MODERATE SEDATION QUESTIONS WITH VERIFIED
ANSWERS
Levels of sedation - Answers - 1) Minimal sedation. 2) Moderate sedation. 3) Deep
sedation. 4) Anesthesia.
Minimal sedation - Answers - 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 - Answers - 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 - Answers - 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 - Answers - 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) - Answers - 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) -
Answers - 1) Emergency department. 2) Oralmaxillofacial surgery clinic. 3) Cardiac cath
lab. 4) Endoscopy unit. 5) ICU. 6) Operating rooms.
Privileges for moderate sedation - Answers - 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 - Answers - 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) - Answers - 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) - Answers - 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) - Answers - 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) - Answers - 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.
NPO recommendations (5) - Answers - 1) Clear liquids - 2 hours NPO. 2) Breast milk - 4
hours NPO. 3) Infant formula - 6 hours. 4) Nonhuman milk (digests like solids) - 6 hours.
5) Light meal - 6 hours. Amount and type of solid food must be considered; fried, fatty
foods, and meat prolong gastric emptying time. For emergency procedures, a full
stomach is assumed, responsible physician will decide appropriateness of sedation.
Intra-procedure monitoring and documentation (7) - Answers - Continuous throughout
procedure, RN should not be assisting with procedure. 1) Vital signs documented prior
to administration of sedation and conclusion of procedure. 2) Vital signs and level of
consciousness (modified ramsay) every 5 minutes or less. 3) Continuous pulse
oximetry. 4) Cardiac monitoring for all patients. 5) Dosage, route, time and effect of
ANSWERS
Levels of sedation - Answers - 1) Minimal sedation. 2) Moderate sedation. 3) Deep
sedation. 4) Anesthesia.
Minimal sedation - Answers - 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 - Answers - 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 - Answers - 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 - Answers - 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) - Answers - 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) -
Answers - 1) Emergency department. 2) Oralmaxillofacial surgery clinic. 3) Cardiac cath
lab. 4) Endoscopy unit. 5) ICU. 6) Operating rooms.
Privileges for moderate sedation - Answers - 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 - Answers - 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) - Answers - 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) - Answers - 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) - Answers - 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) - Answers - 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.
NPO recommendations (5) - Answers - 1) Clear liquids - 2 hours NPO. 2) Breast milk - 4
hours NPO. 3) Infant formula - 6 hours. 4) Nonhuman milk (digests like solids) - 6 hours.
5) Light meal - 6 hours. Amount and type of solid food must be considered; fried, fatty
foods, and meat prolong gastric emptying time. For emergency procedures, a full
stomach is assumed, responsible physician will decide appropriateness of sedation.
Intra-procedure monitoring and documentation (7) - Answers - Continuous throughout
procedure, RN should not be assisting with procedure. 1) Vital signs documented prior
to administration of sedation and conclusion of procedure. 2) Vital signs and level of
consciousness (modified ramsay) every 5 minutes or less. 3) Continuous pulse
oximetry. 4) Cardiac monitoring for all patients. 5) Dosage, route, time and effect of
