International anesthesiology clinics
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Int Anesthesiol Clin · Jan 1999
Nursing education, competency, and role in intravenous conscious sedation.
The advent of new hospital policies addressing analgesia and sedation motivates the nursing education department to implement an education plan for training RNs in the safe administration of medications that produce analgesia and sedation according to hospital policies. Learning materials must be procured or written, classroom content delineated, and a plan to precept all RNs who may be involved in IVCS procedures arranged. ⋯ The RN's role in collecting quality monitoring data is crucial. The development of forms that include all required aspects of patient assessment, care, and monitoring promotes compliance with hospital policy.
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When performing IVCS, one must never forget the primary goal of providing patient comfort without compromising cardiopulmonary function or the patient's ability to react purposely to verbal commands and physical stimuli. When it is anticipated that required sedation will lead to loss of protective airway reflexes, such patients require a greater level of care than exists with IVCS. Deep sedation is a complication of IVCS and must be avoided. ⋯ The use of the narcotic antagonist naloxone and the benzodiazepine antagonist flumazenil should be scrutinized because they should be reserved for the unusual situation in which excessive cardiopulmonary depression occurs. Maintenance of a patent airway and stable cardiovascular function in a patient who can respond to verbal commands and physical stimuli is the primary goal of IVCS. With the agents discussed in this chapter, this goal is easily obtained, keeping the principles just mentioned in mind with all the appropriate monitoring guidelines discussed elsewhere in this text.