Therapeutic Procedures

Overview

Welcome! In this comprehensive learning article, we’ll break down the essential concepts behind key therapeutic procedures, focusing on moderate sedation, perioperative care, device management, infection prevention, and emergency response. By the end, you’ll have a practical framework for prioritizing care, preventing complications, and applying clinical judgment in fast-paced settings—skills vital for the NCLEX-RN and real-world nursing practice.

Concept-by-Concept Deep Dive

Monitoring and Managing Moderate Sedation

What it is:
Moderate sedation (also called conscious sedation) is used to decrease patient anxiety and discomfort during minor procedures, while allowing them to maintain airway control and basic reflexes. The nurse plays a central role in overseeing patient safety during and after sedation.

Key Components:

• Airway and Breathing: Always assess respiratory rate, airway patency, and oxygen saturation. Hypoventilation or apnea can occur unexpectedly.
• Circulation: Monitor pulse, blood pressure, and skin color for signs of hypotension or arrhythmias.
• Level of Consciousness: Use scales like the Ramsay or Richmond Agitation-Sedation Scale to assess sedation depth. Over-sedation can lead to unresponsiveness.
• Reversal Agents: Be familiar with drugs like flumazenil (for benzodiazepines) and naloxone (for opioids).

Step-by-Step Reasoning:

1. Continuously monitor vital signs before, during, and after sedation.
2. If signs of respiratory depression emerge, immediately stimulate the patient, provide supplemental oxygen, and be prepared to use reversal agents.
3. Document responses and any interventions.

Common Misconceptions:

• Thinking monitoring ends when the procedure does: Always monitor until full recovery.
• Assuming “conscious” means no risk: Sedation depth can change quickly; always be alert.

Preoperative and Postoperative Nursing Care

What it is:
Perioperative nursing involves preparing patients physically and psychologically for surgery, preventing complications, and supporting recovery.

Key Components:

• Preoperative Assessment: Identify risk factors (allergies, comorbidities), ensure informed consent, and verify pre-op orders (NPO status, medication management).
• Patient Education: Teach about deep breathing, coughing, incentive spirometry, early ambulation, and pain management to reduce complications like pneumonia or DVT.
• Postoperative Monitoring: Focus on airway, consciousness, wound site, vital signs, and signs of bleeding or infection.

Step-by-Step Reasoning:

1. Complete a thorough assessment, including medication reconciliation and allergy history.
2. Provide clear, tailored instructions on postoperative exercises.
3. Monitor for changes in status post-procedure and intervene promptly.

Common Misconceptions:

• Neglecting patient teaching: Education is crucial for preventing complications.
• Overlooking allergies: Always check for sensitivities to latex, iodine, and medications.

Preventing Device-Associated Complications

What it is:
Devices like urinary catheters, IV catheters, EVDs, and pacemakers are essential but carry risks of infection or malfunction.

Key Components:

• Aseptic Technique: Strict hand hygiene and sterile technique during insertion and care.
• Site Assessment: Regularly inspect for signs of infection, displacement, or malfunction.
• Maintenance and Removal: Remove devices as soon as no longer needed; follow protocols for flushing, dressing changes, and securement.

Step-by-Step Reasoning:

1. Use sterile technique for device insertion and care.
2. Document insertion/removal times and monitor for complications.