Basic Care and Comfort: Mobility, Skin, Nutrition, and Elimination
What you must understand
This domain covers the hands-on fundamentals: positioning and alignment, pressure injury prevention, hygiene, nutrition and hydration, urinary and bowel elimination, sleep, and pain management. Know the Braden scale categories, staging of pressure injuries (stage 1 is nonblanchable erythema; stage 3 extends to subcutaneous tissue; stage 4 exposes muscle or bone; unstageable is obscured by slough or eschar), and the rule that you never massage a reddened area. Know the interventions for constipation, urinary retention, and incontinence-associated dermatitis.
Know the pain assessment tools (numeric scale, Wong-Baker FACES, FLACC for young children, PAINAD for advanced dementia) and the principle that pain is what the client says it is. Understand aspiration precautions: upright positioning during and after meals, chin tuck, and thickened liquids for dysphagia.
Traps to watch
- Do not massage reddened skin or use heat on a new pressure injury.
- Repositioning interval is typically every 2 hours for at-risk clients, but individualized.
- Assess before intervening. If a client reports pain, assess location, quality, and severity first.
- Do not force fluids in a client with heart failure or renal disease without an order.
Rule of thumb
For any comfort question, ask: what is the cause, what is the least invasive effective intervention, and how will I evaluate it? Repositioning and support surfaces come before skin-protectant products.
Worked example
A bedbound client has a 2 cm reddened area over the sacrum that does not blanch. Stage it as a stage 1 pressure injury, keep the client off the area, use a pressure-redistributing surface, reposition every 2 hours, and document. Do not massage the area or apply heat.