Basic Care and Comfort: Practice Questions & Explanations

Pressure injury staging (NPIAP): Stage 1 — intact skin with non-blanchable redness; Stage 2 — partial-thickness skin loss with exposed dermis (looks like a shallow open ulcer, blister, or abrasion); Stage 3 — full-thickness skin loss exposing subcutaneous fat; Stage 4 — full-thickness with exposed bone, tendon, or muscle; Unstageable — full-thickness with eschar or slough obscuring depth; Deep Tissue Injury — intact or non-intact skin with persistent purple/maroon discoloration. Management principles for Stage 2: clean the wound (saline or commercial wound cleanser, not hydrogen peroxide which is cytotoxic); choose appropriate dressing (hydrocolloid for moist wound healing in clean wounds, foam for absorption, transparent film for shallow wounds); reposition every 2 hours; use pressure-redistribution surfaces (alternating pressure mattresses); manage moisture (incontinence care); optimize nutrition (protein, vitamin C, zinc); avoid friction and shear. Never massage pressure injuries — causes more tissue damage.

Aspiration is a major risk of enteral feeding. Signs of aspiration: new-onset cough during or after feeding; increased respiratory rate; decreased oxygen saturation; fever (often delayed); abnormal lung sounds (crackles, decreased breath sounds, especially in dependent areas); change in mental status. Prevention strategies: (1) Verify tube placement before each feeding (radiographic confirmation initially, then mark position and check for migration; pH testing of aspirate is also used — gastric pH should be acidic, less than 5); (2) Keep the head of bed elevated at least 30-45 degrees during feeding and for 30-60 minutes after; (3) Check residual volume per facility policy (typically before each intermittent feeding or every 4 hours for continuous feedings); withhold and notify provider if high residuals (definitions vary, often >250 mL or per provider order); (4) Use small bowel placement (post-pyloric tube) for high-risk clients; (5) Assess swallow function before resuming oral intake. Suspected aspiration: stop the feeding, suction airway, elevate head, assess vital signs, notify provider, anticipate chest x-ray and possibly antibiotics.

Sterile dressing changes follow specific aseptic technique: (1) Hand hygiene, gather supplies, explain procedure to client, position appropriately; (2) Don clean gloves; remove old dressing carefully (note drainage, odor, intact ness); discard in appropriate container; remove gloves; perform hand hygiene; (3) Assess wound: size, location, color (red/yellow/black indicates healing/slough/necrotic), drainage, periwound skin, signs of infection (redness, warmth, pain, purulent drainage, odor); (4) Set up sterile field on clean, dry surface above waist level; (5) Don sterile gloves (or use sterile technique with no-touch method); (6) Clean wound from least contaminated to most contaminated (clean wound: center outward in concentric circles or strokes from top to bottom; contaminated wound: outside in); use each gauze once; clean with normal saline or prescribed solution; (7) Apply sterile dressing per orders (gauze, transparent film, hydrocolloid, etc.); (8) Secure with tape; document wound assessment, procedure, client tolerance. Maintain sterility — sterile to sterile, anything that touches non-sterile becomes non-sterile, sterile field at waist level minimum, keep within sight at all times.

ACUTE PANCREATITIS pain management requires understanding both pharmacological and non-pharmacological approaches. PAIN MANAGEMENT: Opioid analgesics are appropriate and necessary for severe acute pancreatitis — the pain is severe and uncontrolled pain increases physiological stress; THE MORPHINE/SPHINCTER OF ODDI CONCERN: Historically, morphine was thought to cause sphincter of Oddi spasm and worsen pancreatitis; this concern is not supported by current evidence; morphine is used; many centres prefer HYDROMORPHONE or FENTANYL as they may have less effect on the sphincter; POSITIONING FOR COMFORT: FETAL POSITION (knees drawn up toward chest, curled on side) — reduces traction on the retroperitoneum and surrounding structures; patients often spontaneously adopt this position; HOW COMFORTABLE POSITIONING WORKS: The pancreas and surrounding inflamed tissues are retroperitoneal; lying supine stretches these tissues and worsens pain; the flexed position reduces stretch; NPO RATIONALE: NPO prevents stimulation of pancreatic enzyme secretion; even the sight or smell of food stimulates pancreatic secretion; patients need IV fluids and analgesia during NPO period; NASOGASTRIC TUBE: For clients with severe vomiting or ileus — not routinely indicated; provides comfort if vomiting is severe; total parenteral nutrition (TPN) or enteral feeding via jejunal tube for prolonged NPO (beyond 5-7 days).

NASOGASTRIC TUBE FOR GI DECOMPRESSION — patient education requires explaining the rationale clearly so the patient understands and complies. THE EXPLANATION: BOWEL OBSTRUCTION creates a mechanical blockage; intestinal secretions (gastric juice, bile, pancreatic secretions) continue to be produced at approximately 7-8 litres per day; these secretions accumulate proximal to (before) the obstruction; DISTENSION CONSEQUENCES: Progressive distension causes pain, nausea, vomiting; can reduce blood supply to the bowel wall (ischaemia); increases risk of perforation; THE NG TUBE: Drains the accumulating fluid and gas, relieving pressure; NPO STATUS: Eating or drinking adds fluid volume that the bowel can't pass through; worsens distension; increases pain; could complicate any upcoming surgical intervention. HOW TO EXPLAIN WELL: Use plain language; avoid jargon ('decompression' → 'removing gas and fluid that's building up'); tie the explanation to the patient's symptoms ('do you remember how much better you felt when the tube was placed and some of that pressure released? It's doing that continuously'); acknowledge that NPO is uncomfortable; explain what will indicate the obstruction is resolving (return of bowel sounds, passage of flatus, decreased NG output, reduction in distension). GOOD PATIENT EDUCATION: Explains the WHY, not just the what; tailored to the patient's level of understanding; addresses the patient's specific concern (in this case, wanting to eat/drink).