Pediatric Basic Care and Comfort Study Guide

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PEDIATRIC BASIC CARE A N D COMFORT STUDY GUIDESBasic Care and Comfort Study Guide for theNCLEX-RNExamHow to Prepare for Basic Careand Comfort Questions on theNCLEX-RN® ExamGeneral InformationThese questions represent one of four subdivisions of the topicPhysiologies!/ntegrftycovered on the NCLEX-RN® exam. They examine the best practicesfor patient care duringdaily living activities,such ashygiene, physicalmovement,and obtainingnutrition.Here are some of the concepts you arelikely to encounter in these questions.Assistive DevicesAn important part of the basic care and comfort of your patients will involveyour ability to assess the need for assistive devices, provide instructions fortheir use, and evaluate the patient's ability to effectively use them.Types of Assistive DevicesAssistive devices can include those forphysical ambulation and safety,such as a walker, cane, and/or crutches. It is also important to keep in mindthat devices such as hearing aids, sound amplifiers, and other alerting devicesmay be necessary for a patient with ahearing deficit.Likewise, a serviceanimal, walking cane, and Braille devices may be utilized by patientswithvision deficitsor blindness. A patient with aspeech impairment(suchas after a stroke, etc.) may require the use of wordboards, pictureboards, orhandheld speech-generating electronic devices to properly communicate.Assessing the Patient for Device Need

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Each patient will need a full assessment to determine the proper assistivedevices that would be the most helpful. Just as two patients with the samemedical condition may require different therapies for optimal health andfunctioning, no two patients with the same speech, auditory, physical, orcommunication deficits will need the same assistive devices. Youmustindividualizeyourrecommendations based upon the specific needs ofeach patient.Assisting with Proper Use of DevicesNurses play an important educational role fortheir patients who need to useassistive devices. When the patient has been fully assessed and the correctassistive device chosen, the nurse must ensure that the patient is able to usethe device safely and in a manner that allows the patient toefficiently andsafely perform activitiesof daily living while allowing for themaximumamount of independencepossible.Evaluating the Success of Device UseSuccessful use of assistive devices can be determined by directpatientobservationas well as his or her ability to remaininjury-freeduetocorrect usage of the device. The patient should also feel a sense of enhancedself-esteem and self-worth with proper use. If adjustments to physical devicesneed to be made (cane length, height of crutches, etc.), you will beresponsible for helping the patient make this correction. Likewise, if aparticular assistive device does not seem to be allowing a patient to performto his or herfullpotential, discussalternative choicesandmakearrangements for the patient to try something new.EliminationHelping patients meet their elimination needs is central to their basic care andcomfort. Both bowel and bladderfunctionscan become altered, which willrequire you to provide appropriate nursing interventions for your patient'shealth and well-being.Assessment for Elimination IssuesA patient may develop an alteration of either bowel or bladder function (orboth) for many reasons. Thesereasonsinclude, but are not limited to:age,

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decreased muscular tone, physical disorders including anatomicalstructural disorders, neurological disorders, and psychologicalproblems. Medicationuse can also affect your patient's ability toproperlyvoid urine and/or feces. A full nursing assessment is necessary to identify theproper interventions for each patient.Common Terms Relating to Urination ProblemsUrinary elimination is more commonly referred to asm/ctur/tion. One of themost common problems related to micturition is a urinary tract infection (UTI).•Polyuria:excessive production of urine (>2.5 L in 24 hours). Normaloutput is about 2 L a day. Nocturnal polyuria, or nocturia, occurs onlyduring the night time hours.•Oliguria: lessthan normal urinary output (<400 mL in 24 hours).•Anuria:lack of production of urine or severely scant amount of urine(<50 mL in 24 hours)..Dysuria:painful or difficult urination.•Urinary incontinence:the involuntary leakage of urine or loss ofbladder control. The five main types are: functional, reflex, stress, urge,and total.•Urinary retention:theaccumulation of urine inthebladder due to theinability to completely empty it.•Urgency:the strong, sudden, and uncontrollable urge to urinate.Common Terms Relating to Bowel ProblemsThe passage of stool is referred to as defecation. You will need to identifypotential bowel problems based on the age and health of your patient.•Constipation:less than three bowel movements a week..Diarrhea:watery or loose stool. The medical definition of diarrhea isthree or more loose stools over a 24-hour period.

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•Fecal impaction:an accumulation of rock-hard stool inside the rectumthat cannot be passed.•Flatulence:theexpulsionofgastrointestinal gas.IrrigationsAt times, you will b e responsible for performing irrigations of bodily orifices inorder to provide therapeutic intervention and maintain proper organ function.This may include:bladder, eye, ear, and ostomy (urostomyforurinarydiversion andcolostomyforfecal diversion). A gown should always be usedto protect from sprays and splashes in addition to goggles and protectivemasks when these occurrences are expected, and gloves should always beworn. Sterile technique is always used with the exception of fecal diversionirrigation in which you should use clean technique.Skin Care for Incontinent PatientsProviding constant and vigilant skin care is essential for an incontinent patient.Skin that is exposed to urine and feces should bewashed and dried. Inaddition, the use of certainbarrier productscanhelp prevent skinbreakdown and complications. These may include solid skin barriers, moisturebarrier ointments, moisture barrier pastes, and skin sealants.Alternative TherapiesPatients who cannot urinate o n their own or who are unable to ambulate willneed a urinary catheterto promote urination. The most common of these istheFoley catheter.The size of the catheter is referred to as the Frenchor Fr.Men, women, and children all require different sized catheters. Due tothe high risk of infection, catheter insertion is always performed under steriletechnique and never delegated to unlicensed medical personnel.Evaluation of Restorative MethodsSuccessful management of bowel and bladder elimination issues shouldinclude (at the very least):•regular, painless, and nearly complete emptying of both urine and stoolwithout urgency

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-the ability to recognize and respond to the need to urinate and defecate-remaining infection-free•good maintenance of skin integrity.Patients with urinary or fecal incontinence may undergo bladder orboweltrainingtodevelop better control over elimination. Also, be mindfulofbasic interventionsthat can have a significant impact on a patient's abilityto properly urinate and defecate such as diet, fluids, exercise, privacy, timing,and positioning if bedridden.Mobility and ImmobilityA nurse will need to assess a patient's mobility, including strength, gait, motorskills, coordination, and balance. Appropriateinterventionsarenecessary toprevent immobility, which carries the risk ofcomplicationssuchas skinbreakdown and contractures.MobilityPatients' ability to b e mobile is vital to their physical and psychological health.Iti s defined a s "the ability to move freely, easily, and purposefully in one'senvironment." It is essential for life and plays a key function in one's recoveryand overall health. Your assessment of mobility should uncover deficienciesthat can b e corrected with appropriate nursing interventions to beimplemented into the patient's care plan.Mobility AssessmentDirect visualization of the patients is the best way to assess their mobility.Standardized tests may b e used, but simply observing the way they move inbed, sit unassisted, rise from sitting to standing, transfer from the bed to chair,or stand and walk can provide good information. Observe thegaitduringwalking. Gait can give valuable information about balance, motor strength,joint mobility, and muscle coordination. Your assessment should also testeach of these factors individually as well.Assistive Devices

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