulties, he or she should not eat without being monitored.
Monitor Ability to Eat and Drink
When monitoring a client while drinking, the LPN should check the client’s ability to swallow to assess the risk of aspiration (see below). When the client is eating, the LPN should monitor the client’s ability to chew, as unchewed food could become a choking hazard.
Potential for Aspiration
Clients with both acute and chronic conditions can be at risk for aspiration, which occurs when food or liquid enters the trachea. Clients with swallowing difficulties along with sedated clients are at risk for aspiration during eating or drinking. Clients with feeding tubes should constantly be monitored and assessed, as the tube placement could change, placing the client at risk.
Clients with eating difficulties may benefit from an enteral tube. When feeding clients using an enteral tube, the LPN 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 client’s nutritional input, monitoring the client’s elimination and associated impairments is of high importance.
Identify Impairment Risk
When caring for a client, identifying risks for impaired elimination and early action can prevent negative outcomes. One easily preventable elimination impairment risk is related to hydration. Clients should be encouraged to stay hydrated to prevent dehydration and constipation. Clients are also commonly given medications like opiods that decrease gastric motility, which can also lead to or exacerbate constipation.
Clients may be on a bowel or bladder management protocol, and the LPN should assist as needed. This may include caring for clients 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 LPN can auscultate for bowel sounds using a stethoscope. If bowel sounds are absent or decreased, the LPN should inform other members of the care team so that the appropriate interventions are taken.
The LPN 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 or removal of foreign objects.
Clients who are incontinent require meticulous skin care as the perineum is at high risk for skin breakdown. When caring for an incontinent client, 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 clients feel a loss of control. One of the basic needs clients can usually continue independently, or with assistance, is their personal hygiene.
Assist with Hygiene
The LPN can be instrumental in assisting with client hygiene. The LPN should first assess the clients and determine their usual personal hygiene habits and routines. As many hospitalized clients have impairments, the LPN should reinforce teaching on required adaptations for performing activities of daily living, such as use of a shower chair or handrails.
Clients 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 client, 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 LPN will assist with. During postmortem care, the LPN can assist the team with bathing and grooming of the body to prepare for family viewing or transport or assist with documentation tasks.
Rest and Sleep
Most, if not all, clients in an inpatient or outpatient setting are at risk for interrupted rest and sleep, which can have a negative impact on the healing processes.
Assess the Client
To promote optimal rest and sleep, the client should be assessed, and the LPN can identify the client’s usual rest and sleep patterns: ability to nap during the day, ideal bedtime, sleep rituals, or measures that may increase sleep quality. The LPN can use the client’s preferences to determine how and when to interact with the client.
Promote Rest and Sleep
Given that clients 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. Client care activities should be scheduled to promote adequate rest and sleep as opposed to multiple interruptions. Further, the LPN can provide measures to promote sleep and rest as appropriate.