Editing Nursing Skills and Procedures (section)

== Principles That Apply to Every Procedure ==

Before any skill, the nurse verifies the order, identifies the patient using two identifiers, performs hand hygiene, explains the procedure and obtains consent or cooperation, provides privacy, gathers supplies, and positions the patient. After any skill, the nurse assesses the patient's response, restores safety measures such as bed in low position and call light in reach, performs hand hygiene, and documents what was done, what was found, how the patient tolerated it, and what was reported.

=== Clean versus sterile technique ===
Medical asepsis, also called clean technique, reduces the number of microorganisms and is used for routine hygiene, most chronic wound care, and administration of oral medications. Surgical asepsis, or sterile technique, eliminates microorganisms and is required whenever a body cavity or the bloodstream is entered or a break in skin integrity is dressed in an acute care setting. Sterile technique is required for urinary catheter insertion, tracheal suctioning, intravenous insertion, central line dressing changes, and most acute surgical wound dressing changes.

Sterile field rules worth memorizing because they generate exam items:
* A one inch border around the sterile field is considered contaminated.
* Anything below waist level or out of the line of vision is contaminated.
* Moisture wicks microorganisms, so a wet field is a contaminated field.
* Reaching across a sterile field contaminates it. Move around the field instead.
* Sterile items are held above waist level and in front of the body.
* The nurse never turns away from the field.

=== Standard and transmission-based precautions ===
Standard precautions apply to all patients regardless of diagnosis. Transmission-based precautions are added by route.
* Contact precautions: gown and gloves. Used for ''Clostridioides difficile'', multidrug resistant organisms, scabies, draining wounds, and respiratory syncytial virus. ''C. difficile'' additionally requires soap and water handwashing, because alcohol-based rub does not kill spores, and a bleach-based sporicidal cleaner.
* Droplet precautions: surgical mask within about three to six feet. Used for influenza, pertussis, ''Neisseria meningitidis'', mumps, and rubella. Private room preferred.
* Airborne precautions: negative pressure room and a fit-tested N95 or higher respirator. Used for tuberculosis, measles, and varicella. Varicella and disseminated zoster require both airborne and contact precautions.

=== Delegation and scope ===
Assistive personnel may perform standardized tasks with predictable outcomes on stable patients, such as vital signs, hygiene, ambulation, feeding a patient without swallowing risk, emptying a drainage bag and reporting the volume, and specimen collection from a voided sample. Assistive personnel do not assess, teach, evaluate, or perform sterile procedures. Licensed practical and vocational nurses perform most established skills, administer most routine medications, and reinforce teaching the registered nurse initiated. The registered nurse retains initial assessment, care planning, initial teaching, evaluation of outcomes, and care of the unstable patient, and in most jurisdictions retains intravenous push medications, blood product administration, and central line management. State nurse practice acts vary, and exam answers follow the most restrictive common standard.