Moderate Sedation test with verified answers

Levels of sedation - 1) Minimal sedation. 2) Moderate sedation. 3) Deep sedation. 4) Anesthesia. Minimal sedation - Patient responds normally to verbal commands; coordination and physical coordination may be affected, but airway and ventilator responses are intact and cardiovascular function maintained. Moderate sedation - Depression of consciousness, responds to verbal commands alone or by light tactile stimulation. Spontaneous ventilation is adequate, no intervention required to maintain patent airway, cardiovascular function maintained. Reflex withdrawal from pain stimulus NOT considered purposeful movement. Deep sedation - Drug induced depression of consciousness, patient cannot be easily roused but responds purposely with repeated or painful stimulus. Ventilation may be impaired and may require assistance to maintain patent airway. Cardiovascular function maintained. Anesthesia - General anesthesia, spinal anesthesia, or major regional anesthesia. Drug induced loss of consciousness in which patients are not arousable, even to painful stimuli. Ability to maintain ventilator function and patent airway is often impaired, positive pressure ventilation may be required. Cardiovascular function may be impaired. MAC (monitored anesthesia care) is specific for diagnostic or therapeutic procedures and may include varying levels of sedation. Areas allowed for moderate sedation WITH BENZOS AND NARCOTICS by credentialed caregivers (6) - 1) Emergency department. 2) Radiology. 3) Endoscopy lab. 4) Cardiology. 5) ICU/PCU. 6) Specialty clinics. Areas allowed for moderate sedation WITH PROPOFOL AND KETAMINE ONLY (6) - 1) Emergency department. 2) Oralmaxillofacial surgery clinic. 3) Cardiac cath lab. 4) Endoscopy unit. 5) ICU. 6) Operating rooms. Privileges for moderate sedation - Licensed independent practitioners credentialed in anesthesia, emergency medicine, oral surgery, and critical care will have moderate sedation privilege using narcotics, benzodiazepines, propofol, and ketamine. Residents must be supervised by an independent practitioner. RN's present must have BLS, ACLS, and moderate sedation competency (including knowledge of managing sedation and reversal agents and their contraindications and complications). Nurses required to recover moderate sedated patients will have validate Phase II Recovery competency. Rescue - Practitioners should be able to rescue patients from deeper than intended levels of sedation. They should be proficient in airway management and advanced life support. Qualified practitioners should correct adverse consequences and return patients to originally intended level of sedation. IT IS NOT APPROPRIATE TO CONTINUE PROCEDURE AT UNINTENDED LEVEL OF SEDATION. Texas Board of Nursing (scope of practice) - Administration of anesthetic agents (propofol, ketamine, methohexital, etomidate) is outside of the scope of practice for RN's and non-CRNA advanced practice RN's except in the following situations: 1) in the physical presence of CRNA or anesthesiologist; 2) when administering these medication as part of a clinical experience for an advance education program of study that prepares the individual for licensure as a nurse anesthetist (student nurse anesthetist); 3) when administering these medications to an intubated patient in a critical care area; 4) when assisting an individual with current competence in advanced airway management, including emergency intubation procedures. Equipment and supplies for monitoring (3) - All equipment must be present and functioning prior to administration of sedation: 1) continuous ECG/cardiac monitor/defibrillator; 2) O2 nasal cannula and nonrebreather; 3) Emergency equipment: Crash card/defibrillator, oxygen, suction, ambu bag, emergency drugs/reversal agents (narcan, flumazenil, epinephrine, ephedrine). Nursing responsibilities (6) - 1) Obtaining physician order. 2) Obtaining medications. 3) Ensuring medication is administered according to hospital policy. 4) 5 rights. 5) Inconsistencies between physician orders and guidelines should be resolved prior to administration of medication. 6) Operating room non-anesthesia personnel may administer: valium, versed, fentanyl, morphine, Demerol. Pre-sedation assessment/documentation (11) - 1) Complete nursing assessment. 2) H&P by privileged provider. 3) Reassessment prior to med administration to confirm previous assessment. 4) Time-out. 5) Vital signs (BP, ECG, pulse ox). 6) Drug allergies. 7) Current medications. 8) Verify NPO status. 9) Pre-aldrete score. 10) Signed consent. 11) Discharge teaching and transport arrangements.