Moderate Sedation In-Service Training

Moderate Sedation In-Service Training Practitioners performing moderate sedation must have all the skills to provide support to a patient in a state of deep sedation. - ✔✔TRUE The Joint Commission standards on sedatio ...

Moderate Sedation In-Service Training Practitioners performing moderate sedation must have all the skills to provide support to a patient in a state of deep sedation. - ✔✔TRUE The Joint Commission standards on sedation and anesthesia apply whenever a patient receives moderate sedation, deep sedation, or general anesthesia. They do not apply when patients receive anxiolysis/minimal sedation. - ✔✔TRUE The RN giving moderate sedation to the patient should not be scheduled to be involved in duties other than continuous monitoring of the patient. - ✔✔TRUE Case Scenario 1: A 70-year-old 80 kg male is scheduled for cystoscopy and prostate biopsies for prostatic hypertrophy. He has a long history of hypertension and intermittent CHF treated with Lasix and Digoxin. He also has an implanted pacemaker that was placed for his history of heart block. Upon arrival to the clinic his B/P is 160/90, HR 75, RR14 and O2 Sat 96% on room air. Per physician order the patient receives Valium 10mg p.o. and is transferred to the procedure room 30 min. later. The patient feels relaxed and he moves to the exam table himself. B/P 150/80, HR 70, O2 Sat 95 Percent on room air. This case report is an example for: - ✔✔minimal sedation A pre-sedation assessment needs to include all of the following except: - ✔✔hematocrit A 62-year-old 100 kg man with chronic alcoholism and acute hematemesis is scheduled for an upper endoscopy. On admission his mental status is described as alert and oriented. B/P 140/90, HR 110. His Hct is 27. Upon arrival to the GI suite the patient is placed on all monitors. He receives oxygen at 2 liters/min. by nasal cannula and is sedated with Demerol 50mg x 2 IV. The patient is sleepy, but easy to arouse and follows commands. His O2 Sat. is 96% and he shows no signs of airway obstruction. Ten minutes into the procedure the patients' B/P dropped briefly to 86/45 and his HR is 110. - ✔✔moderate sedation A 66-year-old 62 kg male was admitted to the hospital after a 3-day history of new onset of hemoptysis. A left upper lobe mass was noted on his chest x-ray. He is now scheduled for a bronchoscopy. He has a long history of tobacco abuse and he uses heroin up to three times per day. He has a history of hypertension for which he takes Clonidine. B/P 140/90, HR 62, RR 24, O2 Sat 96% on 2 liters/min. nasal cannula. The patient is very anxious. During the first 15 min. the respiratory therapist and pulmonologist try to talk to the patient. He receives his Lidocaine INH, a total of 10 mg of morphine IV, and midazolam 3mg IV. The patient's speech is slurred and he soon becomes unconscious. He is not arousable by painful stimulation. A stridor is noticed, his O2 Sat drops to 78%, his RR is 4-6/min. - ✔✔general anesthesia Intravenous morphine: - ✔✔peaks at 20-30 minutes in effect Which of the following is not true about naloxone? - ✔✔Naloxone should be used routinely to antagonize the effects of morphine or fentanyl following moderate sedation. Pulse oximetry: - ✔✔generally is a good measure of oxygenation. A 23-year-old 60 kg woman is scheduled for endoscopic retrograde cholangiopancreatography (ERCP) secondary to recurrent obstruction and jaundice. She has a history of asthma since childhood and takes daily albuterol via an inhaler. She recently finished a dose pack of steroids. She is very anxious. B/P 100/60, HR 88, RR 20, O2 Sat 97%. She is placed on all monitors and receives supplemental oxygen per nasal cannula. Per physician order the patient receives midazolam a total of 3mg IV and Fentanyl 25mcg IV × three. A few minutes after the last dose of fentanyl the patient shows thoraco-abdominal rocking motion and nasal flaring. Her O2 Sat drops to 89 Percent and she finally opens her eyes after repeated painful stimulations. - ✔✔deep sedation Typical initial IV dose of midazolam (Versed) in healthy patients undergoing moderate sedation per dosage guidelines: - ✔✔1-2.5 mg Hypotension in moderate sedation may be (v3) - ✔✔all of the above Typical initial IV dose of fentanyl for moderate sedation as listed in the dosage guidelines: - ✔✔25 - 50 mcg Which of the following amounts of time must elapse between last dose(s) of flumazenil and discharge in order to assure that patient will not become re-sedated? - ✔✔2 hours hat are signs of upper airway obstruction? - ✔✔all of the above