Basic Care and Comfort
Basic Care and Comfort
This domain tests hygiene, mobility, skin integrity, nutrition and hydration, elimination, sleep, pain, and comfort measures. The exam asks what intervention best maintains function and dignity while preventing complications.
Skin, mobility, and positioning
- Use the Braden Scale to identify pressure injury risk; reposition at least every 2 hours, more often if needed.
- Offload heels and use pressure-redistribution surfaces; keep skin clean and dry; avoid massage over reddened areas.
- Stage 1 pressure injury is non-blanchable erythema; deep tissue injury may appear purple or maroon.
- Encourage early ambulation, active and passive range of motion, and proper body alignment.
- Use mechanical lifts and encourage the client to help as able.
Nutrition, elimination, and comfort
- For dysphagia, sit upright, use prescribed thickened fluids, offer small bites, and place food on the stronger side; keep upright for 30 minutes after eating.
- Prevent constipation with fibre, fluids, mobility, and a toileting routine.
- Prevent catheter-associated urinary tract infection: closed system, bag below bladder, not on the floor, daily review of need.
- Assess pain with a validated scale; use nonpharmacological measures such as positioning, heat or cold, relaxation, and distraction.
- Apply cold for 15-20 minutes and heat for 15-30 minutes; check skin every 5-10 minutes.
- Cluster care to protect sleep.
Worked example
A bedbound client has non-blanchable redness over the sacrum. The PN completes a Braden assessment, repositions the client every 2 hours, offloads the heels, keeps the skin dry, ensures adequate protein and fluids, and documents the stage and interventions. The PN does not massage the reddened area, because massage can worsen tissue damage.
Traps that cost marks
- Massaging a reddened pressure area.
- Leaving a hot water bottle or heating pad on unattended.
- Using a routine indwelling catheter for convenience.
- Feeding a client with dysphagia while they are lying flat.
- Ignoring a pain score because the client "looks comfortable."