Basic Patient Care and Assistance
Domain 6: Basic Patient Care and Assistance. This domain tests routine care: bed making, positioning, safe movement, pressure-ulcer prevention, feeding, elimination help and accurate observation and charting.
Comfort and positioning
An unoccupied bed is made with the patient away; an occupied bed is made with the patient turned and the side rail raised. Never shake linen near the patient's face. Key positions: supine (flat), lateral (side), prone, Sims, Trendelenburg (feet down) and Fowler's (head raised 45–60°). Fowler's helps breathing and feeding; a breathless patient is never left flat.
Safe movement
Plan the move, explain it, get help for heavy patients, keep feet apart, bend the knees, keep the load close and never twist. Use a slide sheet or hoist rather than dragging, which shears skin and strains your back. Raise side rails for an unattended confused patient and keep the call bell within reach.
Pressure ulcer prevention
Assess risk (Braden scale), reposition every two hours, keep heels and bony points off the bed, keep skin clean and dry, avoid massage over red areas, and support nutrition and hydration.
Observation
Record temperature, pulse, respiration, blood pressure, oxygen saturation, pain score, intake and output, stool and urine, and level of consciousness. Report any sudden change at once rather than at the end of the shift.
Worked example
A patient with asthma is breathless and cannot lie flat. Reasoning: raise the head end to Fowler's position, give prescribed oxygen, stay with the patient, record observations and inform the nurse in charge - lying flat would worsen breathing.
Traps
- Dragging instead of lifting a patient.
- Giving oral fluids to a drowsy or coughing patient.
- Documenting care you did not give.