Skip to content

Get the app

Study guide · Physiological Integrity

Basic Care and Comfort

6 to 12% of the exam · 16 activity statements

Basic Care and Comfort covers the everyday care that keeps a client nourished, hydrated, comfortable, mobile, rested, clean and safe: nutrition and enteral feeding, elimination, intake and output, sleep, activities of daily living, assistive devices, irrigations, skin, pain and comfort measures, orthopedic devices, circulation and care after death. REx-PN items test whether the practical nurse carries out this care correctly, spots the finding that signals a complication, works within scope and reports what needs the RN or the primary health care provider.

A study feature written by ExamDragon, not part of the real exam. Each heading is one of the Related Activity Statements the Test Plan lists for this category (16 of them), in our words; the official wording is in the Test Plan.

At a glance

Physiological Integrity
6 to 12%

of the exam (the Test Plan's range)

Activity statements
16
Key terms
8

What this guide covers, statement by statement

  1. Keep track of the client's nutrition
  2. Give tube feedings
  3. Check the client's elimination and act on what you find
  4. Track what the client takes in and puts out and act on it
  5. Check how the client sleeps and rests and act on it
  6. Judge how well the client manages daily self care and help as needed
  7. Teach and help a client manage a loss of physical function, sight or hearing, such as with aids or positioning
  8. Irrigate the bladder, wounds or eyes
  9. Care for the body after death
  10. Check the skin and protect its integrity
  11. Find out what complementary therapies or supplements the client uses and whether they are safe
  12. Ease discomfort without medication
  13. Check for pain and treat it
  14. Put on, look after or take off orthopedic devices such as splints or braces
  15. Help blood flow and venous return, such as through movement, stockings or compression devices
  16. Check and care for enteral tube sites

1Keep track of the client's nutrition

  • Unplanned weight loss is a key sign of risk; 5% or more in a month is significant.
  • Weigh the client at the same time, on the same scale, in similar clothing.
  • Watch intake at meals, chewing and swallowing, dentition, appetite and the ability to feed oneself.
  • Body mass index is weight in kg divided by height in metres squared; 18.5 to 24.9 kg/m² is the usual adult range.
  • Low albumin and hemoglobin with poor intake and weight loss support a nutritional problem; report so a dietitian can assess.
  1. In practiceA resident has lost 4 kg in a month and leaves most of her meals. The nurse confirms the weight on the same scale, records intake for three days and reports to the RN so the dietitian can assess.
  2. Where questions turnRelying on one normal body mass index and missing a recent unplanned weight loss.
Practise this activity

2Give tube feedings

  • Keep the head of the bed raised at least 30 degrees during feeding and, for continuous feeding, at all times.
  • Before each feeding or medication, check the external length mark and, as policy directs, the pH of aspirate; listening for injected air is not reliable.
  • Pump rate equals volume divided by running time (mL divided by h).
  • Flush with water as policy directs before and after each medication and give medications separately, never in the formula.
  • Signs of intolerance: nausea, vomiting, distension, cramping, diarrhea; stop or slow the feeding as policy directs and report.
  • Limit hang time for open-system formula and label and change equipment on schedule.
  1. In practiceBefore a bolus feeding, the nurse finds the tube's mark 8 cm further out than recorded. She holds the feeding and reports to the RN because the tube may have moved out of the stomach.
  2. Where questions turnConfirming tube placement by injecting air and listening, which is no longer an accepted check.
Practise this activity

3Check the client's elimination and act on what you find

  • Know the client's usual bowel and bladder pattern and report changes.
  • Prevent constipation with fluids, fibre, activity and a toileting time after a meal.
  • After catheter removal, small frequent voids, a feeling of incomplete emptying or a palpable bladder suggest retention; bladder scan as policy allows and report.
  • A healthy stoma is moist and pink to red; a pale, dusky, purple or black stoma is reported at once.
  • Prompt toileting and continence care protect the skin and the client's dignity.
  1. In practiceEight hours after her catheter was removed, a client has voided only 60 mL and feels full. The nurse scans her bladder as policy allows and reports a large volume so the primary health care provider can order catheterization.
  2. Where questions turnEncouraging more fluids for a client who is retaining urine.
Practise this activity

4Track what the client takes in and puts out and act on it

  • Record all intake: oral fluids, tube feedings and flushes, intravenous fluids and ice chips as the facility counts them.
  • Record all output: urine, emesis, drainage and liquid stool.
  • Adult urine output below about 0.5 mL/kg/h (around 30 mL/h) is reported.
  • A gain of more than about 1 kg in a day usually reflects fluid; with intake far above output and edema, report it.
  • The nurse does not start fluid restriction or extra fluids that need a prescription.
  1. In practiceA client's intake is 2400 mL and output 900 mL in 24 hours, with a 1.5 kg gain and new ankle swelling. The nurse reports the imbalance to the RN rather than waiting for the next shift.
  2. Where questions turnStarting a fluid restriction without a prescription.
Practise this activity

5Check how the client sleeps and rests and act on it

  • Start with nonpharmacological measures: the client's usual routine, less noise and light, a back rub, toileting before bed.
  • Sleep hygiene: a regular wake time, little caffeine late in the day, no alcohol at bedtime, the bed used for sleep, exercise earlier in the day.
  • If unable to sleep after about 20 minutes, get up and do something quiet.
  • Sedatives increase falls and confusion in older adults and are not a first step.
  • A client with sleep apnea uses CPAP during all sleep, including in hospital, following policy.
  1. In practiceA 76-year-old cannot sleep in hospital. The nurse asks about her routine at home, dims the lights, offers a warm drink and toileting at her usual bedtime, and closes the door.
  2. Where questions turnReaching for a sleeping pill before trying the client's own routine.
Practise this activity

6Judge how well the client manages daily self care and help as needed

  • Assess what the client can do and help only with what they cannot; doing everything creates dependence.
  • Dress the weaker limb first and undress it last.
  • A new change in ability, such as spilling food, is assessed (observe the activity) and reported before the plan changes.
  • Set up tasks, use adaptive equipment and allow extra time.
  • UCPs can assist with activities of daily living; the nurse monitors the care and the client's response.
  1. In practiceA resident who always fed herself is now spilling food. The nurse watches a meal, sees a new tremor in her right hand and reports it so the occupational therapist can assess.
  2. Where questions turnTaking over a task for the client instead of finding out why the ability changed.
Practise this activity

7Teach and help a client manage a loss of physical function, sight or hearing, such as with aids or positioning

  • A cane is held on the stronger side and moves forward with the weaker leg.
  • With a standard walker, move it about one step ahead, step in with the weaker leg, then the stronger leg.
  • For a visual field loss, place essentials in the intact field at first and teach scanning toward the lost side; keep paths clear.
  • For hearing loss, face the client in good light, reduce background noise and speak at a normal pace.
  • Check that the client uses the device correctly and report unsafe use to the RN or therapist.
  1. In practiceA client with a weak left leg holds the cane in his left hand. The nurse moves it to his right hand and has him advance it with his left leg, then watches him walk the hallway.
  2. Where questions turnHolding a cane on the weaker side.
Practise this activity

8Irrigate the bladder, wounds or eyes

  • Eye irrigation: tilt the head toward the affected side and flow from the inner to the outer corner.
  • Wound irrigation: a gentle flow from the cleanest to the dirtiest area, letting fluid drain away; never reuse solution.
  • Continuous bladder irrigation: true urine output equals total drainage minus irrigant infused.
  • Watch bladder irrigation drainage for clots and bright red blood, and report a fall in drainage.
  • Use the solution, volume and technique prescribed and document the return.
  1. In practiceAt the end of a shift, a client's drainage bag holds 3400 mL, and 2600 mL of irrigant ran in. The nurse records 800 mL of urine and notes the light pink colour.
  2. Where questions turnRecording the whole drainage volume as urine output during bladder irrigation.
Practise this activity

9Care for the body after death

  • Place the body flat with a pillow under the head, close the eyes and mouth and put dentures in place, as policy allows.
  • Remove tubes and lines unless the death is a coroner's case, in which case they stay in place.
  • Clean the body, apply identification and handle belongings as policy directs.
  • Give the family time and privacy, and ask about cultural and spiritual practices, such as washing the body themselves.
  • Follow the facility's policy on notifications, including organ and tissue donation.
  1. In practiceA family says their faith requires them to wash the body. The nurse asks how they would like to proceed, provides supplies and privacy, and follows policy on timing.
  2. Where questions turnCompleting routine postmortem care without asking about the family's wishes.
Practise this activity

10Check the skin and protect its integrity

  • Inspect skin over bony prominences at least daily; in dark skin, compare warmth, firmness and colour with nearby skin.
  • Stage 1 is intact skin with nonblanchable redness; it may look purple or darker in dark skin.
  • Braden scale: lower scores mean higher risk; 12 or less is high risk.
  • Prevent injury with repositioning, a pressure-redistributing surface, heels floated off the bed, moisture control and nutrition.
  • Avoid massage of reddened areas, ring cushions, several layers of pads and a high head of bed; use a lift sheet to prevent shear.
  1. In practiceA bedbound resident's Braden score is 12. The nurse arranges a pressure-redistributing mattress, floats her heels and plans repositioning with the UCP at least every two hours.
  2. Where questions turnMassaging a reddened bony area, which damages the tissue further.
Practise this activity

11Find out what complementary therapies or supplements the client uses and whether they are safe

  • Ask every client about supplements, herbal products, aromatherapy, acupressure and other therapies; many do not mention them unless asked.
  • Ginkgo, garlic and fish oil can increase bleeding with anticoagulants.
  • St. John's wort with an antidepressant can cause serotonin syndrome and changes how many drugs are processed.
  • Report possible interactions to the RN or prescriber; do not stop prescribed medications.
  • Follow facility policy before using aromatherapy or similar therapies, considering allergies and others nearby.
  1. In practiceA client on warfarin mentions a new ginkgo supplement. The nurse records it and reports it to the RN because of the bleeding risk.
  2. Where questions turnTreating a natural product as harmless and not reporting it.
Practise this activity

12Ease discomfort without medication

  • Comfort measures include positioning, heat or cold as prescribed, massage where safe, relaxation, music and distraction.
  • Heat and cold: check the skin and sensation first, use a barrier and limit the time to about 20 minutes.
  • Clients with reduced sensation or circulation are at higher risk of burns and cold injury.
  • Children: age-appropriate distraction, parents present and simple honest explanations.
  • Nonpharmacological measures are used with, not instead of, prescribed analgesia.
  1. In practiceA client with a back strain has heat prescribed. The nurse wraps a warm pack in a towel, checks the skin after 10 minutes and removes it at 20 minutes.
  2. Where questions turnApplying heat or cold directly to the skin or for too long.
Practise this activity

13Check for pain and treat it

  • The client's self-report is the most reliable measure of pain; accept it even if behaviour seems to differ.
  • Assess pain at rest and with activity; pain that stops coughing or walking is not controlled.
  • When a client cannot self-report, use a validated behavioural tool (face, breathing, vocalization, body language, consolability).
  • A new pain with different features in a client with chronic pain is assessed as new, not assumed to be the old problem.
  • Reassess after each intervention and report pain that is not relieved.
  1. In practiceAfter abdominal surgery, a client rates pain 3 out of 10 at rest but will not cough. The nurse asks for a rating with movement, splints the incision with a pillow and reports that pain is limiting his recovery.
  2. Where questions turnRecording pain as controlled based on a low rating at rest.
Practise this activity

14Put on, look after or take off orthopedic devices such as splints or braces

  • After a cast is applied, check circulation, movement and sensation of the fingers or toes regularly.
  • Report pain that increases despite elevation and analgesia, numbness, tingling, pallor, coolness and slow capillary refill (possible compartment syndrome).
  • A plaster cast feels warm while it sets; itching is common, and nothing is pushed under the cast.
  • Traction weights hang freely and are never lifted or removed without a prescription.
  • Splints and braces are applied as prescribed, with skin checked under the edges.
  1. In practiceSix hours after a forearm cast, a client reports worsening pain and tingling fingers that are cool and pale. The nurse elevates the arm and reports immediately.
  2. Where questions turnTreating pain under a new cast with more analgesia without checking circulation and sensation.
Practise this activity

15Help blood flow and venous return, such as through movement, stockings or compression devices

  • Active and passive range of motion keep joints mobile and promote venous return; support the joint and stop at resistance.
  • Antiembolism stockings: measure for size, apply when swelling is least, smooth wrinkles, never roll down, remove daily for skin checks.
  • Sequential compression devices are not applied to a leg with signs of a clot.
  • Unilateral calf pain, warmth and swelling are reported promptly; do not massage the calf.
  • Early mobilization, position changes and leg exercises reduce the risk of clots.
  1. In practiceBefore applying compression devices, the nurse notes the right calf is warm, swollen and painful. She holds the devices, keeps the client at rest and reports to the RN.
  2. Where questions turnApplying compression or massage to a leg with signs of a clot.
Practise this activity

16Check and care for enteral tube sites

  • Clean around a gastrostomy site with mild soap and water, dry well and leave open or under a light dressing.
  • Check the external length mark each shift; a change suggests the tube has moved.
  • Report redness, warmth, swelling, thick drainage or leakage around the site.
  • Nasogastric tubes: check the nostril for pressure, keep the securing device clean and give frequent mouth and nose care.
  • A new gastrostomy tube that comes out: cover the site and report at once; never reinsert it in a new tract.
  1. In practiceA gastrostomy placed two weeks ago comes out during a turn. The nurse covers the site with dry gauze, notes the time and reports to the RN immediately.
  2. Where questions turnPushing a dislodged tube back into a new tract.
Practise this activity

Key terms

Body mass index
Weight in kilograms divided by height in metres squared.
Feeding intolerance
Signs such as vomiting, distension, cramping or diarrhea showing a tube feeding is not tolerated.
Urinary retention
Inability to empty the bladder completely.
Braden scale
A pressure injury risk tool; lower scores mean higher risk.
Shear
Skin moving one way while deeper tissue moves another, as when a client slides down in bed.
Homonymous hemianopia
Loss of the same half of the visual field in both eyes, often after a stroke.
Compartment syndrome
Rising pressure within a muscle compartment that compromises circulation and nerves.
Postmortem care
Care of the body after death, including positioning, cleaning and identification, with respect for the family's practices.

After this guide: You should be able to give basic care safely, calculate intake, output and feeding rates, recognize the findings that signal a complication and know what the practical nurse does and what goes to the RN or the primary health care provider.

Practise Basic Care and Comfort