Moderate "Conscious" Sedation - ANS A minimally depressed level of consciousness induced by the administration of pharmacologic agents in which the patient retains continuous and independent ability to maintain protective reflexes and a patent airway and to be aroused by physical or verbal stim...
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MODERATE SEDATION
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CERTIFICATION EXAM
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,Moderate "Conscious" Sedation - ANS A minimally depressed level of consciousness
induced by the administration of pharmacologic agents in which the patient retains
continuous and independent ability to maintain protective reflexes and a patent airway
and to be aroused by physical or verbal stimulation.
Levels of Sedation Analgesia - ANS 1. Minimal Sedation
2. Moderate Sedation/Analgesia
3. Deep Sedation/Analgesia
4. General Anesthesia
Minimal Sedation - ANS 1. Patient is able to respond normally to verbal stimulation.
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2. Airway and Spontaneous Ventilation is not affected and thus "normal"
3. Cardiovascular function is not affected
Moderate Sedation/Analgesia - ANS 1. Patient responds to verbal or tactile
stimulation
3. Spontaneous ventilation is adequate
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2. No intervention to maintain patent airway
4. Cardiovascular function is usually maintained
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Deep Sedation/Analgesia - ANS 1. Patient responds to repeated or painful
stimulation
2. May require intervention to maintain patent airway
3. Spontaneous ventilation may be inadequate
4. Cardiovascular function is usually maintained
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General Anesthesia - ANS 1. Patient cannot be aroused, even with painful stimuli
2. Intervention required to maintain patent airway
3. Spontaneous ventilation is frequently inadequate
4. Cardiovascular function may be impaired
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Goals of Safe Sedation - ANS 1. Maintain adequate ventilation, homeostasis, and
circulation
2. Maintenance of appropriate level of consciousness
3. Promote comfort by elevating pain threshold
4. Patient Safety-be knowledgeable about possible consequences of respiratory
depression, airway obstruction, apnea, hypoxia, hypercapnia, bradycardia, asystole,
brain injury/death
5. Using the essential components required to conduct safe sedation
,6. Understand the importance of a systematic approach to sedation that promotes
safety and efficacy.
Role of the Sedation Nurse - ANS 1. Pre-op Nursing Assessment
2. Intra-op Nursing Actions: medication administration; patient monitoring; patient
safety; procedure specific
3. Post-op monitoring during recovery
4. Follow post-op d/c criteria
5. Explain post-d/c written instructions
6. Follow-up
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JCAHO Care Standard: Qualified Individuals conducting sedation must possess
education, training, and experience in? - ANS 1. Evaluating patients prior to moderate
or deep sedation
2. Rescuing patients who slip into a "deeper than desired" level of sedation or
anesthesia
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3. Managing a compromised airway during a procedure
4. Handling a compromised CV system during a procedure.
Pre-Operative Nursing Assessment Steps - ANS 1. Chart Review
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2. Patient Interview
3. Physical Exam and Review of Systems
Pre-sedation Assessment Overview: Parts of the Assessment - ANS 1. NPO Status
2. Chief complaint
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3. Current medications
4. Drug allergies
5. H/O substance abuse
6. Concurrent medical problems
7. Communication Ability
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How is Aspiration Risk Reduced - ANS 1. Pre-procedure fasting--Defined as no food
for 6 hours prior to procedure. May have clear fluids until 2h prior to procedure.
2. Medication is titrated to maintain reflexes
What conditions place patient's at enhanced risks for aspiration with sedation? - ANS
1. Obesity
2. DM
3. Pregnancy
4. Bowel Dysfunction
, Patient history to consider during pre-op preparation - ANS 1. Smoking- PPD and
years
2. Drug allergies and reaction
3. Alcohol Abuse
4. Menstrual Hx and Urine HCG for fertile women
5. Height and Weight to dose medications
6. Drug Abuse
7. Daily Medications
8. Post Facial/Neck Trauma or Surgery
9. Dentures or any removable items in mouth
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Elements of Pre-operative Preparation - ANS 1. Patient counseling
2. Rapport
3. Verbal reassurance
4. Patient expectations
5. IV Access
6. EKG/BP
7. Pulse Ox
8. Informed Consent lo
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Pre-Sedation Assessment: Chart Review - ANS 1. Past medical illnesses
2. Prior Surgical Procedures
3. Allergies
4. Drug reactions and intra-anesthetic complications
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5. Lab Studies
6. Current medications
7. Compliance of medication regimen
Pre-Sedation Assessment: Ancillary Studies - ANS 1. Recent EKG (<1year)
2. Patients at risk for myocardial injury (anti-hypertensive)
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3. Pregnant, must have OB consult
4. <5 years old require a consult with anesthesia
ASA Physical Status - ANS American Society of Anesthesiologists Physical Status
System helps qualify the relative risk to patients sedative medications pose
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