Patient Care, Comfort and Basic Nursing Assistance
This domain tests the everyday care that keeps a dependent patient clean, safe, comfortable and dignified, and the documentation that proves it was done.
Comfort and positioning
Common positions: supine (flat), Fowler's (sitting up 45–60°), semi-Fowler's (30°), lateral (side-lying), prone and Trendelenburg (head-down, used rarely and only on order). Fowler's helps breathing and feeding; lateral relieves pressure on the sacrum.
Core care activities
- Bed making: unoccupied and occupied; keep linen wrinkle-free and never shake linen near your face.
- Bed bath and mouth care: maintain privacy, check skin and mouth for sores, dry skin folds thoroughly.
- Pressure-ulcer prevention: risk assessment, reposition every 2 hours, keep skin clean and dry, use pressure-relieving mattresses, ensure nutrition and hydration.
- Feeding: sit the patient up, check for choking, never feed an unconscious patient orally.
- Elimination: bedpan, urinal, catheter care, and strict intake–output recording.
- Mobility: passive and active range-of-motion exercises, early mobilisation, and safe transfer with correct body mechanics.
- Safety: side rails, call bell in reach, non-slip footwear, fall-risk identification, correct patient identification before any task.
Worked example
A 70-year-old with stroke is bedridden and cannot turn herself. Plan: reposition two-hourly using the 30-degree lateral tilt, inspect the sacrum, heels and ears at each turn, keep the skin dry, encourage oral fluids if swallowing is safe, start passive range-of-motion exercises, document each turn and report any reddened area that does not blanch. Reasoning: pressure injury develops over 2 hours on unrelieved pressure, so prevention is scheduled turning plus skin inspection plus nutrition, not just a special mattress.
Traps that cost marks
- Confusing Fowler's (head up) with Trendelenburg (head down).
- Dragging a patient instead of using a gait belt and leg muscles.
- Omitting intake–output or turn charts - if it is not recorded, it is treated as not done.
- Exposing the patient during a bath or procedure.