Bedside Sedation
This flowsheet contains all required documentation for a bedside sedation procedure.
Patient Prep Checklist (also includes Universal Protocol timeout and charges for procedure)
Procedural Sedation (VS can be charted here)
True or False: The RN can decrease or discontinue suicide precautions.
False. Only the provider can D/C or decrease a patient’s suicide scale or orders.
When would a CIWA patient need to be transferred to ICU?
Score >18 after 3 stacked doses of benzos, and score is not decreasing.
These CBG values require LIP notification.
<70 mg/dl and >420 mg/dl (or per patient's specific orders)
This is the average dwell time for Continuous Ambulatory Peritoneal Dialysis (CAPD).
3-5 hours
This is the reversal agent for Midazolam (Versed).
Flumazenil (Romazicon)
Describe the roles of a nightshift nurse and a dayshift nurse in terms of communicating positive orthos.
Nightshift RN: Document positive orthos in 24hr note (must also document actions taken if LIP intervention needed in the moment), discuss in bedside report.
Dayshift RN: Notify provider of positive orthos, addend previous night’s 24hr note to state which specific provider was notified and any resulting orders/actions.
If a patient receives this form of Ativan, reassessment is required in 60 minutes.
PO
These critical values require a stat lab blood glucose.
</= 40 mg/dl or >/= 500 mg/dl
Where and how often do we charge for CAPD?
$Manual PD exchange Adult - Peritoneal Dialysis flowsheet, once per day.
With the new Universal Protocol, this must be turned into the charge RN at the completion of the procedure.
Procedural Safety Checklist - attach patient label, time and type of procedure performed.
Name the suicide risk: Patient has endorsed specific plan for killing themself in the last 3 months.
High
This is the leading indicator of poor perfusion and what CHEETAH measures.
Stroke Volume Index
Why is timing of insulin and meal consumption important?
To help control glucose spike during meals and prevent hypoglycemia.
This form of PPE is required for anyone in the room during a CAPD exchange.
Mask and sterile gloves for RN performing procedure
During a bedside sedation procedure, these VS should be documented every 5 minutes.
BP and Sedation Rating Scale (SRS)
Fall scale reassessment, iCare/huddle, progress note, care plan/education updated, notification to family and LIP
Actions to take after a patient fall
According to CHEETAH, this result indicates that a patient is likely fluid responsive.
>= 10% increase in SVI
If a patient has an A1c of 8.0 or higher, CBGs <70 or >300, or an insulin pump, who should you get involved?
Diabetic educator
Peritonitis, hyperglycemia, catheter occlusion, hernia
Potential complications of CAPD
This must be completed if a reversal agent is given, sedation level is deeper than intended, or airway support is needed.
iCare and notification to LIP
Dizziness, lightheadedness, blurry vision, weakness, nausea
Symptoms of positive orthos
CHEETAH uses these two methods to increase a patient's preload to determine if they are fluid responsive.
Passive leg raise or fluid bolus
This should be done if the patient has two or more early morning (fasting) CBGs less than 100 mg/dl.
Contact the LIP for an insulin dose reduction.
A "dry weight" is best taken at which stage of CAPD?
After the peritoneum has drained and before dialysate is infused (ideally the first run of the morning).