NCLEX-PN basic care and comfort: hygiene, mobility, nutrition, and elimination

Immobility leads to pressure injuries, deep vein thrombosis, pneumonia, constipation, and muscle atrophy. The LPN/LVN implements repositioning schedules, range of motion exercises, and mobility assistance as part of the care plan.

Repositioning: Every 2 hours for patients who cannot reposition independently. Use the 30-degree lateral tilt (not full side-lying) to reduce pressure on bony prominences. Inspect bony prominences at each repositioning: heels, sacrum, coccyx, ischial tuberosities, trochanters, lateral malleoli, and occiput.

Correct positioning: Head-of-bed elevation 30–45° for patients at aspiration risk. Semi-Fowler's (30–45°) for cardiac and respiratory patients. Left lateral decubitus for pregnant patients beyond 20 weeks gestation (prevents aortocaval compression). Trendelenburg is not recommended for shock (evidence does not support improved outcomes; increases ICP and respiratory compromise).

Safe patient handling: Mechanical lifts for patients who require total lift. Gait belt for patients with partial weight-bearing ability. Two-person assists for dependent transfers when mechanical lift is unavailable. Never drag — dragging creates shear force that damages skin.

Adequate nutrition supports healing, immune function, and pressure injury prevention. LPN/LVN responsibilities include meal assistance, monitoring intake, and enteral tube feeding per established protocol.

Dysphagia and aspiration risk: Never offer oral food or fluids to a patient with an unknown swallowing status. Following aspiration event or suspected dysphagia — NPO and notify RN/provider for swallowing evaluation. Speech-language pathology (SLP) determines diet texture. Common modified textures: regular, soft, minced, pureed, and thickened liquids (nectar-thick, honey-thick, pudding-thick).

Enteral nutrition: Verify tube placement before each feeding (pH 1–5.5 for gastric; X-ray gold standard). HOB 30–45° during and 30–60 minutes after feeding. Flush with water before and after medications. Monitor for residual per protocol (gastric residual volume >250–500 mL — hold and report per protocol). Signs of intolerance: vomiting, abdominal distension, diarrhea.

Oral care is a high-yield NCLEX-PN topic because it directly connects to infection prevention (ventilator-associated pneumonia, aspiration pneumonia) and patient comfort.

ICU oral care: Chlorhexidine gluconate (CHG) oral rinse twice daily is evidence-based practice for VAP prevention in intubated patients. Foam swabs and suction tools for unconscious patients — never leave oral secretions to pool. Suction before repositioning to prevent aspiration of secretions.

Complete bed bath: Warm water 43–46°C, change water when cool or dirty. Clean from cleanest to most contaminated areas (face → body → perineum). Assess skin condition during bath — document and report breakdown, redness, moisture-associated skin damage (MASD), or concerning lesions.