Transcript Slide 1

Procedural Sedation
KEY POINTS IN ADMINSTRATION
San Diego
San Diego
What is Procedural Sedation?
Procedural Sedation also referred to as “moderate
sedation/analgesia” or “conscious sedation” ….
“a drug-induced depression of consciousness during which individuals
respond purposefully to verbal commands either alone or accompanied
by light tactile stimulation. No interventions are required to maintain a
patent airway, and spontaneous ventilation is adequate.
Cardiovascular function is usually maintained.”
Joint Commission, 2001
Complications of Procedural Sedation can include:
Hypoventilation, allergic or adverse reaction, abnormal cardiac
function, deterioration in mental status.
San Diego
Examples of Procedural Sedation
 In a Moderate Procedural
Sedation the patient’s level
of consciousness is altered,
though response to verbal
commands is still possible.
 For a Deep Sedation the
patient’s consciousness is
altered and cannot be easily
aroused, but can respond to
purposeful or painful
stimulation.
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Procedural Sedation is DEFINED by Patient’s
Level of Conscious
■ Minimal (Anxiolysis)
LOC 2
■ Drug induced state, patient responds normally to verbal commands.
■ Moderate (Procedural Sedation)
LOC 1
■ Drug induced depression of consciousness, patient responds
purposefully to verbal commands, either alone or accompanied by
light tactile stimulation.
■ Deep Sedation (requires special privileges!)
LOC 0
■ Drug induced depression of consciousness, patient cannot be easily
aroused, but respond purposefully following repeated or painful
stimulation. (Limited to ED, and Pediatric Sub specialists)
■ Anesthesia LOC 0
■ Drug induced loss of consciousness, patient is not arousable, even by
painful stimulation.
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Scoring Patient’s Level of Conscious
■ Procedure & Anesthesia Scoring System (PASS)
■ Used before giving medication(s), during procedure, during recovery,
and before discharge
■ Consists of 7 categories
 Consciousness
 Activity
 Circulation
 Respiration
 O2 Sat
 Pain
 Emetic
■ All are scored using a point scale of 2, 1, 0
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PASS Assessment Scale
Physiologic Assessment Scoring System
PASS Scoring
1. Score prior to sedation (all 7 elements)
as baseline
2. Score at the conclusion of procedure
3. Score prior to discharge
Note: Patient must meet pre-sedation PASS
Score prior to discharge.
Recovery/Level of Sedation
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Score
Consciousness
Awake and alert, turns toward voice
Arousable, but drifts back to sleep when not disturbed
Unresponsive (except to painful/repeated stimuli)
2
1
0
Activity
Appropriate for age or development
Weak for age or development
No voluntary movement
2
1
0
Circulation
Stable BP within 15% of pre-sedation level (baseline)
BP within 30% of pre-sedation level
BP > 30% higher or <30% lower than baseline
2
1
0
Respiration
Able to cough, breath deeply or cry
Dyspnea or limited breathing
Apnea/obstructed breathing requires assistance to maintain airway
2
1
0
Saturation
Room air: O2 Sat > 95%
Needs supplemental O2 to maintain O2 Sat > 95%
O2 Sat < 95% with O2 supplementation
2
1
0
Readiness for Discharge
Score
Pain
None or mild pain
Moderate or severe pain controlled with IV analgesics
Persistent severe pain
2
1
0
Emetic
None or mild nausea with no vomiting
Transient vomiting or retching
Persistent moderate to sever nausea or vomiting
2
1
0
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WHAT is NOT Procedural Sedation?
■ Providing for comfort
■ Preventing predictable anxiety to a procedure or treatment by
utilizing narcotics and anxiolytics in dosages appropriate to relieve
pain and/or anxiety without altering the LOC
■ Non-invasive and routine procedures (dressing changes)
■ Procedure that takes so little time to perform that the fear of the
procedure is often worse than the actual process
■ One type dose medication administration to relieve anticipated pain
or anxiety for a particular patient (no titrating dose to “effect”)
■ Patient in ICU, intubated, and mechanically ventilated (airway is
protected)
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WHAT is NOT Procedural Sedation?
■ Pain and/or anxiety management that may be performed
on all inpatient units
■ Repetitive procedures (e.g. once daily) and a patient who is on
a standard dose, or combination of medication that
provides comfort
■ A change in medication dose that would potentially
induce pain and/or anxiety
Note: If patients have been on a medication regime in the ICU with
Fentanyl/Versed, the physician should be consulted to determine if the choice of
narcotics may be changed to an equianalgesic dosage of hydromorphone or
morphine sulphate, and the midazolam changed to a non-amnesiac anxiolytic
such as lorazepam or valium
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WHY Provide Procedural Sedation?
■ Allows patient to tolerate an unpleasant procedure
while maintaining consciousness
■ Patient does not remember majority of procedure,
awakens comfortable (depending on medications utilized)
■ Rapid return to presedation state
■ Uncomfortable and/or painful procedures can be
performed safely utilizing procedural sedation
■ Patient safety during, and recovering from, sedation
is VITAL!
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WHO can Provide Procedural Sedation?
■ Physicians must have current sedation privileges. An updated list can
be accessed on the SD Credentialing Website: http://cred.zion.ca.kp.org
■ Residents may perform procedures only when the privileged attending
physician is present
■ RNs with age-specific training in ACLS or PALS may administer
Procedural Sedation and recover the patient
■ MD will complete the Procedural Sedation Record Physician documentation
(Health Connect), including auscultation of heart and lungs and airway
assessment
■ RN will complete the Procedural sedation Record RN documentation
(Health Connect)
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Procedural Sedation SETTING
■ Emergency Medications, Equipment & Supplies
■ Crash cart with defibrillator, O2, suction
■ Reversal agents (naloxone, flumazenil)
■ Pulse oximeter, blood pressure monitor
■ Endotracheal tube (ET) CO2 monitoring device
■ Physical Environment
■ Emergency power outlets, or flash light
■ Telephone
■ Transportation after Sedation
■ By RN or MD
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Procedural Sedation Preparation
■ Consent needs to be obtained by physician
for both the procedure and the sedation
■ Pre-sedation Assessment
■ Evaluation of Risk (American Society of
Anesthesiologists ASA status)
■ PASS Scores
■ Sedation plan (medications ordered)
■ Time Out
■ Team members discuss any risks
ASA Status
Class I
Risk Assessment
Healthy patient
Class II
Mild systemic disease, no
functional limitation
Class III
Severe systemic disease
that limits activity (not
incapacitating)
Class IV
Incapacitating systemic
disease that is a threat to
life (Anesthesia consult)
■ Team members know roles and responsibilities
■ Patient Safety
■ Identify patient (2 identifiers), must have arm
band
■ Site/side verified
Class E
Emergent
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Presedation Assessment
■ AMPLE
■ Allergies – medication, food, latex
■ Medications – presently taking
■ Past medical history
■ Last meal (NPO Guidelines)
■ Event leading to need for procedure
■ NPO Guidelines
AGE
0-6mo
6mo-3yrs
3yrs +
Solids & Non-Clear Fluids
4 hours
6 hours
6-8 hours
Clear
2-3 hours
2-3 hours
2-3 hours
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Care During Sedation
■ Ensure Patient SAFETY
■ RN remains with patient at all times
■ RN responsibility is to monitor the patient –
ensure safety
■ RN will NOT be expected to assist with the
procedure
■ Maintain level of sedation that allows for
continuous patent airway
■ Monitor patient’s response to medications
■ Assess vital signs q 15 minutes
■ Sedation plan (medications ordered)
■ Document
■ Use the Procedural Sedation
Navigator (Health Connect)
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Procedural Sedation Documentation
Use the Procedural Sedation Navigator (Health Connect)
From the patient’s open record,
Click Action  Procedural
Sedation on the Main Menu.
Procedure Sedation
Navigator Appears
Four (4) Main Topics
Navigate through each section
to document your findings…
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Common Sedation Agents
Click Deep Sedation Agents
for details
Moderate Sedation
Agents
Deep Sedation
Agents
1. ChloralSedation
Hydrate does not include:
Procedural
2. Chlorpromazine (Thorazine)
1. Diazepam
Alfentanil (Alfenta)
3.
(Valium)
4.
(Sublimaze)
2. Fentanyl
Etomidate (Amidate)
5.
(Vistaril)
3. Hydroxyzine
Ketamine (Ketalar)
6.
(Ativan)
4. Lorazepam
Methohexital (Brevital)
7.
(Demerol)
5. Meperidine
Propofol (Diprivan)
8. Midazolam
(Versed)
6. Thiopental (Sodium Pentothal)
9. Morphine Sulfate
10. Pentobarbital
(Nembutal)
11. Promethazine
(Phenergan)
ADULT DRUG DOSAGE GUIDELINES for
Moderate and Deep Sedation
San Diego
Dosages require adjustment based on patient's clinical condition
Adapted from: Southern CA Regional Drug Information Services
BENZOIDIAZEPINES, DOSAGE
Midazolam (Versed): Slow IV: 0.5 - 1 mg
(over 2 minutes) and titrate to desired effect
by repeating doses every 2-3 minutes if
needed
Precaution: Reduce dose for elderly or
those that have COPD or receiving
concomitant narcotics. Some pt’s respond
to 1mg. Usual total dose: 2.5-5 mg
Lorazepam (Ativan): IV: 0.05 mg/kg, 1-4 mg
IV every 10-20 mins. 4 mg max.
PO: 1-2 mg initially. Usual dosing is 2-6
mg/day divided. May gradually increase to
10 mg daily in 2-3 divided doses
Precaution: Monitor blood pressure and
assess motor and autonomic responses
ONSET
IV: 2-5 mins
DURATION
Peaks at 30 – 60
minutes.
Duration: 2-6
hours
IV: 5-20 mins
PO: 60 mins
IV, PO: 2 – 6 hours
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ADULT DRUG DOSAGE GUIDELINES for
Moderate and Deep Sedation
Dosages require adjustment based on patient's clinical condition
Adapted from: Southern CA Regional Drug Information Services
Diazepam (Valium):
IV: 2.5-5 mg incremental doses of 2.5 mg
can be given in 3-4 minute intervals.
Usual total 2-10 mg.
PO: 2-10 mg 2-4 times/day
Precaution: incompatible with most
medications. Potential complications:
hypotension, confusion, drowsiness &
apnea
IV = intravenous; IM = intramuscular;
IN = intranasal; PO = by mouth;
PR = by rectum; and SC = subcutaneous
IV: 2-5 mins
PO: 30 mins
Peaks at 6090 minutes
Elimination
half-life
36hours
ADULT DRUG DOSAGE GUIDELINES for
Moderate and Deep Sedation
San Diego
Dosages require adjustment based on patient's clinical condition
NARCOTICS, DOSAGE
ONSET
DURATION
Morphine: IV: 1-5 mg every 2-15 minutes. 2-5 mg IV: 5-10 mins/
IV every 5-15 mins
15-60 mins
Precaution: Itching & hypotension may occur
Fentanyl (Sublimaze): IV: 1 - 4 mcg/kg. Typical
IV: 30-60 sec
dose is 25-50 mcg; may repeat every 5-15
minutes. Usual total 50-200mcg
Precaution: 100 times more potent than
morphine. Rapid administration causes skeletal
muscle & chest wall rigidity
IV: 2 – 4 hours
Meperidine (Demerol): IV: 12.5-50 mg every 15
minutes. Usual dose is 50-100mg.
IV: 2-4 hours
IV: 5-10 mins
Peaks in 5-15
mins
IV: 30-60 min
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ADULT DRUG DOSAGE GUIDELINES for Moderate and Deep Sedation
Dosages require adjustment based on patient's clinical condition
Adapted from: Southern CA Regional Drug Information Services
OTHER AGENT, DOSAGE
Diprivan (Propofol): IV: 0.5-1.5mg/kg. May
repeat 0.5mg/kg boluses every 3-5 mins
as needed for continued sedation
Note: Injectable Emulsion for adults & children
>2years. Adhere to strict aseptic technique during
handling. A soy based product containing egg
lecithin with no preservatives, can support growth
of microorganisms
Precaution: rapid bolus injection can result in
undesirable cardiorespiratory depression (apnea
and hypotension). Discard unused portions at the
end of the procedure or at 6 hours. Flush IV every
6 hours & at the end of the procedure to remove
residual from the line
ONSET
IV: 1-2 mins
DURATION
IV: 3-10
minutes
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ADULT DRUG DOSAGE GUIDELINES for Moderate and Deep Sedation
Dosages require adjustment based on patient's clinical condition
Adapted from: Southern CA Regional Drug Information Services
REVERSAL AGENTS, DOSAGE
ONSET
DURATION
Naloxone (Narcan): Narcotic antagonist
IV: 0.2-0.4 mg every 2-3 minutes as
needed
Precaution: rapid reversal may cause
nausea, hypertension
IV: 1-2
mins
IV: 30-60 mins
short half- life30-81 mins;
may require
repeat in 1-2
hours
IV: 30-60 mins
short half-life41-79 mins;
may repeat 20
min intervals
Flumanzenil (Romazicon):
IV: 1-3
Benzodiazepine antagonist
mins
IV: 0.2 mg every minute up to max of 1mg.
Most patients respond to 0.6-1 mg; up to 3
mg has been reported
Precaution: may induce seizures in pt’s
with seizure history
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Pediatric Guidelines for Moderate and Deep Sedation
Guidelines do not apply to neonates or ex-premature infants up to 6 mos
Dosages require adjustment based on patient's clinical condition
Consider Adult dosing guidelines for patients greater than 50 kg
Midazolam (Versed), DOSAGE
ONSET
DURATION
IV: 0.05 mg/kg, maximum of 5 mg titrated over IV: 1-2 min IV, IM: 30–
one hour
IM: 5-15 min 60 min
IM: 0.1 mg/kg
IN/PO:10min
IN: 0.2-0.4 mg/kg, maximum dose 7.5 mg
IN/PO:
PO: 0.25-0.5 mg/kg; maximum total dose 12 mg
1–2 hours
Precaution: Three times more potent than
diazepam. Used with opiates can cause
overdosage and complications
(IV = intravenous; IM = intramuscular;
IN = intranasal; PO = by mouth; PR = by rectum;
and SC = subcutaneous)
Adapted from: Southern CA Regional Drug Information Services
San Diego
Pediatric Guidelines for Moderate and Deep Sedation
Guidelines do not apply to neonates or ex-premature infants up to 6 mos
Dosages require adjustment based on patient's clinical condition.
Consider adult dosing guidelines for patients greater than 50 kg
BARBITUATES, DOSAGE
Pentobarbital (Nembutal) *
IV: 1-3 mg/kg; may repeat up to 6 mg/kg
IM: 2-5 mg/kg
PO: 2-3 mg/kg
ONSET
IV: 1-5 min
IM: 5-15 min
PO: 15-60 min
DURATION
IV:15–60 min
IM, PO: 2–4
hours
Methohexital (Brevital) *
PR: 20-30 mg/kg
PR: 5-15 min
PR: 30–90
min
*These agents are restricted to practitioners with
deep sedation privileges operating under
guidelines approved by the Medical Executive
Committee
Adapted from: Southern CA Regional Drug Information Services
San Diego
Pediatric Guidelines for Moderate and Deep Sedation
Guidelines do not apply to neonates or ex-premature infants up to 6 mos
Dosages require adjustment based on patient's clinical condition.
Consider adult dosing guidelines for patients greater than 50 kg
OTHER AGENTS, Dosage:
Chloral hydrate;
PO, PR: 25-100 mg/kg; maximum 2 g Precaution: May
necessitate ongoing monitoring
Ketamine (Ketalar): *
IV: 0.5-2 mg/kg IM: 3-4 mg/kg
Adverse Effects: Increased systemic, intracranial, &
intraocular pressures; hallucinogenic emergence
reactions; laryngospasm; & excessive airway secretions
Diprivan (Propofol) *
IV: 0.5-1mg/kg. May repeat 0.5mg/kg boluses every 3-5
mins as needed for continued sedation.
Precaution: rapid bolus injection can result in undesirable
cardiorespiratory depression (apnea and hypotension). Discard
unused portions at the end of the procedure or at 6 hours. Flush
IV every 6 hours & at the end of the procedure to remove residual
from the line
* Agents restricted to practitioners with deep sedation privileges
Adapted from: Southern CA Regional Drug Information Services
ONSET
PO, PR:
15-30 min
DURATION
PO,PR:
2–3 hours
IV: 1-2 min
IV, IM:
IM: 3-10mins 15–60 min
IV: 1-2 min
IV: 3-10 min
Pediatric Guidelines for Moderate and Deep Sedation
San Diego
Guidelines do not apply to neonates or ex-premature infants up to 6 mos
Dosages require adjustment based on patient's clinical condition.
Consider adult dosing guidelines for patients greater than 50 kg
NARCOTICS, DOSAGE
ONSET
Morphine IV: 0.05-0.1 mg/kg
IV: 5-10 mins
Precaution: Itching & hypotension may
occur
Fentanyl (Sublimaze) IV: 1-4 mcg/kg
Precaution: one hundred times more
potent than morphine. Rapid
administration causes skeletal muscle
& chest wall rigidity
IV: 2-3 mins
Adapted from: Southern CA Regional Drug Information Services
DURATION
IV: 2-4 hours
IV: 20–60 mins
San Diego
Pediatric Guidelines for Moderate and Deep Sedation
Guidelines do not apply to neonates or ex-premature infants up to 6 mos
Dosages require adjustment based on patient's clinical condition.
Consider adult dosing guidelines for patients greater than 50 kg
REVERSAL AGENTS: DOSAGE
ONSET
DURATION
Naloxone (Narcan): Narcotic antagonist
IV, IM,: 0.1 mg/kg (20kg or less) – max 2mg; if above
20kg  2 mg; may repeat in 5min to effect
Precaution: rapid reversal may cause nausea,
Hypertension
IV: 1-2 mins
IM: 2-5mins
45mins,
may be shorter
than duration of
opiate
Flumanzenil (Romazicaon): Benzodiazepine
antagonist
IV: 0.01 mg/kg; Max. single dose 0.2 mg; may repeat
every minute up to a maximum total dose of 1 mg
Precaution: may induce seizures in pt’s with seizure
history
IV: 1-3 min
45-60 mins, may
be shorter than
duration of the
benzodiazepine
Adapted from: Southern CA Regional Drug Information Services
Medication Administration
Requirements
San Diego
Clinical Library
To find out more information about medications, visit KP’s Clinical Library
at http://cl.kp.org. This resource includes information on medication:
■ Dosages
■ Routes
■ Therapeutic range
■ Pharmacologic classification
■ Mechanism of action
■ Safe use of clinical practice guidelines formularies
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Post Sedation Recovery and Care
Ensure Patient SAFETY
■ RN remains with patient at all times
■ RN is responsible to monitor the patient –
until pt. achieves his/her presedation LOC
■ If transferring the patient, the RN
administering sedatives must accompany
the patient, give a complete, concise report to the
receiving RN responsible for further patient care
■ Monitor patient’s vital signs and pulse oximetry
q 15 minutes until stable
■ Reorient patient to time and place
■ Limit stimuli to the patient (loud noises)
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Discharge Requirements
Patient Must
■ Be discharged by a physician
■ Have adequate respiratory function and stable vital signs
■ Meet their preprocedural LOC, and return to their
preprocedural status
■ Have their pain under control, and site stable without
evidence of bleeding
■ Not be discharged for 20-30 minutes after last
medication, longer if reversal agents given
■ Be discharged to a responsible driver and advised not to
drive or use heavy machinery for at least 24 hours
■ Receive post-procedural written discharge instructions
■ Verbalize understanding of instructions and education
(and/or responsible caregiver)
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Patient Safety Special Considerations
Patient Special Considerations
■ Elderly patient’s may need more time
for monitoring
■ Ensure a good intact gag reflex
especially in children
■ Evaluate each INDIVIDUAL patient
based on a number of considerations,
not just meeting these outline criteria
■ Document time patient leaves the
facility
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PROCEDURAL
SEDATION
POST TEST
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Procedural Sedation Post Test
1. Which treatment is an example of procedural sedation?
A. Preventing anxiety prior to treatment without altering the
patient’s level of consciousness.
B. Providing comfort measures to the patient.
C. Performing a simple dressing change.
D. Administering medication to alter the level of consciousness prior to
a procedure.
2. A Physician prescribes a one-time dose of Morphine and Ativan to
reduce the patient’s pain and anxiety during a dressing change.
This is considered procedural sedation.
A. True
B. False
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Procedural Sedation Post Test
3. To prepare for procedural sedation, the RN must:
A. Obtain patient consent for both the procedure and the sedation.
B. Confirm auscultation of heart, lungs, and airway assessment was performed by MD
C. Be aware of sedation plan
D. Perform patient identification and a “Time-Out”
E. Perform a baseline PASS assessment.
F. All of the above
4. To perform procedural sedation, the RN must:
A. Have age-specific resuscitative equipment.
B. Have a physician privileged in Procedural Sedation present in the room.
C. Receive age specific advanced life support certification.
D. Provide a cardiac monitor, O2 monitoring, and ET CO2 monitoring.
E. Follow all of the above.
San Diego
Procedural Sedation Post Test
5. When performing procedural sedation, it is satisfactory to have the physician be
available by pager during the procedure.
A. True
B. False
6. The nurse providing moderate sedation should remain with the patient at all times.
A. True
B. False
7. Before a procedural sedation patient can be discharged, they need to be observed
for a minimum of 30 minutes after the last dose of sedative or analgesic was
administered. Longer periods of observation are required if reversal agents are
used.
A. True
B. False
San Diego
Procedural Sedation Post Test
8. To discharge a patient following procedural sedation, a post-procedural
assessment must be conducted (by a credentialed practitioner privileged in this
procedure), the patient needs to receive written discharge instructions, and a
responsible adult/driver must be identified.
A. True
B. False
9. A “time-out” is performed prior to the start of the procedure and typically
includes:
A. A description of the nature of the procedure, the patient’s condition, details of any
abnormal history or condition, and any special patient needs.
B. Use of two patient identifiers – patient name and medical record on arm band.
C. Verification of the site, both physically and verbally, and if required, marking of the
site.
D. A review of the expected course of the procedure and recovery.
E. All of the above
San Diego
Procedural Sedation Post Test
10. Development of chest wall rigidity (“wooden chest”) may result in
serious respiratory compromise and is most often seen with the rapid
administration of:
A. Fentanyl (Sublimaze)
B. Morphine
C. Ketamine (Ketalar)
D. Flumazenil (Romazicon)
11. The reversal agent and initial dose preferred for a 300-pound 18
year-old who has had Diazepam, Midazolam, and Lorazepam
during a procedure is:
A. Flumazenil (Romazicon) 0.2 mg, repeat every 1-2 minutes as needed
B. Naloxone (Narcan) 0.4 mg, repeat every 2-3 minutes as needed
C. Both a and b
San Diego
Procedural Sedation Post Test
12. During conscious sedation, vital signs and oxygenation status are recorded at
least every ______ minutes.
A. 1
B. 5
C. 15
13. To verify a physician’s privileges to perform procedural sedation:
A. Call the house supervisor
B. Go to the Kaiser Permanente Credentialing web site
C. Call the MD to see if they are privileged
14. Complications of procedural sedation can include:
A. Abnormal cardiac function and deterioration
B. Hypoventilation and allergic or reverse reaction
C. Hypoventilation, allergic or adverse reaction, abnormal cardiac function, and
deterioration in mental status
San Diego
Procedural Sedation Post Test
15. A 60 year-old male patient with coronary artery disease undergoes a pacemaker
implant under IV sedation. During the procedure, the patient’s oxygen saturation
decreases to 84%. The patient is snoring and responds to vigorous stimulation.
You should:
A. Lift the chin and jaw, attempt to provide a better airway, notify the physician
immediately after the change in the patient's condition, increase oxygen delivery,
call for assistance and consider reversal agents.
B. Continue to monitor for further changes; reduce the next dose of sedation
medication by half.
C. Document the patient's status on the assessment form; notify the MD at the
conclusion of the procedure.
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Procedural Sedation Post Test
16. After receiving Morphine and Valium for sedation and analgesia, your patient
loses consciousness and becomes dusky in appearance, and the oxygen
saturation decreases rapidly from 95% to 75%. What is the appropriate nursing
action?
A. Ambu bag delivery of oxygen
B. Nasal cannula delivery of oxygen
C. Be ready to give IV Narcan and Romazicon
D. A and C
17. During a procedure in which you are administering procedural sedation,
respirations suddenly become stridorous and you notice a red rash occurs on the
patient’s hands. The appropriate nursing action is to:
A. Intubate
B. Do nothing
C. Stop the medication and treat per the physician’s order
D. Call a code blue
San Diego
Procedural Sedation Post Test
18. Emergency equipment which must be immediately accessible during IV sedation
includes:
A. Emergency cart with defibrillator, cardiac monitor, airways, bag-valve mask, and
intubation equipment, including ET CO2 monitor
B. Emergency drugs including reversal agents
C. Oxygen and suction with tubing
D. All of the above
19. The reversal agent and initial dose preferred for a 44-pound (20-kg) child who has
had Morphine during a procedure is:
A. Flumazenil (Romazicon) 0.1 mg – 0.2 mg
B. Naloxone (Narcan) 0.01 mg/kg
C. None of the above
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Procedural Sedation Post Test
20. A patient whose PASS score is “1” for consciousness is:
A. Presumed to be moderately sedated
B. Presumed to be minimally sedated
C. Presumed to be deeply sedated