Module 3 Flashcards
For nitrous oxide used what documentation must be obtained
- informed consent & documentation in chart
- percentage of N2O administered
- length of time the patient was sedated
- flow rate of gases during administration
- indications for use of N2O
- patient response & tolerance
what are the properties of ideal sedation with nitrous oxide
- produces analgesic & anxiolytic effects
- rapid onset –> 2 - 5 minutes
- wide safety margin
- quick recovery time
- no “hangover” effect
why does nitrous oxide have a rapid onset
low blood solubility
does nitrous oxide have an effect on HR or BP
no (can have the slightest increase on BP)
what can nitrous oxide induce at high concentrations
unconsciousness
T/F nitrous oxide diffuses slowly across alveolar-arterial membrane
FALSE - rapidly
T/F nitrous is excreted unchanged through the lungs
TRUE
does nitrous oxide cross the BBB and/or the placenta
yes
what are the indications for nitrous oxide sedation
- anxiety
- tendency of fainting
- strong gag reflex
- medically compromised (decreases stress –> angina pectoris, post MI, post CVA)
- long procedures
- inadequate local anesthesia
what defines ABSOLUTE contraindications for nitrous oxide
administration of drug INCREASES possibility of a life threatening situation
NEVER ADMINISTER
what defines RELATIVE contraindications for nitrous oxide
administration of drug is PREFERABLY AVOIDED due to possible adverse reactions
ADMINISTER JUDICIOUSLY
what are examples of ABSOLUTE contraindications
- nasal obstruction
- vitamin B12 deficiency
- alcohol / recovering addict
- uncommunicative
- pt refusal
what are examples of RELATIVE contraindications
- middle ear infection
- balance disorder
- susceptibility to motion sickness
- claustrophobia
- pulmonary diseases
- immunocompromised
- pregnancy
- psychiatric disorders / bipolar
- marijuana or hallucinogenic drug use
what are the side effects of nitrous oxide sedation
- nausea & vomiting
- dysphoria, hallucination, dizziness
- headache
- mask claustrophobia
- urinary incontinence
- increased apprehension
what can long term exposure to nitrous oxide induce
- bone marrow suppression
- reproductive system disturbances (spontaneous abortion, premature delivery, infertility)
- neurological deficits (numbness, paresthesias, impaired equilibrium, difficulty concentrating)
- possible hepatotoxicity
what is the equipment color for oxygen
green
what is the equipment color for nitrous oxide
blue
what does the flush button do
fills reservoir bag and can be used for OVER-SEDATION
what is the minimum O2 level for the oxygen fail safe mechanism
30%
what is the maximum N2O level for the oxygen fail safe mechanism
70%
what does the oxygen fail safe mechanism do
shuts off if O2 flow stops
what does the O2 cylinder contain
ONLY GAS
does the O2 cylinder gauge reflect the actual contents of the cylinder?
yes
what does the N2O cylinder contain
compressed gas in both liquid and gaseous states
filled to 90-95% capacity with liquid U& a gas layer above
does the N2O cylinder gauge reflect the actual content of the cylinder?
no - as long as liquid remains the gauge will show full
once ALL liquid is gone & ONLY gas remains then the gauge will fall to show remaining gas level
what is in place so that tanks cannot be inadvertently reverse
pin index safety system
what causes N2O flow to terminate if O2 delivery pressure falls
oxygen fail safe
what allows atmospheric air in if flow or gases stop
emergency air inlet
what allows for rapid delivery of high flow O2 to patient in cases of oversedation
oxygen flush button
what is the first step of nitrous oxide administration
selecting the appropriately sized nasal hood
what is the second step of nitrous oxide administration
inflating the reservoir bag
what is the flow rate of the reservoir bag
5 - 6 L/min of 100% O2
what is the third step of nitrous oxide administration
placing the nasal hood on the pt and adjusting and tightening for comfort
what is the fourth step of nitrous oxide administration
instruct the pt to breathe normally and then adjust the flow rate accordingly
what is the fifth step of nitrous oxide administration
gradually titrate N2O - O2 in 10% intervals
ask how the pt feels and watch for signs of sedation
what is the typical required N2O - O2 levels for a pt
50% N2O & 50% O2
what should you never do when nitrous oxide is administered
leave the patient unattended
what do you do with the nitrous oxide levels when treatment is completed
reduce N2O to zero & increase O2 to 100% for 5 minutes
what is the final step of nitrous oxide administration
documentation of the procedure
