Why This Matters
Every nursing procedure you learn serves a deeper purpose: protecting patients from harm, gathering critical clinical data, and delivering therapeutic interventions safely. These foundational skills aren't just checkboxes on a competency list—they represent the core principles of infection prevention, patient safety, clinical assessment, and therapeutic communication that you'll be tested on throughout your nursing education and career. When you understand why each technique matters, you can adapt to any clinical situation, not just the ones you've memorized.
As you study these procedures, focus on the underlying rationale for each step. Why do we use sterile technique for some procedures but clean technique for others? What makes certain assessments time-sensitive? How do documentation practices protect both patients and nurses? Don't just memorize the steps—know what principle each technique demonstrates and what could go wrong if it's performed incorrectly.
Infection Prevention and Control
The chain of infection requires a pathogen, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Breaking any link in this chain prevents infection transmission. These techniques target multiple links simultaneously.
Hand Hygiene
- Most effective single intervention for preventing healthcare-associated infections—reduces pathogen transmission by up to 50%
- Two methods: soap and water for visibly soiled hands or Clostridioides difficile exposure; alcohol-based sanitizers (60-95% alcohol) for routine decontamination
- Five Moments for Hand Hygiene: before patient contact, before aseptic procedures, after body fluid exposure, after patient contact, after touching patient surroundings
Infection Control Practices
- Standard precautions apply to ALL patients regardless of diagnosis—assumes all blood and body fluids are potentially infectious
- Personal protective equipment (PPE) selection based on anticipated exposure: gloves for contact, gowns for splashes, masks/respirators for airborne or droplet transmission
- Environmental cleaning breaks the reservoir link—high-touch surfaces require disinfection between patients and at regular intervals
Compare: Hand hygiene vs. PPE use—both prevent transmission, but hand hygiene targets the healthcare worker as a vector while PPE creates a physical barrier. On exams asking about infection prevention priorities, hand hygiene is always the first-line intervention.
Clinical Assessment and Monitoring
Assessment is the first step of the nursing process and the foundation for all clinical decision-making. Accurate, timely assessment data drives appropriate interventions and early detection of deterioration.
Vital Signs Measurement
- Four core parameters: temperature, pulse, respiration rate, and blood pressure—often expanded to include oxygen saturation and pain as the "sixth vital sign"
- Trending matters more than single readings—a blood pressure of 100/60 may be normal for one patient but signal shock in another
- Timing and technique affect accuracy: wait 15-30 minutes after activity, use appropriate cuff size, position patient correctly for blood pressure
Patient Assessment
- Head-to-toe systematic approach ensures no body system is overlooked—consistency prevents missed findings
- Subjective data (what the patient reports) combined with objective data (what you observe and measure) creates a complete clinical picture
- Documentation of baseline status enables detection of changes—you can't identify deterioration without knowing the patient's normal
Pain Assessment and Management
- Standardized pain scales (numeric 0-10, Wong-Baker FACES, behavioral scales) ensure consistent measurement across providers
- Pain is subjective—the patient's self-report is the most reliable indicator; never dismiss pain based on appearance or vital signs alone
- Multimodal approach combines pharmacological and non-pharmacological interventions for optimal relief with fewer side effects
Compare: Vital signs measurement vs. comprehensive patient assessment—vital signs provide quick physiological data, while full assessment captures functional status, psychosocial factors, and subtle changes. Know when each is appropriate: vital signs for routine monitoring, comprehensive assessment for admission or status changes.
Medication and Fluid Administration
Safe medication administration requires systematic verification processes. Medication errors are among the most common—and most preventable—sources of patient harm in healthcare.
Medication Administration
- Five Rights (expanded to 9-10 in many facilities): right patient, medication, dose, route, time, documentation, reason, response, and patient's right to refuse
- Three checks: verify medication against the order when retrieving, when preparing, and at the bedside before administration
- Patient education is part of safe administration—patients who understand their medications can catch errors and improve adherence
Intravenous (IV) Therapy
- Verification before initiation: correct solution, rate, and compatibility with other infusions—wrong solutions can cause fatal electrolyte imbalances
- Site assessment every 1-4 hours for infiltration (swelling, coolness, pallor) and phlebitis (redness, warmth, pain along the vein)
- Infection prevention: aseptic technique for all access, dressing changes per protocol, prompt removal when IV no longer needed
Oxygen Therapy
- Delivery device selection based on oxygen needs: nasal cannula (1-6 L/min, 24-44% FiO2), simple mask (5-10 L/min, 40-60% FiO2), non-rebreather (10-15 L/min, up to 100% FiO2)
- Pulse oximetry monitoring with target SpO2 typically 94-98% for most patients; 88-92% for COPD patients at risk for oxygen-induced hypercapnia
- Safety considerations: oxygen supports combustion—no smoking, keep away from heat sources, secure tanks properly
Compare: Oral medication administration vs. IV therapy—oral is safer and preferred when the GI tract is functional, but IV provides immediate bioavailability for emergencies or when patients cannot take oral medications. Exam questions often test your understanding of when each route is appropriate.
Invasive Procedures and Sterile Technique
Procedures that breach the body's natural defenses require strict aseptic technique. Sterile technique prevents introduction of pathogens into normally sterile body sites.
Catheterization
- Indication assessment first—urinary catheters are a leading cause of healthcare-associated infections; use only when medically necessary
- Strict sterile technique during insertion: sterile gloves, sterile field, sterile catheter, and proper perineal cleansing reduce infection risk
- Ongoing monitoring: assess urine output (minimum 30 mL/hour indicates adequate kidney perfusion), watch for signs of CAUTI (fever, cloudy urine, new confusion in elderly)
Wound Care and Dressing Changes
- Assessment before intervention: document wound size, depth, drainage characteristics, wound bed appearance, and periwound skin condition
- Sterile vs. clean technique: sterile for acute surgical wounds and deep wounds; clean technique may be appropriate for chronic wounds in home settings
- Healing trajectory documentation—wounds should show progressive improvement; stalled healing indicates need for intervention change
Nasogastric (NG) Tube Insertion and Care
- Placement verification is critical before any use—aspirate gastric contents and check pH (should be ≤5.5), or obtain x-ray confirmation per facility policy
- Securing and marking prevents migration—mark the tube at the naris and reassess position before each use
- Complications to monitor: aspiration, nasal erosion, tube displacement, and electrolyte imbalances from gastric drainage
Tracheostomy Care
- Airway patency is priority—suction as needed using sterile technique, typically no longer than 10-15 seconds per pass
- Stoma care prevents skin breakdown and infection: clean inner cannula per protocol, assess site for redness, swelling, or purulent drainage
- Emergency preparedness: keep spare tracheostomy tube, obturator, and suction equipment at bedside; know the steps for accidental decannulation
Compare: Urinary catheterization vs. NG tube insertion—both are invasive procedures requiring sterile technique, but catheterization carries higher infection risk due to direct access to the urinary tract. Both require ongoing assessment for complications and removal as soon as clinically appropriate.
Patient Safety and Mobility
Safe patient handling protects both patients and nurses from injury. Proper body mechanics and positioning prevent complications ranging from pressure injuries to falls to musculoskeletal injuries in caregivers.
Patient Positioning and Transfer Techniques
- Body mechanics principles: wide base of support, bend at knees not waist, keep load close to body, avoid twisting—these protect the nurse's spine
- Therapeutic positioning: elevate head of bed for respiratory distress, position to prevent pressure injuries, maintain proper alignment for comfort and circulation
- Assistive devices (gait belts, slide boards, mechanical lifts) are required when patient weight or mobility limitations exceed safe manual handling thresholds
Compare: Manual repositioning vs. mechanical lift use—both achieve the same goal, but mechanical lifts are required for patients who cannot bear weight or when the patient's weight exceeds safe manual handling limits. Knowing when to use each protects everyone involved.
Emergency Response
Rapid recognition and response to life-threatening emergencies can mean the difference between survival and death. BLS skills must be automatic—there's no time to think through steps during a cardiac arrest.
Basic Life Support (BLS)
- Chain of Survival: early recognition and call for help, early CPR, early defibrillation, early advanced care, and post-arrest care
- High-quality CPR: compression rate 100-120/min, depth at least 2 inches (5 cm) for adults, full chest recoil, minimal interruptions
- AED use: apply as soon as available, follow voice prompts, clear the patient before shock delivery—early defibrillation dramatically improves survival in shockable rhythms
Documentation and Legal Considerations
Documentation creates the legal record of care and enables continuity across providers. If it wasn't documented, it wasn't done—this phrase captures the legal and communication importance of thorough charting.
Documentation and Charting
- Timeliness and accuracy: document as close to the event as possible; late entries should be clearly labeled with actual time of documentation
- Objective, factual language: describe what you observed and did, avoid subjective interpretations or judgmental terms
- Legal protection: complete documentation demonstrates standard of care was met; incomplete records create liability and communication gaps
Compare: Narrative charting vs. standardized forms—narrative allows detailed description of complex situations, while standardized forms ensure consistency and completeness for routine assessments. Most facilities use a combination; know when each is appropriate.
Quick Reference Table
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| Infection Prevention | Hand hygiene, Infection control practices, Sterile technique in catheterization |
| Assessment Skills | Vital signs measurement, Patient assessment, Pain assessment |
| Medication Safety | Five Rights of medication administration, IV therapy verification |
| Sterile Technique | Catheterization, Wound care, NG tube insertion, Tracheostomy care |
| Airway Management | Oxygen therapy, Tracheostomy care, BLS |
| Patient Safety | Positioning and transfer techniques, Body mechanics |
| Emergency Response | BLS, AED use, Airway management |
| Legal/Professional Practice | Documentation, Patient education, Informed consent |
Self-Check Questions
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Which two procedures share the requirement for strict sterile technique, and why is this standard necessary for both?
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A patient's blood pressure reading is 118/76. What additional information would you need to determine if this is a concerning finding, and what nursing principle does this illustrate?
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Compare and contrast the infection prevention strategies of hand hygiene and PPE use—when would you prioritize one over the other?
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You're preparing to administer a medication and realize the dose seems unusually high. Using the principles of safe medication administration, what steps should you take before proceeding?
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A patient with a urinary catheter develops fever and cloudy urine on day 4 of catheterization. What complication do you suspect, what assessments would you perform, and what intervention might you advocate for based on best practices for catheter use?