8.5 Therapeutic Procedures

Performing Procedures Safely

Therapeutic procedures make up much of the LPN/VN's hands-on day. The NCLEX-PN tests whether you can match the device or dressing to the clinical situation, choose sterile versus clean technique, and honor the safety limits (suction time, oxygen flow, heat/cold duration) that keep procedures from harming the patient.

Wound Care and Dressing Selection

Wounds heal by primary intention (approximated edges, e.g., a surgical incision), secondary intention (open, granulating from the base, e.g., a pressure injury), or tertiary (delayed closure after infection clears). Healing phases run hemostasis → inflammatory (days 1-4) → proliferative (days 4-21) → remodeling (up to 2 years). Assess and document size (length × width × depth), wound-bed color (red = healthy granulation, yellow = slough, black = eschar), drainage, periwound skin, and pain.

Match logic the NCLEX loves: wet wound needs an absorbent dressing (alginate); dry wound needs a moisturizing dressing (hydrogel).

Drainage Devices

NG tube care: confirm placement (aspirate pH < 5.5 or X-ray) before instilling anything, secure without nostril pressure, and monitor for hypokalemia from suctioned gastric contents.

Suctioning: Technique and Limits

• Oropharyngeal/Yankauer: clean technique, comfort suctioning.
• Endotracheal / tracheostomy: sterile technique.

Safety sequence: hyperoxygenate first, limit each pass to 10-15 seconds, apply suction only on withdrawal, rest between passes, and reassess breath sounds and SpO2. Suctioning longer than 15 seconds causes hypoxia, bradycardia, and dysrhythmias.

Oxygen Therapy

Safety: post "Oxygen in Use" signs, allow no flames or smoking, and humidify flows above 4 L/min to protect mucosa. For COPD, the Venturi mask is preferred because its precise FiO2 avoids blunting the hypoxic respiratory drive.

Heat and Cold Therapy

Avoid heat with acute injury, active bleeding, or impaired sensation/circulation; avoid cold with Raynaud's, peripheral vascular disease, open wounds, or decreased sensation. Always place a barrier between the device and skin.

Urinary Catheterization

Indications include acute retention, accurate strict intake-and-output, the perioperative period, and end-of-life comfort. Use sterile technique for an indwelling catheter; typical sizes are 14-16 Fr (female) and 16-18 Fr (male). Insert until urine flows, then advance another 1-2 inches before inflating the balloon with sterile water, and secure to the thigh. The greatest risk is a catheter-associated urinary tract infection, so maintain a closed system and never raise the bag above the bladder.

Specimen Collection

Obtain a clean-catch midstream urine after cleansing; aspirate a catheter sample from the sampling port (never open the closed system); keep a 24-hour urine chilled; and for stool occult blood avoid red meat, vitamin C, and NSAIDs beforehand. Label specimens at the bedside immediately and transport promptly — a common error tested is delaying labeling, which risks misidentification.

Enteral Feeding and Ostomy Care

The LPN/VN often manages enteral nutrition and ostomies. Before each tube feeding, verify placement and check gastric residual, keep the head of bed elevated at least 30-45 degrees during and for 30-60 minutes after to prevent aspiration, and flush with water per policy to maintain patency. Hold the feeding and report a high residual or signs of intolerance (nausea, distention). For a new colostomy or ileostomy, assess stoma color — a healthy stoma is pink to red and moist, while a dusky or dark stoma signals impaired circulation and must be reported at once.

Empty the pouch when it is one-third full and protect the peristomal skin from effluent.

Restraints and Procedural Safety

When restraints are unavoidable, they require a provider order, are time-limited, and need frequent monitoring of circulation, skin, and elimination, with release every 2 hours for range of motion. Tie restraints to the bed frame with a quick-release knot, never to side rails. Across every procedure in this section, three safety constants recur: use sterile technique for anything entering a sterile body space (bladder, trachea, vascular access), honor the time and flow limits that prevent injury (suction 10-15 seconds, heat/cold 20-30 minutes, oxygen flow matched to need), and reassess the patient's response afterward.

Choosing the action that prevents complications, and reporting the early warning sign, is the judgment the NCLEX-PN consistently rewards in Reduction of Risk Potential.