Sedation Exam 5
where are can sedation occur
* never on the floor* - GI suites - Critical care areas - ED or OR - Cath LAB - Dx imaging area
what should be at the bedside during sedations
- BP - Pulse OX - Cardiac Monitor with defib - crash cart with ambu bag - emergency drugs-- naloxone, flumazenil - sunction -oxygen
What should you monitor every five minutes when someone is sedated
- Pulse OX - BP -EKG -RESP -LOC
procedure assessment for MD
- baseline history - airway assessment - informed consent - NPO stat
RN responsibility for sedation
- verify consent - NPO status - Baseline Aldrete score
pt during moderate sedation
-can respond to age appropriate commands -can maintain airway, but can be compromised. -arousable to verbal stimuil -can answer your questions and respond to verbal stimuli-- take a deep breath - take full, not shallow breaths
a pt ingested clear liquids, water, fruit juice w/o pulpe, carbonated beverage, clear tea, black coffee) should be NPO how long
2 hours
a pt ingested breast milk should be NPO for how long
4 hours
a pt ingested infant formula, NPO
6 hours
a pt ingested nonhuman milk ( simlar to solids) , NPO
6 hours
a pt ingested solids , NPO ( fatty/ fried foods, light meal
6 hours
fentanyl
75-125 more poten than morphine no amnestic properties-- for pain only
Deep sedation only given in
ED OR radiology ICU MD soley responsible,RN can not five, MD responsible for charting response
people with heart and lund diseae have
a decrease ability to tolerate any levels of deviation from normal LOC decompsensate really fast with mild hypoxia
benzos produce
amnesia
opiods produce
analgesia
opiod and benzo combined produced
analgesia and amnesia -- moderate sedation
deep sedations
can not be easily aroused but respond to painful stimul airway support
airway obstruction
cyanotic increased HR increase RR stridor labored breathing no breath sounds snoring decreased sats
Aldrete Score
determine if some is safe to be discharged after sedation
minimal sedations
drug induced state during which client will respond normally to verbal commands
Nasal
fentanly or mitolazam children NO more than 1 ml per nostril smallest amount possible
midazolam reversal
flumazenil
nurses can not give
ketamine nor push propatol.
moderate sedation
medically controlled state of depressed consciousness
moderate meds
midazolam propofol etomidate-- only by MD that is credential * airway is never compromise*
minimal sedation meds
midazolam ( versed) fentanly
nurses do not give medications in deep sedation
monitor, MD at bedside, push med, and must have sedation privilges
Aldrete score 8 or less
monitored longer
when ever you are finna sedate someone
never do it unless MD is present and notified
aldrete score 9-10
normal
clients during minimal sedation
normal respiration, eye movement, response to command, baseline mental orientation
a pt with minimal sedation can maintain their airway, but
nurse still montior-- popsicle, make sure can handle and not vomit
What RN can sedate
one that has specific competencies for moderate sedation BLS training PALs, ACLS, or a review of MS passing an exam from a review of Pharm, Etc.
Moderate sedation meds RN can give
opiods-- fentanly morphine benzo- midazolam, diazepam, lorazepam
a pt in moderate sedations sats start to drop
oxygen or " take a deep breath"
if a reversible agent is use after surgery,
pt must stay in recovery/ PACU one hour post
midazolam
rapidly enters CNS then redistrubute. DO NOT HELP WITH PAIN
sedation
reduced the state of awarness
analgesia
reduces or eliminates perception of pain
SE of fentanyl
respiratory depression
midazolam effects
sedative amnestic-- wont remember drowsiness- anti-convulsant
bezos are
sedatives with no pain reliving efforts
nursing for minimal sedation
side rails up make sure they can get to car-- wheel chair teach family to monitor at all, etc
nasal nursing
squirt up nose, snift hold head back taste nast
When sedating someone it is important for the nurse
to only be responsible for that pt
