Basic Nursing and Patient Care Procedures
Scope
The exam tests the safe performance of routine care - vital signs, bed making, positioning, hygiene, feeding and fluid balance - and the recording that proves you did it. Marks are given for the correct order of steps and for the normal ranges.
Core rules and normal values
- Adult resting: pulse 60–100/min, respiration 12–20/min, oral temperature 36.5–37.5 °C, axillary about 0.5 °C lower, BP 120/80 mmHg.
- Count pulse for a full minute; count respiration for one minute without telling the patient (30 seconds and doubling is acceptable only if the rhythm is regular).
- Reposition a bed-bound patient at least every 2 hours; inspect pressure points (sacrum, heels, occiput, elbows, trochanters) each time.
- Fowler's = head of bed 45–60°, semi-Fowler's 30–45°, used for breathlessness and after nasogastric feeding.
- Ryle's tube: confirm placement, elevate the head 30–45°, check residual volume, give feed at room temperature, flush with water afterwards.
- Intake–output chart: oral, tube, IV fluids and fluid in food all count as intake; urine, vomit, drain, stool and insensible loss are output.
Worked example
A 24-hour chart shows 1500 mL IV, 800 mL oral, 400 mL soup, urine 1200 mL, vomit 200 mL, drain 100 mL. Reasoning: intake = 1500 + 800 + 400 = 2700 mL. Output = 1200 + 200 + 100 = 1500 mL. Balance = +1200 mL (positive). Same-day totals, not separate shifts, are compared; a positive balance may be acceptable in a healthy adult, but a negative balance with a rising pulse must be reported.
Traps that cost marks
Recording output but forgetting the IV flush; writing a temperature without °C or route; measuring BP over a clothing sleeve or on the arm carrying an IV line; leaving bed rails down after care; documenting a procedure before actually performing it.