Transcript Conscious Sedation

Conscious Sedation
Jan Bazner-Chandler
CPNP, CNS, MSN, RN
Conscious Sedation
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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.
Definition and Goals
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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.
Patient Selection and Pre-procedural
Assessment
ASA 1
No know systemic
disease
ASA 2
Milk or well-controlled
systemic disease.
Multiple or moderate
controlled system
disease.
Poorly controlled
systemic disease
Moribund patient
ASA 3
ASA 4
ASA 5
May have conscious
sedation without other
consultation
Same as above
Consider medical
consultation.
Mandatory involvement of
Anesthesiology
Department
Same as above
ASA Patient Classification
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ASA 1 = health patient
ASA 2 = Patient smokes and has wellcontrolled 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.
Monitoring and Equipment
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Oxygen
Suction
Airway management
Monitors
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Pulse oximeter
Cardiac monitor
Automated blood pressure device
Monitoring Equipment
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Resuscitative equipment / medications
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Ambu bag
Defibrillator with ECG recorder
Emergency drugs
Emergency drug card and ACLS protocols
PAL protocol
Pre-procedure
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Allergies
Weight to calculate medications
Recent history and physical
Baseline vitals with blood pressure and pulse
oximeter
Developmental assessment
Documentation of Care
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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.
Documentation of Care
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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.
Notify Medical Doctor
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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.
Discharge Assessment
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Vital signs to pre-procedural baseline
Gag reflex / able to swallow
To pre-procedural level of awareness
Discharge Teaching
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Verbal and written discharge instructions.
Instructions should be initiated in preprocedure phase and repeated in postprocedural phase.
Discharge Instructions
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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
Policies and Procedures
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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.
Competencies
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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.”