Physical Care Skills
Core concepts
Physical care questions test safe performance of delegated tasks and recognition of when to stop and report. Master vital signs (temperature, pulse, respirations, blood pressure, pulse oximetry), hand hygiene and standard precautions, bed bath and perineal care, oral care, dressing, positioning and body alignment, range of motion, transfers and ambulation with assistive devices, nutrition and fluid intake, intake/output measurement, elimination care, specimen collection, skin observation, oxygen safety, and postmortem care. Know normal ranges and which route is safe: oral temperatures are avoided for residents who are confused, uncooperative, or likely to bite; rectal temperatures are avoided with diarrhea or rectal surgery.
Traps
Questions often ask for the first or best action. The answer is usually hand hygiene, safety, or reporting to the nurse-not diagnosing or changing the care plan. Do not massage reddened pressure areas, put lotion between toes, soak a diabetic resident's feet, trim toenails of a resident with diabetes or poor circulation, or use hot water bottles on insensate skin. Do not raise side rails as a restraint. Never feed a resident who is NPO or has swallowing precautions. Avoid taking blood pressure on an arm with an IV, dialysis fistula, or mastectomy unless facility policy and the nurse direct otherwise. For dizziness on rising, dangle the resident and rise slowly.
Worked example
You notice new redness over a resident's sacrum. The wrong answer is to massage the area. The right response is to keep the area clean and dry, reposition the resident off the reddened area, and report the finding to the nurse. New, different, or worse findings always go to the nurse.
Rule of thumb
If it is new, different, or worse, report it. If it is not in your training, your care plan, or a lawful delegation, do not do it.