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Adult Nursing II - Exam 2 > Moderate & Deep Sedation > Flashcards

Moderate & Deep Sedation Flashcards

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1
Q

What drugs are used for minimal sedation (anxiolysis)?

A
  • Morphine
  • Dilaudid
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2
Q

What is moderate sedation & what drugs are used for this type of sedation?

KNOW THIS!!!!!

A

Drug induced depression of consciousness but the patients respond purposefully to verbal commands

  • patient should be able to mantain their airway

Ketamine & Propofol

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3
Q

What key thing should patients under moderate sedation (analgesia) be able to do?

A

Maintain their airway

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4
Q

In what instances is moderate sedation often used?

A
  • Drainage in sensitive areas (rectal abscess)
  • Shoulder or hip dislocation
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5
Q

Explain each of the ASA (American Society of Anesthesiologists) Classifications

A
  • ASA I: normal healthy patient, no organic, pathological, biochemical, or psychiatric disturbance or disease
  • ASA II: Patient with mild to moderate systemic disturbance or disease
  • ASA III: Patient wiht severe systemic disturbance or disease
  • ASA IV: Patient with severe & life-threatening systemic disease or disorder
  • ASA V: Patient who is unlikely to survive without the planned procedure
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6
Q

What is an ASA I classification?

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A

Normal healthy patient with no organic, pahtologic, biochemical, or psychiatric disturbance or disease

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7
Q

What is ASA II Classification?

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A

Patient with mild to moderate systemic disturbance or disease caused by either the condition to be treated or another pathological process

  • slightly limited heart disease
  • well-controlled HTN
  • anemia
  • smoker w/out significant respiratory disease
  • pregnancy
  • well-controled diabetes
  • neoplastic disease with chemotherapy
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8
Q

What is ASA III Classification?

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A

Patient with severe systemic disturbance or disease

  • Angina
  • Poorly controlled HTN
  • Past MI w/ current mild to moderate symptoms
  • systemic respiratory disease (COPD, Asthma, etc.)
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9
Q

What is ASA IV Classification?

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A

Patient with severe & life-threatening systemic disease or disorder

  • unstable angina
  • active or chronic CHF
  • hepatorenal failure (requires dialysis)
  • patient in SVT who is cardioverted
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10
Q

What is ASA V Classification?

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A

Patient who is unlikely to survive without the planned procedure

  • rutured aneurysm with severe shock
  • massive PE
  • major cerebral trauma w/ rapidly increasing ICP
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11
Q

What is Mallampati Scoring?

KNOW THIS!!! - BOLD, RED

A

Allows providers to know how difficult intubation will be on a patient

I: full visualization (soft palate, hard palate, & uvula visible)
II: only soft palate & uvula are visible
III: soft palate & part of the uvula are visible
IV: hard to visualize (only soft palate is visible)

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12
Q

What drugs are used for moderate / deep sedation?

KNOW THIS!!! - BOLD, RED

A

Propofol & Ketamine

  • must be pushed by the provider
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13
Q

Safety to remember when sedating patients

IMPORTANT!

A
  • all sedatives & narcotics can cause respiratory depression
  • Sedatives & analgesics have a cumulative effect
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14
Q

What are the two goals when sedating a patient regarding medication that is given?

A

Sedate the patient & pain relief

  • sedative + opioid (for pain)

Sedatives:
* Propofol
* Benzodiazepines (Versed, Valium, Ativan)

+

Opioids
* Dilaudid
* Morphine
* Fentanyl

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15
Q

Rescue Capacity Care During Sedation

KNOW THIS!!! - RED, BOLD

A
  • IV access & fluids running
  • Ensure access to rescue equipment including crash cart
  • Bag-Valve Mask
  • Suction
  • Intubation equipment
  • Reversal agents
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16
Q

Monitoring During Care of Sedated Patients

KNOW THIS!!! - RED, BOLD

A
  • 1:1 (nurse cannot multitask)
  • Continuous Pulse Ox
  • BP & vitals every 5 minutes (during procedure)
  • Continuous EKG monitoring
17
Q

How often are vitals measured during and after a procedure with mdoerate/deep sedation? At what point can that monitoring stop and what does monitoring interval go to?

A
  • During: LOC, BP, & respiratory status every 5 minutes
  • After Procedure: every 15 minutes until the patient gets to the point where they were at in terms of LOC & vitals pre-procedure
18
Q

What are the antedotes / reversal agents for opioids & benzodiazepines?

KNOW THIS!!! – IN RED, BOLD, HIGHLIGHTED!!!!!

A

Opiods = naloxone (Narcan)

Benzodiazepines = flumazenil (Romazicon)

19
Q

What is the antedote for opioids?

KNOW THIS!!!! - RED, BOLD

A

naloxone (Narcan)

20
Q

What is the antedote for benzodiazepiens?

KNOW THIS!!!! - RED, BOLD

A

flumazenil (Romazicon)

21
Q

What immediate interventions can be used for a patient in moderate / deep sedation who goes into respiratory distress?

KNOW THIS!!!! - RED, BOLD

A
  • Stop sedation
  • Check LOC
  • Chin Lift (maintain airway)
  • Assist ventalations with bag-valve mask
  • Reversal agents
  • Call anesthesia
22
Q

What does aldrete score measure?

A
  • LOC
  • BP
  • O2 sat
  • Activity
  • Respirations
  • Nausea

Highest is a 15

23
Q

What is a sedation awakening trial?

A

Patient is taken off all sedation medications to assess their neuro status & if they understand what’s going on. Occurs at least once per day:
* turn off sedative infusions & stop analgesics
* Assess Richmond Agitation Sedation Scale (RASS) or the Riker Sedation-Agitation Scale (SAS)
* Assess LOC & neuro function

24
Q

True or False? Sedation negates the need for analgesia in mechanically intubated patients.

A

FALSE

25
Q

What is one of the major causes of delerium in the hospital? What are signs and symptoms of delerium?

KNOW THIS!!! - BOLD, RED

A

S&S: Lack of sleep, confusion, restlessness, hallucinations

common in the ICU

26
Q

Non-Pharmacological Interventions to Prevent Delirium

Pharmalogical Interventions for Delerium

KNOW THIS!!!! - RED, BOLD

A

Non-Pharmalogical
* Spontaneous awakening trials
* Early mobility (can get a ventilated patient up into chair)
* Daily delirium monitoring
* Sleep protocol

Pharmalogical Interventions = Haldol (haloperidol)

27
Q

What type of medication is NOT recommended for the treatment of delerium?

KNOW THIS!!!! - RED, BOLD

A

benzodiazepines

Adult Nursing II - Exam 2 (4 decks)

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