Page 2 - Basic Care and Comfort Study Guide for the NCLEX-RN Exam

Nutrition and Oral Hydration

The intake of the proper amount of water—in addition to the various nutrients, vitamins, and minerals required to maintain and promote health and wellness—will be a nursing priority for every patient. This will require you to have working knowledge of the four food groups (dairy, meat, fruits/vegetables, and grains) and the needs of your patients based on their age, weight, condition, medications, and ability to eat and drink independently. You should also be aware of cultural or religious considerations that play a role in nutritional recommendations and choices.

Assessing the Patient

Each patient should have a nutritional assessment that includes a stated intake history (subjective), one or more standardized tools (objective), anthropometric data like height, weight, BMI, etc. (objective), clinical data like activity, skin condition, quality of mucous membranes, etc. (objective), and biochemical data such as albumin, creatinine, hemoglobin, and transferrin (objective) to screen for proper intake and potential deficiencies.

Physical Ability

Paramount to a patient’s ability to have proper oral nutrition and hydration is an assessment of his or her ability to eat independently, chew adequately, and swallow properly. Poor dentition can also affect a patient’s ability to eat properly so this should be included in your assessment as well. It is important to remember that neurological conditions and side effects from therapies such as chemotherapy and/or radiation may affect your patient’s physical ability to obtain proper hydration and nutrition.

Nutritional Requirements

While most patients will simply require a well-rounded diet, some may have special restrictions due to specific health conditions or personal beliefs. Health conditions such as diabetes, hypertension, and high cholesterol mandate low-carbohydrate, low-sodium, and low-cholesterol diets, respectively. Specific religious and cultural entities, such as Jewish or Hindu populations, practice elimination of specific types of meat, particularly pork and beef, respectively.

Food Restrictions

Be mindful that patients may also have certain food restrictions both due to allergies to foods and potential medication interactions. Drugs can affect the digestive process overall, but foods may also hinder or enhance the action of the drug. Examples would include foods rich in vitamin K antagonizing the effects of warfarin and grapefruit juice inhibition of the cytochrome P450 enzyme, one of the most important in the metabolism of many different drugs.

Patient Preferences

Your patient’s preference for certain foods and quantities of food and water may depend on several factors. Each should be discussed and taken into consideration when developing the nutritional care plan. A few factors that may affect these preferences may include: age, gender, ethnicity, culture, personal preferences, and personal beliefs about food and food intake, as well as spiritual and religious practices and rituals.

Mathematical Calculations

The nurse will need to employ several mathematical calculations with regard to a patient’s nutrition and hydration. Examples include calorie counts, body mass index (BMI), and maintaining the daily intake and output record.

Managing Food Intake

It will be your responsibility to help your patient maintain, gain, or lose weight by developing a dietary plan that meets his or her specific needs based on your assessment. While most patients will likely need to lose weight, remember that those suffering with chronic diseases or conditions that involve nausea, vomiting, or diarrhea may need to gain weight. Regardless, all patients should have a balanced and healthy diet that includes a variety of choices and appropriate preferred foods.

Calorie Counts

Diets intended to stimulate weight loss or gain will involve the use of calorie counts. This will involve calculations of the number of calories in each gram of fat, protein, and carbohydrate that is eaten. The quantity or weight of the food consumed is needed for the calorie content of the food. Food labels provide this valuable information, and your patient should be educated on their use as well as how to calculate the number of calories consumed in both fresh and prepared foods.


Despite a well-rounded diet, nutritional supplementation may be necessary. Examples include drinks such as Ensure® and Boost®, which provide extra protein and some essential vitamins and minerals.

Measuring BMI

To assist in the understanding of how a patient’s nutritional status impacts his or her health, simple calculations like body mass index (BMI) may be calculated. The formula for measuring BMI is BMI= kg/m2 (body mass index = kilometers/meters squared). This formula helps to determine the measure of body fat based on a patient’s height. A result less than or equal to 18.5 indicates the patient is underweight, 18.5–24.9 normal weight, 25–29.9 overweight, and 30+ obese. Some patient’s results may be impacted by increase in muscle mass, as muscle is heavier than fat.

Eating Independence

Just as in all other activities of daily living, nurses and all other members of the healthcare team should encourage as much independence in eating as the patient can manage. If assistive devices are needed for this process, they must be incorporated into the patient’s care plan.

Alternative Feeding Methods

For patients unable to eat on their own or unable to get adequate amounts of food via oral intake, enteral nutrition may be given. This may be given on a continuous basis, intermittently, or in bolus form. Enteral feeding is done with a variety of different tubes; nasogastric, gastrostomy, and percutaneous endoscopic gastrostomy (PEG) are a few examples. Commercially prepared formulas are used for these feedings and are selected based on the patient’s specific nutritional needs. Pureed foods may also be used with some types of tube feedings.

Nurses must maintain the tubes and ostomy sites, maintain their correct positioning and cleanliness, and ensure proper functioning and patency. Common complications to watch for are aspiration, leakage, diarrhea, dehydration, nausea, vomiting, tube displacement, nasal irritation (naso tubes only), and infection (ostomy sites).

Monitoring Intake and Output

Measuring a patient’s daily intake and output (I&O) is essential for proper management and care. Intake includes calculation of all food and fluids consumed orally, given intravenously, and through tube/enteral feedings per day. Output is calculated by the volume of urine, vomitus, and wound/ostomy drainage that is produced per day and the number of bowel movements or volume of diarrhea excreted in a day. These calculations can be used (in part) to explain changes in a patient’s weight, hydration status, laboratory values, and vital signs.


Fluid imbalances can be in one of two categories: fluid excess (edema) or fluid deficits (dehydration). Each will have distinguishing clinical features and corresponding changes in a patient’s vital signs with which you should be familiar. Medications can trigger imbalances as can the age, gender, and underlying medical condition of the patient (diabetes, fever, etc.).

Personal Hygiene

Personal hygiene is considered an activity of daily living. Each patient will need assessment of these functions and may need intervention if unable to properly or safely perform hygiene activities independently.

Hygiene Assessment

Your assessment should include the patient’s ability to: bathe, wash, and shower; perform foot, hair, nail, and perineal care; shave; and perform proper oral and mouth care, including denture care when indicated. Remember that many different influences (cultural, religious, energy level, underlying condition, etc.) will impact a patient’s hygiene habits and routines. Just like any other aspect of patient care, hygiene care should be tailored to your patient’s needs, practices, routines, and preferences.

Daily Care Modification

Different patients will require different levels of nursing care and intervention for their hygiene needs. As you assess each patient, be mindful of the established standards for each task and provide proper education when necessary. Also incorporate assistive devices such as shower chairs, handrails, back sponges, and special tools for nail care. Remind patients to use devices consistently and demonstrate proper use to ensure their safety while maintaining the maximum amount of independence.

Post-Mortem Care

Nurses will provide post-mortem care and prepare the deceased’s body for viewing by the family and loved ones. This will include washing and drying the body, removing all medical equipment (IV lines, catheters, etc.), placing the arms, hands, and legs in good alignment, closing the eyes and jaw, and placing a shroud over the body. An identification tag should be placed on the toe, outside of the shroud, prior to transportation to the morgue.

Rest and Sleep

Rest and sleep are critical to overall health and recovery from an illness or acute stage of a medical condition or disease. Sleep disorders and lack of rest can negatively impact a patient’s physical and psychological health and well-being.

Assess for Patient Needs

Patients will vary in their individual needs for sleep and rest depending on their age, developmental stage, level of wellness, and activity level. It is important to note that, regardless of a patient’s baseline sleep needs, his or her needs will be increased during the time of an illness or other health-related problem. Other factors that can affect sleep include: medications, lifestyle choices, work schedules, sleep environment, and emotional/psychological stress.

Proper nursing interventions can be tailored when a specific sleep disorder has been identified. To determine this, a full physical examination, subjective sleep history, sleep log, and polysomnography are useful tools.

Use Pathophysiology Knowledge

Based on the specifics of a patient’s sleep disorder, you can use your knowledge of the associated pathophysiology to help your patient sleep and rest better. These interventions may include pharmacologic measures (pain control and nocturnal enuresis), non-pharmacological measures (stress/anxiety relief via relaxation techniques), and assistive devices (continuous positive airway pressure/CPAP for sleep apnea).

Adjust Patient Care Schedules Appropriately

Establishing a routine of good sleep hygiene will help your patients rest better while under your care and provide a template for them to follow once they are back at home. Regular bedtimes and wake times, regular physical activity, limiting daytime naps, avoidance of heavy meals and alcohol later in the evening, and establishing a quiet, calm, and relaxing sleep environment are just a few examples of this.

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