Lights out Pediatric moderate sedation and analgesia

Lights out: Pediatric moderate sedation and analgesia The researchers concluded that using objective discharge criteria may ensure a status closer to baseline compared to nursing judgment using standard criteria; however, ensuring the status to this level may delay the discharge of sedated children.3 Cote points out that discharge criteria shouldn’t be based on the clock but rather patient responses, which confirms the work of Malviya and colleagues.12 As the practice of pediatric moderate sedation and analgesia evolves, so do the methods for safely providing it. As nurses, our mandate is to ensure that moderate sedation and analgesia is provided in the safest manner possible using evidence-based guidelines, so we can prevent life-threatening complications. OR 4. Hoffman G, Nowakowski R, Troshynski T, Berens R, Weisman S. Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists Process Model. Pediatrics. 2002;109(2):236-243. REFERENCES 11. Newman DH, Azer MM, Pitetti RD, Singh S. When is a patient safe for discharge after procedural sedation? The timing of adverse effect events in 1,367 pedaitric procedural sedations. Ann Emerg Med. 2003;42(5):627-635. 1. Gross, JB, Bailey PL, Connis, RT, et al. Practice guidelines for sedation and analgesia by non-anesthesiologists. An updated report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Anesthesiology. 2002;96(4):1004-1017. 5. Cote CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics. 2000;106(4):633-644. 6. Cote CJ, Notterman DA, Karl HW, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: a critical incident analysis of contributory factors. Pediatrics. 2000;105(4 pt 1):805-814. 7. Vardi A, Salem Y, Padeh S, Paret G, Barzilay Z. Is propofol safe for procedural sedation? A prospective evaluation of propofol versus ketamine in pediatric critical care. Crit Care Med. 2002;30(6):1231-1236. 8. Masue T, Shimonaka H, Fukao I, Kasuya S, Kasuya Y, Dohi S. Oral high-dose midazolam premedication for infants and children undergoing cardiovascular surgery. Paediatr Anaeth. 2003;13(8):662-667. 9. Krauss B, Green SM. Sedation and analgesia for procedures in children. N Engl J Med. 2000;342(13):938-945. 10. American Heart Association. Pediatric advanced life support. Circulation. 2005;112(24, suppl1):IV-167-IV-187. 12. Cote C. Round and round we go: sedation—what is it, who does it, and have we made things safer for children. Pediatr Anesth. 2008;18(1):3-8. 2. American Academy of Pediatrics, American Academy of Pediatric Dentistry, Cote CJ, Wilson S, Work Group on Sedation. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006;118(6):2587-2602. The author has disclosed that she has no significant relationship with or financial interest in any commercial companies that pertain to this educational activity. 3. Malviya S, Voepel-Lewis T, Ludomirsky A, Marshall J, Tait AR. Can we improve assessment of discharge readiness? A comparative study of observational and objective measures of depth of sedation in children. Anesthesiology. 2004;100(2):218-224. DOI-10.1097/01.ORN.0000388941.60223.67 Patricia A. Moloney-Harmon is an advanced practice nurse and clinical nurse specialist in children’s services at Sinai Hospital in Baltimore, Md. For more than 60 additional continuing education articles related to surgical topics, go to NursingCenter.com/CE. Earn CE credit online: Go to http://www.nursingcenter.com/CE/ORnurse and receive a certificate within minutes. INSTRUCTIONS Lights out: Pediatric moderate sedation and analgesia TEST INSTRUCTIONS • To take the test online, go to our secure Web site at http://www.nursingcenter.com/ORnurse. • On the print form, record your answers in the test answer section of the CE enrollment form on page 39. Each question has only one correct answer. You may make copies of these forms. • Complete the registration information and course evaluation. Mail the completed form and registration fee of $21.95 to: Lippincott Williams & Wilkins, CE Group, 2710 Yorktowne Blvd., Brick, NJ 08723. We will mail your certificate in 4 to 6 weeks. For faster service, include a fax number and we will fax your certificate within 2 business days of receiving your enrollment form. • You will receive your CE certificate of earned contact hours and an answer key to review your results.There is no minimum passing grade. • Registration deadline is December 31, 2012. 38 OR Nurse 2010 November DISCOUNTS and CUSTOMER SERVICE • Send two or more tests in any nursing journal published by Lippincott Williams & Wilkins together and deduct $0.95 from the price of each test. • We also offer CE accounts for hospitals and other health care facilities on nursingcenter.com. Call 1-800-787-8985 for details. PROVIDER ACCREDITATION Lippincott Williams & Wilkins, publisher of ORNurse2010 journal, will award 2.0 contact hours for this continuing nursing education activity. Lippincott Williams & Wilkins is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Lippincott Williams & Wilkins is also an approved provider of continuing nursing education by the District of Columbia and Florida #FBN2454. This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 2.0 contact hours. Your certificate is valid in all states. The ANCC’s accreditation status of Lippincott Williams & Wilkins Department of Continuing Education refers only to its continuing nursing educational activities and does not imply Commission on Accreditation approval or endorsement of any commercial product. www.ORNurseJournal.com Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. 2.0 ANCC CONTACT HOURS Lights out: Pediatric moderate sedation and analgesia GENERAL PURPOSE: To provide the professional registered nurse with an overview of the care of pediatric patients receiving moderate sedation and analgesia. LEARNING OBJECTIVES: After reading the preceding article and taking this test, you should be able to: 1. Explain the physiologic response to moderate sedation and analgesia. 2. Identify issues and interventions related to the safety of children receiving moderate sedation and analgesia. c. anxiety. d. protective reflexes. 1. In the past, pediatric analgesia protocols were based on the belief that a. children would be less cooperative with analgesia. b. analgesia had a deep calming effect on children. c. children didn’t remember pain. d. the technique of administrating analgesia raised children’s anxiety levels. 6. Guidelines for fasting before moderate sedation and analgesia a. aren’t necessary for infants who are breastfeeding. b. are based on the child’s comorbid conditions. c. should be the same as for elective anesthesia. d. aren’t as important for children as for adults. 2. The ASA’s definition of moderate sedation and analgesia a. is the same for adult and pediatric patients. b. distinguishes between adult and pediatric patients. c. requires a state of nonresponse to physical stimulation. d. notes the value of different levels of sedation. 3. During moderate sedation and analgesia, a patient a. gradually descends into deeper sedation. b. experiences reduced pain with an alert level of consciousness. c. needs help to maintain a patent airway. d. retains protective reflexes. ENROLLMENT FORM 14. Moderate sedation and analgesia dosages for children are based on a. weight. c. developmental level. b. age. d. age and height. 8. In an emergency, a nonfasting pediatric patient requiring moderate sedation and analgesia a. can receive a preoperative gastric motility agent. b. will need a slightly increased level of sedation. c. should have general anesthesia instead. d. can receive moderate sedation and analgesia only if the child is over 36 months. 15. Used for moderate sedation and analgesia, midazolam provides a. analgesia and amnesia. b. amnesia and anxiolysis. c. anxiolysis and analgesia. d. analgesia only. 10. In the SOAPME mnemonic, P stands for a. patent airway. c. pediatric. b. pharmacy. d. prolonged. 11. A patient with severe systemic disease that limits activities has an ASA classification of a. P2. c. P4. b. P3. d. P5. 5. Children under age 6 are especially prone to the sedating medication’s effect on a. cardiac rhythm. b. purposeful response. 13. The most serious complications of moderate sedation and analgesia directly affect which body system? a. respiratory c. neurologic b. cardiovascular d. musculoskeletal 7. A child who ingested infant formula should fast before moderate sedation and analgesia for a. 4 hours. c. 8 hours. b. 6 hours. d. 10 hours. 9. In the AAP’s mnemonic for moderate sedation and analgesia safety, SOAPME, S stands for a. security. c. safeguard. b. selection. d. suction. 4. Preexisting physical conditions in pediatric patients a. provide guidance for the type of medication used. b. are an absolute contraindication. c. are an absolute contraindication only for patients under age 6. d. are an absolute contraindication only for the developmentally delayed. a. surgeon. b. scrub nurse. c. RN first assistant. d. provider not directly involved in the procedure. 12. Physiologic monitoring during moderate sedation and analgesia should be done by the 16. Cote’s study of the relationship between outcome and medications reported that a. poorer outcomes resulted from I.V. drug administration. b. drug combinations correlated with better outcomes. c. negative outcomes correlated with drugs that have shorter half-lives. d. there was no relationship between outcome and drug class or route used. 17. The reversal agent for benzodiazepines is a. naloxone. c. flumazenil. b. propofol. d. methohexital. 18. The minimum Modified Aldrete Score indicating readiness for discharge is a. 7. c. 11. b. 9. d. 13. OR Nurse 2010, November, Lights out: Pediatric moderate sedation and analgesia A. Registration Information: ❑ LPN ❑ RN ❑ CNS ❑ NP ❑ CRNA ❑ CNM ❑ other _____________________ Last name ____________________________ First name ________________________ MI _________ Job title __________________________________ Specialty ______________________________ Type of facility ________________________________ Are you certified? ❑ Yes ❑ No Address ________________________________________________________________________________ Certified by _________________________________________________________________________ City _______________________________________ State _________________ ZIP _________________ State of license (1) __________________________ License # ____________________________ Telephone ___________________ Fax ___________________ E-mail ___________________________ State of license (2) __________________________ License # ____________________________ ❑ Please check here if you do not wish us to send promotions to your email address. ❑ Please check here if you do not wish us to release your name, address, email address to a third Registration Deadline: December 31, 2012 Contact hours: 2.0 Pharmacology hours: 0.0 party vendor. Fee: $21.95 B. Test Answers: Darken one circle for your answer to each question. 1. 2. 3. 4. a b c d ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ 5. 6. 7. 8. a b c d ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ 9. 10. 11. 12. a b c d ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ C. Course Evaluation* 1. Did this CE activity’s learning objectives relate to its general purpose? ❑ Yes ❑ No 2. Was the journal home study format an effective way to present the material? ❑ Yes ❑ No 3. Was the content relevant to your nursing practice? ❑ Yes ❑ No 4. How long in minutes did it take you to read the article ____, study the material ____ and take the test ____? 5. Suggestion for future topics ______________________________________________________________ 13. 14. 15. 16. a b c d ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ a 17. ❍ 18. ❍ b c d ❍ ❍ ❍ ❍ ❍ ❍ D. 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