Page 1 of 41
MODERATE SEDATION CERTIFICATION MOST TESTED
QUESTIONS WITH VERIFIED ANSWERS CREDITED TO PASS.
. Will the patient be able to lie flat for procedure?
-Paroxysmal nocturnal dyspnea
Moderate "Conscious" Sedation
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
1. Minimal Sedation
2. Moderate Sedation/Analgesia
3. Deep Sedation/Analgesia
4. General Anesthesia
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
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
JCAHO Care Standard: Qualified Individuals conducting sedation must possess education, training, and
experience in?
1. Evaluating patients prior to moderate or deep sedation
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2. Rescuing patients who slip into a "deeper than desired" level of sedation or anesthesia
3. Managing a compromised airway during a procedure
4. Handling a compromised CV system during a procedure.
Pre-Operative Nursing Assessment Steps
1. Chart Review
2. Patient Interview
3. Physical Exam and Review of Systems
Pre-sedation Assessment Overview: Parts of the Assessment
1. NPO Status
2. Chief complaint
3. Current medications
4. Drug allergies
5. H/O substance abuse
6. Concurrent medical problems
7. Communication Ability
How is Aspiration Risk Reduced
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?
1. Obesity
2. DM
3. Pregnancy
4. Bowel Dysfunction
Patient history to consider during pre-op preparation
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
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6. Drug Abuse
7. Daily Medications
8. Post Facial/Neck Trauma or Surgery
9. Dentures or any removable items in mouth
Elements of Pre-operative Preparation
1. Patient counseling
2. Rapport
3. Verbal reassurance
4. Patient expectations
5. IV Access
6. EKG/BP
7. Pulse Ox
8. Informed Consent
Pre-Sedation Assessment: Chart Review
1. Past medical illnesses
2. Prior Surgical Procedures
3. Allergies
4. Drug reactions and intra-anesthetic complications
5. Lab Studies
6. Current medications
7. Compliance of medication regimen
Pre-Sedation Assessment: Ancillary Studies
1. Recent EKG (<1year)
2. Patients at risk for myocardial injury (anti-hypertensive)
3. Pregnant, must have OB consult
4. <5 years old require a consult with anesthesia
ASA Physical Status
American Society of Anesthesiologists Physical Status System helps qualify the relative risk to patients
sedative medications pose
ASA 1
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-Normal, healthy adult
-No chronic illness
-No regular medications
-Excludes very young and very old
-Good exercise tolerance
ASA 2
Mild systemic disease:
-Controlled HTN
-Type II DM
-H/O tobacco use
-Obesity
-Non-metastatic carcinoma
-Well controlled asthma
-Child with underlying cerebral palsy
-Child with well-controlled seizure disorder
ASA 3
*Severe systemic disease that is not incapacitating:
-Poorly controlled HTN
-Multiple medications for cardiac, respiratory, and/or metabolic disorders
-Metastatic dz with some interference with function
-PNA
*Divided into Stable and Unstable
ASA 4
*Severe systemic dz that is a constant threat to life
-COPD on multiple inhalers and difficulty breathing supine
-Metastatic dz with severe organ dysfunction
-Recent MI with continuing symptoms
-Severe HTN with angina
-Sepsis
-Organ insufficiency
MODERATE SEDATION CERTIFICATION MOST TESTED
QUESTIONS WITH VERIFIED ANSWERS CREDITED TO PASS.
. Will the patient be able to lie flat for procedure?
-Paroxysmal nocturnal dyspnea
Moderate "Conscious" Sedation
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
1. Minimal Sedation
2. Moderate Sedation/Analgesia
3. Deep Sedation/Analgesia
4. General Anesthesia
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
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
JCAHO Care Standard: Qualified Individuals conducting sedation must possess education, training, and
experience in?
1. Evaluating patients prior to moderate or deep sedation
, Page 2 of 41
2. Rescuing patients who slip into a "deeper than desired" level of sedation or anesthesia
3. Managing a compromised airway during a procedure
4. Handling a compromised CV system during a procedure.
Pre-Operative Nursing Assessment Steps
1. Chart Review
2. Patient Interview
3. Physical Exam and Review of Systems
Pre-sedation Assessment Overview: Parts of the Assessment
1. NPO Status
2. Chief complaint
3. Current medications
4. Drug allergies
5. H/O substance abuse
6. Concurrent medical problems
7. Communication Ability
How is Aspiration Risk Reduced
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?
1. Obesity
2. DM
3. Pregnancy
4. Bowel Dysfunction
Patient history to consider during pre-op preparation
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
, Page 3 of 41
6. Drug Abuse
7. Daily Medications
8. Post Facial/Neck Trauma or Surgery
9. Dentures or any removable items in mouth
Elements of Pre-operative Preparation
1. Patient counseling
2. Rapport
3. Verbal reassurance
4. Patient expectations
5. IV Access
6. EKG/BP
7. Pulse Ox
8. Informed Consent
Pre-Sedation Assessment: Chart Review
1. Past medical illnesses
2. Prior Surgical Procedures
3. Allergies
4. Drug reactions and intra-anesthetic complications
5. Lab Studies
6. Current medications
7. Compliance of medication regimen
Pre-Sedation Assessment: Ancillary Studies
1. Recent EKG (<1year)
2. Patients at risk for myocardial injury (anti-hypertensive)
3. Pregnant, must have OB consult
4. <5 years old require a consult with anesthesia
ASA Physical Status
American Society of Anesthesiologists Physical Status System helps qualify the relative risk to patients
sedative medications pose
ASA 1
, Page 4 of 41
-Normal, healthy adult
-No chronic illness
-No regular medications
-Excludes very young and very old
-Good exercise tolerance
ASA 2
Mild systemic disease:
-Controlled HTN
-Type II DM
-H/O tobacco use
-Obesity
-Non-metastatic carcinoma
-Well controlled asthma
-Child with underlying cerebral palsy
-Child with well-controlled seizure disorder
ASA 3
*Severe systemic disease that is not incapacitating:
-Poorly controlled HTN
-Multiple medications for cardiac, respiratory, and/or metabolic disorders
-Metastatic dz with some interference with function
-PNA
*Divided into Stable and Unstable
ASA 4
*Severe systemic dz that is a constant threat to life
-COPD on multiple inhalers and difficulty breathing supine
-Metastatic dz with severe organ dysfunction
-Recent MI with continuing symptoms
-Severe HTN with angina
-Sepsis
-Organ insufficiency
