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Guidelines for
the Care of the Patient receiving Conscious Sedation
Note:
This standard should be
considered in combination with the procedure specific practical guidelines.
Definition
I.V. Conscious Sedation is
produced by the administration of pharmacologic agents.
A
patient under conscious
sedation has a depressed level of consciousness but retains the ability to
independently and continuously maintain a patent airway and respond
appropriately to physical stimulation and or verbal command.
Pre Procedure
The RN will...
Complete the
nursing history and assessment for, particularly noting prior response to:
IV Sedation (Valium, Demerol, Fentanyl, Versed, etc.)Use of narcotics,
benzodiazepines or other analgesic sedative or "social' drugs.
2.
Inform the
patient of restrictions related to driving or using equipment requiring
clear judgment or quick physical responses. It is advised not to drive for
24 hours.
3. Advise
patients against ingesting alcohol for 24 hours post sedation.
4. Assure
the patient has made discharge transportation arrangements according to
hospital policy.
5.
Document findings and
inform physician of significant findings.
Intra
Procedure
The RN will ...
-
Document medications received
by the patient.
-
Provide and document minimal
monitoring of all patients including: BP, pulse, respirations, level of
consciousness, temperature and dryness of skin and pain tolerance at the
initiation, during and at the completion of the procedure. As indicated by
the patient response, assessment may be more frequent.
-
Monitor O2 saturation and
heart rate as determined by continuous pulse oximetry.
-
Ensure the immediate
availability of Emergency Equipment, e.g. Oxygen, oral airway, ambu bag,
medication to reverse the effects of narcotics ond benzodiazepines.
Post
Procedure
The RN will ...
-
Assess BP, heart rate ,
respiratory rate depth and effort and level of consciousness on admission
to recovery area, after 15 minutes, until stable and at discharge. Post
procedure oximetry must be performed until the patients respiratory status
is stable or returned to pre-procedure state.
-
Assess and document
unexpected events and post procedure complications as related to sedation
and taking interventions as required.
-
Assist and accompany patient
to the bathroom, assess presence of orthostatic hypotension.
-
Assess gait prior to
discharge.
-
Remove IV access prior to
discharge, assess site and document.
-
Reinforce pre procedure
teaching regarding driving, equipment operation and making decisions
requiring judgment. The teaching provided should be in written form and a
copy given to the patient prior to discharge.
The
Registered Nurse functions within the limitations of the provincial
licensing body and Institutional policies.
Disclaimer
The CSGNA
assumes no responsibility for the practices or recommendations of any member
or other practitioner or for the policies and practices of any Endoscopy
unit.
Bibliography
American
Society of Post Anaesthetc Care Nurses(1991). Position Statement on the role
of the registered nurse in the management of the patent receiving conscious
sedabon.
Bailey,R.
(1996). Consensus in Endoscopy. Canadian Journal of Gastroenterology. July
10 (4). 237-242.
Bell,G.,
McCloy, R., Charlton, J., Campbell, D., Dent, N., Gear, M., Logan, R., Swan,
C. (1991). Recommendabons for standards of sedation and patient monitoring
during Gastrointestnal Endoscopy. GUT 7 ( 32), 823-827.
Kidwell, J. (1
991). Nursing care of the patient receiving conscious sedation during
gastrointestinal procedures. Gastroenterology Nursing 13 (3) 134-139.
McCloy, R.,
Fleisher, D. (1993). Sedation and monitoring for gastrointestinal endoscopy.
UK Colloquim International, Ltd.
Society of Gastroenterology
Nurses and Associates Inc. ( 1991).
Position
Statement :Responsibilities of the Gastroenterology Registered Nurse related
to Conscious Sedation.
Somerson, S.,
Husted, C, Sicilia, M. (1995). Insights into Conscious Sedation. American
Journal of Nursing. June 26 -32.
Wansbrough, G.
(1 996). Quality Assurance Medicaton Administration Standards. The College
of Nurses of Ontario College Communique. November 21 (5) 4 -31.
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