N2o O2 Sedation Case Study

-Use of indiscriminate sedatives, benzos, and opioid’s, especially in post-op patient who retains Co2, may suppress the ventilator drive and lead to respiratory failure

The nurse found Mrs Smith to be tachypnoeic, her respirations were recorded as 24 breaths per minute it was observed as being fast and it appeared that her accessory muscles were being used. Mrs Smith’s pallor also appeared flushed and her saturations were documented as 93%. The nurse used the stethoscope to check for wheeze the patient’s lungs were clear and chest rise was symmetrical. Mrs Smith was commenced on 100% oxygen through a non-rebreathe mask, oxygen as an intervention is necessary as Creed & Spiers (2010) highlight ‘metabolic demand for oxygen throughout the body is hugely increased by sepsis and is essential to ensure the supply of oxygen is maximized’ .The nurse monitored the patient closely because in her confused state the patient may try to remove the oxygen mask.

Lack of enough trained staff in conscious sedation available at the time of the procedure

While there was a policy in place for conscious sedation, even good policies rely on the vigilance of staff to adhere to them. Often times, working conditions allow for distractions, and even the best of practitioners, with the best of intentions, make errors. There were several areas presented in this scenario that require examination and improvement.

A policy for conscious sedation was in place and not followed by staff. As all staff had been trained in the procedure, completed the appropriate modules, and

Not only did insufficient staffing contribute to the causes of this particular event, but human error also played a significant role. When Mr. B arrived at the ED, he was hyperventilating. His leg “appeared shortened.” He had edema in his calf, ecchymosis, limited ROM, and he rated his pain at a ten out of ten. Mr. B also had a history of prostate cancer, impaired glucose tolerance, elevated cholesterol and lipids, and chronic pain. He was admitted to the ED with a plan to relocate his hip. Dr. T ordered diazepam 5.0 mg to be administered through IVP and then just five minutes later ordered 2.0 mg hydromorphone to be administered because it appeared that the diazepam was not having the intended sedating effect. Again, just five minutes later, Dr. T was still not satisfied with the level of sedation and instructed the nurse to

Original research related to sedation management occurred in the year 2000 by Kress, Pohlman, O ' Connor, and Hall. Their findings served as a landmark study and initiated the impetus related to improving our sedation practices. According to Kress et al. (2000), daily interruption of sedation led to a decrease in the number of days on the ventilator in the intensive care unit. Several studies since this time have focused on the influence of sedation protocols, and outcomes. This paper will review the synthesis of the discovered studies and highlight the noted contraindications and inconsistencies. Also, explanations including a preliminary conclusion will be discussed.

This Anaesthetic case study would describes and discussed the scenario of a patient through the anaesthetic role of their surgical procedure. It will include and discuss the anaesthetic safety procedures equipment and drug interventions used to ensure this particular patients maximum safety and comfort before and during the procedure. The case study will include pre and peri-operative assessment in order to describe the involvement contribution of various specialties in the holistic care of the critical care patient. This assignment will focus only on the anaesthetics side of the procedure but will also highlight the importance of the triad of anaesthesia and discuss the administration, maintenance and reversal of

At the Tooth Booth Family Dental Clinic, we care about our patients and we work hard to ensure everyone receives the highest quality dental care, even if a dental anxiety or phobia has prevented proper care in the past. Dr. Booth specializes in sedation dentistry to help reduce fear, pain, and anxiety.

Throughout my clinical rotation, the only concern for this patient was pain management and discomfort from the chest tube site. The patient was given Ketorolac for a pain of 4/10 using the numeric pain sale. The patient was also at risk for pneumonia and pressure ulcers from immobility and not coughing/deep breathing. Nursing interventions were getting the patient up to the chair and using the incentive spirometer ten-times per hour. Another concern was SOB and fatigue with activities.

He tells her that she believes that the patient has two issues on hand. The first being that the he has been taking too much Acetaminophen and the second the Oxycodone in the Percocet and the high amounts of Diphenhydramine Hcl in his sinus medication is causing increased sedation. According to www.fda.gov the recommended amount of Acetaminophen in 24 hrs is not more that 4000mg or 4 grams. (Use a conversion factor) Taking more that this has been linked to liver disease, which could be the reason for the yellow skin color. Jt has been taking 325mg of Acetaminophen in his Percocet every 4 hrs as well as 650mg of Acetaminophen in his Equate allergy. In combination this places his Acetaminophen dosage at 5,850mg a day which is 1,850mg over the recommended maximum dose. Jt has also been taking 50mg of Diphenhydramine or Benadryl every 4 hrs as well as the narcotic Oxycodone in the Percocet. Both medications are known to make people sleeping, but in combination there will be as increased risk of sedation. While the doctor waits for the lab results he has the staff start and IV and infuses Normal Saline 1000ml over 1 hrs to help dilute the medication in his

The discharge criteria in the policy states the patient will be fully awake, vital signs stable, no nausea or vomiting, and the patient is able to void. All practitioners that provide moderate sedation must complete a training module prior to providing moderate sedation, this includes personnel assisting with the procedure. The first process failure was not meeting the required monitoring of the patient as mandated by the moderate sedation policy. In the absence of ECG or respiratory monitoring the sedation administered produced apnea then asystole without ED personnel being aware of acute changes in the patient’s condition. There is no explanation for why the patient was not on continuous ECG monitoring. Equipment was found to be in good working order.

assess Mr. B’s respiratory states while Nurse J. and Dr. T finished the sedation and reduction

The record does not document any nurse-initiated interventions or call to the doctor requesting a chest x-ray or recommending a respiratory therapy consult for breathing treatment and incentive spirometer. On post-op day two Ms. C’s respiratory status declined requiring a non-rebreather mask, rapid response team consult, and a transfer to the intensive care unit for a diagnosis of respiratory distress (p. 392).

After being reminded by the instructor, I was aware of my mistakes and noticed that I failed to maintain patient’s safety. An oxygen below 90% can be very dangerous for the patient, especially for a post-op day #1 patient, because prolonged hypoxemia can cause fatigue, headache, acute respiratory failure, cardiac problems (increased heart rate,