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A minimally depressed level of consciousness
induced by the administration of pharmacologic
Moderate "Conscious" agents in which the patient retains continuous and
Sedation independent ability to maintain protective reflexes
and a patent airway and to be aroused by physical or
verbal stimulation.
1. Minimal Sedation
Levels of Sedation 2. Moderate Sedation/Analgesia
Analgesia 3. Deep Sedation/Analgesia
4. General Anesthesia
1. Patient is able to respond normally to verbal
stimulation.
Minimal Sedation 2. Airway and Spontaneous Ventilation is not affected
and thus "normal"
3. Cardiovascular function is not affected
1. Patient responds to verbal or tactile stimulation
Moderate 2. No intervention to maintain patent airway
Sedation/Analgesia 3. Spontaneous ventilation is adequate
4. Cardiovascular function is usually maintained
1. Patient responds to repeated or painful stimulation
2. May require intervention to maintain patent airway
Deep Sedation/Analgesia
3. Spontaneous ventilation may be inadequate
4. Cardiovascular function is usually maintained
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, 1. Patient cannot be aroused, even with painful stimuli
2. Intervention required to maintain patent airway
General Anesthesia
3. Spontaneous ventilation is frequently inadequate
4. Cardiovascular function may be impaired
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
Goals of Safe Sedation 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.
1. Pre-op Nursing Assessment
2. Intra-op Nursing Actions: medication administration;
patient monitoring; patient safety; procedure specific
Role of the Sedation
3. Post-op monitoring during recovery
Nurse
4. Follow post-op d/c criteria
5. Explain post-d/c written instructions
6. Follow-up
1. Evaluating patients prior to moderate or deep
JCAHO Care Standard: sedation
Qualified Individuals 2. Rescuing patients who slip into a "deeper than
conducting sedation must desired" level of sedation or anesthesia
possess education, 3. Managing a compromised airway during a
training, and experience procedure
in? 4. Handling a compromised CV system during a
procedure.
1. Chart Review
Pre-Operative Nursing
2. Patient Interview
Assessment Steps
3. Physical Exam and Review of Systems
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, 1. NPO Status
2. Chief complaint
Pre-sedation Assessment 3. Current medications
Overview: Parts of the 4. Drug allergies
Assessment 5. H/O substance abuse
6. Concurrent medical problems
7. Communication Ability
1. Pre-procedure fasting--Defined as no food for 6
How is Aspiration Risk hours prior to procedure. May have clear fluids until
Reduced 2h prior to procedure.
2. Medication is titrated to maintain reflexes
What conditions place 1. Obesity
patient's at enhanced risks 2. DM
for aspiration with 3. Pregnancy
sedation? 4. Bowel Dysfunction
1. Smoking- PPD and years
2. Drug allergies and reaction
3. Alcohol Abuse
4. Menstrual Hx and Urine HCG for fertile women
Patient history to consider
5. Height and Weight to dose medications
during pre-op preparation
6. Drug Abuse
7. Daily Medications
8. Post Facial/Neck Trauma or Surgery
9. Dentures or any removable items in mouth
1. Patient counseling
2. Rapport
3. Verbal reassurance
Elements of Pre-operative 4. Patient expectations
Preparation 5. IV Access
6. EKG/BP
7. Pulse Ox
8. Informed Consent
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