Introduction: Basic Care and Comfort – NCLEX-RN®

00:01 Welcome to the physiological integrity category.

00:04 Now, this category has four subcategories, basic care and comfort, pharmacological and parenteral therapies, reduction of risk potential and physiological adaptation.

00:16 Now we're going to look at each category by itself, and we're going to start with basic care and comfort. That's about 6 to 12% of the exam.

00:24 One thing I want to point out here, when you look at your performance and you look at which category you're struggling the most in physiological integrity is most often the category that students are struggling in.

00:36 But there's a reason.

00:38 Look at that.

00:39 You've got four subcategories in there.

00:42 So when you're looking at your results, you want to make sure that you don't just stop looking at the physiological integrity section, drill down and see which one of these four categories was the most problematic for you.

00:54 Basic Care and Comfort.

00:56 The definition for this category is providing comfort and assistance in the performance of activities of daily living.

01:03 This one is pretty straightforward when you read the definition, but I want to make sure you're clear on the types of content you might encounter.

01:10 So let's say that a client has some type of physical or sensory impairment that's definitely going to be difficult for their activities of daily living.

01:19 It's our job to recognize what type of positioning is better, what type of assistive device should they use.

01:25 What if the client is struggling with alterations in bowel and bladder elimination? Make sure that you're familiar how to keep them safe from skin breakdown and how to work through bowel and bladder training.

01:36 You may have to irrigate something, whether it's bladder irrigation, your irrigation, eye irrigation, because remember it addresses the senses which is are involved in the activities of daily living.

01:47 Now, skin assessment is a big one here, right? You want to make sure that you assess their skin frequently and you do the things that we know to do to maintain skin integrity.

01:56 If the patient's immobile, we're going to have to do a lot more interventions than a patient who can walk and talk and dress themselves and get around.

02:05 Orthopedic devices also fall into this category of basic care and comfort.

02:10 Now, don't get nervous.

02:12 I don't want you to go in and memorize all these types of things.

02:15 I'm going to give you some simple, basic common sense things to watch for.

02:19 And you should be okay in this area.

02:22 So with orthopedics, first of all, that's the kind of surgery I cannot watch because you're using all kinds of power tools on humans.

02:30 I can't take it.

02:31 But if you get an orthopedic question on this section of the end, I don't want it to freak you out. So here's the things I want you to keep in mind.

02:40 If the patient has some type of pin through their body, think of that as okay, the pins going to do two things risk for infection because you've broken the skin.

02:50 Second thing, it might impair circulation.

02:53 So you want to keep a very close eye on their circulation.

02:58 Also, remember anybody who's had a traumatic injury as at risk for compartment syndrome, that edema, that just compresses the blood supply.

03:06 So that's how we're going to deal with those types of orthopedic devices.

03:09 We're going to look for infection.

03:11 We're going to do good pin care and we're going to check for circulation frequently to see if the patient is still okay in those areas.

03:18 The other orthopedic device you'll likely run into is called traction.

03:24 I can't set up traction.

03:25 That's why we have specialists in the hospital that's set up.

03:28 So make sure in the question, are these things in order, the patient needs to be in alignment. So if you're in traction, you don't want them twisting if they're in traction on their legs.

03:40 Keep them in alignment.

03:42 Keep the sandbags off the floor.

03:44 Those are two cardinal rules when someone's in traction.

03:49 Keep those in mind.

03:50 And I promise you, you're going to do pretty well on those questions.

03:54 Now, the last one I talked about circulation, but I want to go back to that.

03:57 I want to revisit it because circulation is important for obvious reasons.

04:04 But we check circulation in the orthopedic patient, but also in other patients who might not be orthopedic patients, patients who are immobile.

04:13 So you can have both active or passive range of motion.

04:16 Active means I do it myself.

04:19 Passive means I am the patient.

04:22 I don't put any energy into this.

04:24 The therapist or the nurse will move my arm for me.

04:28 So in this case, I want you to keep in mind in RN world, the whole deal is to keep your patient as independent as possible.

04:38 Only do passive range of motion if the patient is paralyzed or it would cause harm to them. Always choose to keep them as active and independent as possible.

04:48 So there's going to be a tendency to want to select the answers that deal with keeping them active as long as it's safe.

04:56 Now, what about positioning? Well, there's three rules for positioning.

05:00 I want you to be able to picture in your mind what positioning looks like.

05:04 Think about what you're trying to promote and what you're trying to prevent.

05:08 Yeah, these questions can show up in activities of daily living.

05:11 So let's take, for example, somebody who is who's had a big head trauma and we want to position them where we promote.

05:20 They have a lowered intracranial pressure.

05:23 So what does the position look like? Yeah, I'm going to have their head of their bed elevated.

05:27 What am I trying to promote? Well, I know when I lower their head it's going to make their ICP go up, so I don't want to have their head lowered.

05:37 I want to raise it to help lower that intracranial pressure.

05:42 So what am I trying to promote? Lowered intracranial pressure? What am I trying to prevent? Elevated intracranial pressure? So when you're thinking of positioning, I want you to keep in mind what is the position look like? What am I trying to promote? What am I trying to prevent? And that's the key. So go back and look at those Fowler's supine prone.

06:03 You need to know what all of those positions are used for.

06:07 Now, lastly, it's mobilization, and you want to make sure the patient is moving safely.

06:12 Right? We talked about assistive devices.

06:14 We talked about patients that might have a sensory impairment, but you want to make sure that you keep them as active and mobile as possible as long as they are safe.

06:25 All right. Remember, we have that very detailed list that's in your handout for this section. But what I want to you kind of focus on as we wrap this part up is thinking about pain, what a patient takes in, and a weird one, postmortem care.

06:41 So in pain, we're looking at ways for you to intervene that aren't really pharmacological.

06:47 So you'll have questions on pain control in the pharm section.

06:50 But here we'll be looking at things more like complementary therapies and things that you can use, like aromatherapy or acupressure or supplements.

06:59 Those are respectable options.

07:01 So see if they are the best option in the question, they could be the correct answer.

07:06 So we're looking at non-pharmacological comfort measures and pain treatment in basic care and comfort.

07:12 Now nutrition comes into this role too.

07:14 So if the patient can eat by themselves, that's one thing.

07:17 But you might see patients who need to eat through a tube or who receive their medications through a tube, always flush before and after each medication.

07:28 So your role in this section is really to assess the client's ability to perform their activities of daily living.

07:36 So we talked about pain, we talked about what people eat, what goes in.

07:41 And the last thing we're going to talk about is postmortem care.

07:45 Now, there's not very many specific things that you need to know for this outside of it's all about respect for the patient and the family.

07:54 They remain your client until they leave your floor.

07:59 So that is in a nutshell what you can see in the basic care and comfort section.

08:05 Good luck on the practice questions.

08:07 Keep going. You can do this.