🛏️ New Lesson 20
Basic Care & Comfort
Hygiene, mobility, positioning, rest, elimination, nutrition assistance, and non-pharmacological comfort.
Positioning
Therapeutic Positioning
| Position | Use | Key Points |
|---|---|---|
| Fowler's (45–60°) | Cardiac/respiratory patients, tube feeding | Improves breathing, reduces aspiration |
| Semi-Fowler's (30–45°) | Most post-op patients, GERD, tube feeding | HOB 30–45° = aspiration prevention standard |
| Supine (flat) | Spinal precautions, after LP | Lie flat 1–4 hrs post lumbar puncture |
| Prone | ARDS, pressure injury prevention (alternate) | Improves oxygenation in ARDS |
| Left Lateral (Sims) | Enema, rectal exam, unconscious patient | Protects airway, facilitates drainage |
| Trendelenburg | NOT for shock — use modified (legs up only) | Classic Trendelenburg is NO longer standard for shock |
| Reverse Trendelenburg | GERD, aspiration risk patients | Head up, feet down |
| Left Lateral (OB) | Late pregnancy, fetal decelerations, LION | Relieves aortocaval compression |
Hygiene & Safety
Hygiene & Fall Prevention
🛁
Hygiene principles: Work clean to dirty. Wash face before perineal care. Warm water. Patient preference drives scheduling when possible.
| Fall Prevention Bundle | Details |
|---|---|
| Bed in lowest position | Reduces injury severity if fall occurs |
| Call light within reach | Teach patient to call before getting up |
| Non-slip footwear | Grip socks or shoes — never bare feet |
| Adequate lighting | Especially nighttime bathroom trips |
| Scheduled toileting | Reduces urgency-related falls |
| Medications review | Sedatives, diuretics, antihypertensives = high fall risk |
| Bed/chair alarms | Alert staff before patient attempts independent transfer |
⚠️
MORSE Fall Scale ≥45 = High Risk — implement full fall precautions bundle immediately. Document fall risk in the care plan.
Elimination
Elimination — Urinary & Bowel
| Parameter | Normal | Action Threshold |
|---|---|---|
| Urine output | ≥30 mL/hr adult | <30 mL/hr for 2+ hrs = notify provider |
| Urine color | Pale yellow, clear | Dark amber = dehydration | Red = blood |
| Bowel frequency | 3x/day to 3x/week | No BM for 3+ days in hospitalized patient = assess |
| Stool color | Brown, formed | Black tarry = upper GI bleed | Bright red = lower GI |
🚽
Catheter care: Maintain closed drainage system. Bag always BELOW bladder. Assess for CAUTI: cloudy/foul urine, fever, dysuria. Remove catheter ASAP.
💊
Constipation prevention: All patients on opioids MUST receive a bowel regimen (stool softener + stimulant laxative). Constipation is the ONE opioid side effect that never develops tolerance.
Nutrition Assistance
Nutrition Assistance & Dysphagia
🍽️
Before ANY oral intake after stroke or head/neck surgery: Swallowing assessment by the nurse → SLP evaluation → diet modification per recommendation.
| Situation | Nursing Action |
|---|---|
| Patient at aspiration risk | HOB 90°, thickened liquids per SLP, chin-tuck technique, small bites, remain upright 30–60 min after meals |
| Patient on tube feeding | Verify placement before each feeding, check residual, HOB 30–45°, flush before/after meds, monitor for diarrhea/constipation |
| Patient refusing meals | Assess cause (nausea, pain, culture, depression), offer preferred foods, document intake, consult dietitian |
| Patient with diabetes | Consistent carbohydrate timing with insulin, check glucose pre-meal, hold next meal if hypoglycemic until treated |
📖 Study Notes
🛏️
Positioning mnemonic: FOWLer's = FOWLs (birds) like to be UP. Semi-Fowler = standard post-op and feeding position. Left lateral = OB emergencies and unconscious airway protection.
💡
Non-pharmacological comfort measures: Cold/heat therapy, repositioning, distraction, guided imagery, music therapy, massage. These are first-line comfort tools and frequently tested.
⚠️
Heat vs Cold application: Heat = muscle relaxation, increases circulation (chronic pain, spasms). Cold = reduces swelling and inflammation (acute injury, first 24–48 hrs). Never apply directly to skin — protect with cloth.