• NRNP 6566 Week 8 Knowledge check

• NRNP 6566 Week 8 Knowledge check What type of ICU sedation would be appropriate for a 32 year old male patient who is intubated with bilateral chest tube following a motor vehicle crash. Correct Answer: The Society of Critical Care Medicine publishes a guideline on sedation. It is: Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (2018). Light sedation is suggested for intubated ICU patients. Non-benzodiazepine sedatives (either propofol or dexmedetomidine) are preferable to benzodiazepine sedatives (either midazolam or lorazepam) in critically ill, mechanically ventilated adults. Describe the levels of sedation (minimal, moderate, deep, general anesthesia, and dissociation) and its affect on consciousness, airway, ventilation, and reflexes. Correct Answer: Sedation decreases a patient’s awareness to the environment and their responses to external stimulation. Sedation occurs a long a continuum which includes minimal, moderate, deep, general anesthesia, and dissociation. Minimal sedation is a drug induced relief of anxiety or apprehension with minimal to no affection on sensorium. Most often this is achieved with an anti- anxiety medication. Moderate sedation causes a depression of consciousness but the patient can still respond to external stimuli. Airway, spontaneous ventilation, and cardiovascular function are maintained. Deep sedation causes a depression of consciousness in which the patient cannot be aroused but responds purposefully to repeated or painful stimuli. Cardiovascular function is maintained but airway and spontaneous ventilation may be compromised. General anesthesia is a state of unconsciousness where the patient is unable to respond to any stimuli. Close monitoring of all airway, ventilation, and cardiovascular function is essential. Dissociation is considered to be a type of moderate sedation that occurs when using medications in the phencyclidine group (such as ketamine). They cause a dissociation of the limbic system preventing higher centers from receiving sensory stimuli. Like moderate sedation, airway reflexes, spontaneous ventilation, and cardiovascular function are all maintained. The APRN has determined that a 21 year old motor vehicle crash victim needs a rapid sequence intubation. The patient weighs 77 kg. What medications are indicated to successfully achieve the rapid sequence intubation?