Basic Care & Comfort

Points to Remember
Nutrition & Fluid Intake

 All individuals require the same nutrients, but the amounts vary according to factors such as
age, weight, activity level, and health state.

 The energy value of foods is defined in calories; only proteins, fats and carbohydrates provide
calories.

 Essential amino acids cannot be synthesized; they must be ingested daily.

 Weight is maintained when daily food intake equals energy expenditure.

 Weight loss is a long-term process and patients need long-term support.

 Increased fiber in the diet may cause flatulence.

 The normal thirst mechanism in the elderly may be diminished and they may need
encouragement to drink sufficient water to prevent dehydration.

 The average adult drinks 2 to 3 liters of water per day.

 Normal lab values to know:

o Sodium: 135 - 145 mEq/L (135-145 mmol/L)

o Potassium: 3.5 - 5.1 mEq/L (3.5-5 mmol/L)

o Chloride: 96-106 mEq/L (96-106 mmol/L)

o Bicarbonate: 22 - 29 mEq/L (22-26 mmol/L)

Elimination

 In constipation, increase fluid to 3000 mL/day (unless contraindicated).

 Small frequent loose stools or seepage of stool are often indicative of a fecal impaction.

 Use transparent drainage bag initially for assessment of stoma and drainage.

 Avoid foods that cause odor, gas, diarrhea, or may block ileostomy.
 The majority of residents in nursing homes are incontinent but incontinence is not a normal
sequela of aging.

Pain

 Allow the client to rate the degree of pain (typically using a 10 point scale) and later to assess
(and chart) degree of relief from pain relief measures.

 Self-control methods to manage pain: distraction, massage, guided imagery, relaxation,

biofeedback, and hypnosis.

 Initiate pain relief before the pain becomes unbearable.

 Patient controlled analgesia (PCA) is effective at controlling pain and avoiding the peaks and
valleys of nurse-administered narcotics; clients typically use less pain medication overall than
clients receiving nurse-administered narcotics.

 Be sure to assess and monitor respiratory rate for client on PCA; have Narcan ready to reverse
effects of the narcotic.

Mobility

 There should be at least two inches between axilla and top of arm piece of crutch to prevent
pressure on the brachial plexus.

 Prevent deformities and complications such as contractures, thrombophlebitis, and pressure

ulcers by regularly turning and positioning the client in good alignment.

 Discontinue ROM exercises at point of pain.

 Use non-skid, rubber tips on crutches and canes to prevent slipping.