Pre-procedure Moderate Sedation Assessment (Pediatric, Adult and Geriatric) A comprehensive pre-procedure preparation is essential to safe endoscopic moderate sedation. Standardized nursing assessment and interventions before, during and following a procedure should be included:
Summary of American Society of Anesthesiologists Pre-procedure Fasting GuidelinesIngested Material: Clear Liquids Ingested Material: Breast Milk Ingested Material: Instant Formula Ingested
Material: Nonhuman Milk Ingested Material: Light Meal
Personnel and EquipmentFor more information, please view the following position statements:
Before sedating a patient, the appropriate personnel should be present:
Emergency equipment must be immediately available whenever sedation and analgesia are being performed
Emergency Resuscitative Equipment
*All appropriate sizes should be available Back to top Patient Safety Issues with Use of Herbal SupplementsHerbals are just one type of dietary supplements as defined by the Food and Drug Administration (FDA). According to the FDA, a dietary supplement is defined as a product that contains one or more dietary ingredient such as:
Risks of Herbal SupplementsThere is no systematic scientific methodology to evaluate possible interactions between herbal supplements and medications that might be prescribed by a physician. As a result, information and recommendations are largely based on the aggregate of animal studies, case reports, historical contraindications, extrapolation from basic pharmacology data and the occasional clinical trial. Much of the information on adverse effects related to herbal supplements has focused around the following problems:
Warfarin is the most common physician prescribed pharmaceutical cited to have negative interactions with herbals. St. John's Wort is the most frequent herbal product reported as being associated with adverse interaction effect with drugs. In addition, herbal supplements that are not known to cause adverse effects when taken at the recommended doses may have toxic effects if extremely high doses are used. Licorice and ginseng in particular have been associated with toxicities from overuse. (FDA) has classified the following supplements as high risk and therefore need be avoided by all patients:
Perioperative ConcernsPreprocedure assessment of herbals should commence in the primary care setting before the patient is actually referred to gastroenterology for a procedure. By the time the patient arrives to his/her procedure, it may already be too late to stop potential drug-to-drug interactions with herbals. The assessment of the patient scheduled to undergo sedation for a procedure includes a history and physical exam. Many patients do not tell their doctor about dietary supplements they may be taking, in part because physicians may not be as knowledgeable about supplements, and patients may fear the physician will be unhappy about the patient using nonconventional therapy. However, doctors and nurses need to know if the patient is taking any supplements because the risk of complications from herbal supplements may be elevated in the perioperative period. This is because of potential interactions between herbals the patient is taking and the anesthesia drugs and other medications that may be administered during the procedure. Also, herbs may contain contaminants and/or other unknown ingredients. Rare complications that might in part be due to supplements include myocardial infarction and stroke (i.e. ephedra) liver injury (i.e., echinacea,kava), ineffective anticoagulation and bleeding (i.e. garlic and gingko), prolonged or inadequate anesthesia (i.e. kava) and rejection of organ transplant (i.e. St. John’s wort). As a result it is generally recommended to avoid herbal supplements for 2 weeks prior to a surgical procedure and anesthesia. The following is a list of common supplements that are of particular concern with regard to the perioperative period.
Sedation Airway ManagementIntroduction:
Symptoms of Partial Airway Obstruction
Symptoms of Complete Airway Obstruction
Airway AnatomyNormal respiration relies on a series of structures that conduct air into and out of the lungs. An understanding of the functional anatomy of this region is critical to airway management. Upper airway The upper airway consists of the structures above the vocal cords. It is divided into the following regions:
Basic Airway ManagementImmediate action must be taken at the first signs of compromised respiratory function. If initial attempts to relieve airway obstruction through verbal and tactile stimulation are unsuccessful, the following techniques can be employed to restore effective ventilation: Manual Maneuvers
Artificial airway devices
Bag-mask ventilation
Advanced Airway ManagementCases where non-invasive means are insufficient to provide adequate oxygenation and ventilation, a clinician may need to use one of the following advanced airways:
Physical AssessmentThe pre-procedure physical examination should include the following assessments to evaluate the patient’s airway and uncover physical traits that could contribute to respiratory complications:
SourcesAmerican Society for
Gastrointestinal Endoscopy. (2003). Guidelines for conscious sedation and American Society of Anesthesiologists. (2011). Granting Privileges for Administration of Moderate Sedation to Multisociety sedation curriculum for gastroenterology. (2012) Gastrointestinal Endoscopy. 76; 1; 2012 Retrieved American Society for Gastrointestinal Endoscopy. (2008). Sedation and anesthesia in GI endoscopy. Society of Gastroenterology Nurses and
Associates. (2009). SGNA Manual of Gastrointestinal Procedures, 6th Cohen, L.B., DeLegge, M.H., Aisenberg, J. et al. (2007). AGA Institute Review of Endoscopic Sedation, Ang-Lee M et al. (2001). Herbal Medicines and Perioperative Care. The Journal of the American Medical Medline Plus: Drugs, Supplements, and Herbal Information. Retrieved from: American Heart Association. The handbook of Emergency Cardiovascular Care for Healthcare Providers. 2010 American Heart Association. (2011). Advanced[1]Cardiovascular Life Support (ACLS) Provider Manual, 36, 38 - ASAhq.org. ASA Physical Status Classification System Hagberg, C. (2007). Benumof’s Airway Management, 2nd Ed.736-737 American Society of Anesthesiologists Task Force on Sedation and Analgesia by on Anesthesiologists. (2002). Dobbins, K. (2002). Protocols for Practice: Noninvasive Blood Pressure Monitoring. Critical Care Nurse. 22(2):123- Kost, M. (2004). Moderate Sedation/Analgesia: Core Competencies for Practice, 2nd Ed. St. Louis, MO: Lightdale, C.J.& Lightdale, J.R. (2003). Advances in Endoscopy and Endoscopic Sedation. Medscape.[1] Rex, D.K. (2006). Moderate Sedation for Endoscopy: Sedation Regimens for Non-Anesthesiologists. Ailmentary Winnipeg Health Region. Guidelines for Moderate (Conscious) Sedation and GI Endoscopy Procedures. 2010 Van Dam. J., & Wong, R.C.K. (2004). Handbook of Gastrointestinal Endoscopy, Georgetown, Texas: Landes American Society for Gastrointestinal Endoscopy. (2002). Complications of upper GI endoscopy. Gastrointestinal American[1]Society for Gastrointestinal Endoscopy. Adverse events of upper GI endoscopy Meneghini, L.F. (2009). Perioperative management of diabetes: Translating evidence into practice. Which intervention will the nurse administer when preparing a patient for a gastrointestinal diagnostic procedure?The following are the nursing interventions before colonoscopy:. Secure an informed consent. ... . Obtain a medical history of the patient. ... . Provide information about the procedure. ... . Ensure that the patient has complied with the bowel preparation. ... . Establish an IV line. ... . Provide reassurance.. What will the nurse administer when preparing a patient for a gastrointestinal GI diagnostic procedure quizlet?What will the nurse administer when prepping a patient for a gastrointestinal (GI) diagnostic procedure? A cleansing enema is frequently administered to clear the colon before GI diagnostic procedures.
What should the nurse advise a patient who is scheduled for Esophagogastroduodenoscopy EGD )?Instruct the patient to fast and restrict fluids for 6 to 8 hr prior to the procedure to reduce the risk of aspiration related to nausea and vomiting. The patient may be required to be NPO after midnight.
Which change to the GI tract with the nurse anticipate with aging?Age-related changes in the stomach include degeneration of the gastric mucosa, decreased secretion of gastric acids and digestive enzymes, and decreased motility (Lewis et al, 2007). The stomach of an older adult is not able to accommodate large amounts of food because of decreased elasticity.
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