Conscious sedation

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shaho dizayee on Dec 11, 2012 Says :

hi... is general anesthesia a type of sedation(unconscious sedation)... i mean can we refer to general anesthesia as unconscious sedation...???

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Slide 1 :

Conscious Sedation Jan Bazner-Chandler CPNP, CNS, MSN, RN

Slide 2 :

Conscious Sedation The use of non-anesthesiologists to manage patients receiving sedation has increase over the past 20 years. State board of nursing issued position statements regarding the role of the registered nurse in managing conscious sedation.

Slide 3 :

Definition and Goals Conscious sedation is produced by the administration of pharmacologic agents, by an route, that results in a depressed level on consciousness but allows the patient to independently maintain a patent airway and respond appropriately to verbal commands or physical stimulus.

Slide 4 :

Patient Selection and Pre-procedural Assessment

Slide 5 :

ASA Patient Classification ASA 1 = health patient ASA 2 = Patient smokes and has well-controlled hypertension. ASA 3 = Diabetes, stable angina, takes medications. ASA 4 = Diabetes, angina, CHF, dyspnea, chest pain. ASA 5 – Patient is unstable, but not expected to survive without procedure.

Slide 6 :

Monitoring and Equipment Oxygen Suction Airway management Monitors Pulse oximeter Cardiac monitor Automated blood pressure device

Slide 7 :

Monitoring Equipment Resuscitative equipment / medications Ambu bag Defibrillator with ECG recorder Emergency drugs Emergency drug card and ACLS protocols PAL protocol

Slide 8 :

Pre-procedure Allergies Weight to calculate medications Recent history and physical Baseline vitals with blood pressure and pulse oximeter Developmental assessment

Slide 9 :

Documentation of Care Pre-procedure assessment Dosage, route, time, and effects of all medications and fluids used. Type and amount of fluids administered, including blood and blood products. Monitoring devices and equipment used.

Slide 10 :

Documentation of Care Physiologic data from continuous monitoring at 5 to 15 minute intervals and following significant events. Level of consciousness Nursing interventions and patient’s response Untoward significant patient reactions and their resolution.

Slide 11 :

Notify Medical Doctor Rise or fall in systolic pressure 30 mm HG from baseline. Tachycardia or bradycardia Rise or fall in respiratory rate Oxygen saturation less than 90% or significantly below pre-sedation level. Marked decrease in patient responsiveness to verbal or painful stimulation Signs or symptoms of medication intolerance or allergies Patient does not meet discharge criteria.

Slide 12 :

Discharge Assessment Vital signs to pre-procedural baseline Gag reflex / able to swallow To pre-procedural level of awareness

Slide 13 :

Discharge Teaching Verbal and written discharge instructions. Instructions should be initiated in pre-procedure phase and repeated in post-procedural phase.

Slide 14 :

Discharge Instructions Instructions should cover: Home medications administration Dietary requirements Limitations on activity Post-procedural care Signs and symptoms of complications Emergency numbers / physician numbers Follow-up appointment

Slide 15 :

Policies and Procedures Every practice setting should have policies and procedures in place. They should be written, reviewed periodically, and readily available within the practice setting. These policies and procedures provide guidelines for patient care, minimize risk factors, standardize practice, assist staff members, and establish guidelines for quality monitoring and quality improvement.

Slide 16 :

Competencies AORN states that “the RN monitoring the patient’s care be clinically competent in the function and in the use of resuscitation medications and monitoring equipment and be able to interpret the data obtained from the patient.”

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