Physical assessment on sedated pts

iluvivt, BSN, RN · Sep 23, 2015

You do NOT stop your drips to perform an assessment. You keep them at their prescribed rates and titrate based upon your protocols and MD orders and of course, your assessment and goals for the patient . Patients are sedated to relieve pain,reduce their stimuli and keep them still for their own safety and healing. Many are intubated,trying to pull out lines and medical devices,bite down on their ET tube and many become combative. You need to protect them against all of these and many more things that can and do happen. So you just assess frequently chart their current neuro status. Your assessment will be accurate because they are sedated or paralyzed for a reason which you will have witnessed or been made aware of and you do not need to recreate that to verify it. All hell could break lose if you stop these medications. I am certain an awesome ICU nurse will chime in here with more explanation.

Hoozdo, ADN · Sep 23, 2015

You assess them with the drips on. Also there is a difference on whether a pt is sedated or sedated and paralyzed.

Typically, there is an order for a "sedation vacation" in a pt that is sedated and on the vent every AM to see if they can tolerate breathing with minimal assistance from the vent.

If a pt is sedated AND paralyzed you don't usually turn the drips off for anything. In anycase, you need an order to turn off any drips.

Coffee Nurse, BSN, RN · Sep 23, 2015

Why aren't you asking a nurse/mentor/educator on your own unit rather than strangers on the Internet? This is an incredibly inappropriate resource to be using to answer this essential question.

RNperdiem, RN · Sep 23, 2015

For a patient who is sedated and paralyzed? No.

For a patient who is sedated and on neuro checks? Then I would have to hold sedation because an accurate neurological exam requires patient cooperation. After the assessment, I turn the drips back on.

If the patient is not a neuro patient on fentanyl and midazolam, I keep the drips going if I can get them to follow commands. Some patients are sedated to an ideal level where they are sedated when left alone, but can be briefly woken up long enough move all extremeties to command and nod yes/no when asked about pain.

ixchel · Sep 23, 2015

So I'm new to icu, only one month experince. My question is about performing a physical assessment on pts that are sedated/paralyzed ( propofol, versed,fentanyl, rocuronium etc) Are you supposed to briefly stop these drips to get an accurate assessment or do you assess with them turned on?

This is a question you would have observed an answer to not only during nursing school, but also the first day you observed a preceptor on orientation and probably every day since. You would also know how much this would/would not affect the accuracy of your assessments well before now.

KatieMI, BSN, MSN, RN · Sep 23, 2015

You do not stop the drips of any kind during assessment unless you have an order to do so. Access them and document as they are, with understanding of what meds are doing.

You also need to know what to access specifically for which drip. In case of therapeutic paralysis, only one key to nervous system assessment will be pupillary reactions. In case of opioid drip like fentanyl, pupillary responces will be suppressed and not reliable, but propofol affects them much less.

Horseshoe, BSN, RN · Sep 23, 2015

This is a question you would have observed an answer to not only during nursing school, but also the first day you observed a preceptor on orientation and probably every day since. You would also know how much this would/would not affect the accuracy of your assessments well before now.

When I read the OP, I thought it was either a joke or a homework question.

ixchel · Sep 23, 2015

When I read the OP, I thought it was either a joke or a homework question.

It sounds to me like a patient or patient family member.

icuRNmaggie, BSN, RN · Sep 23, 2015

This is an excellent question. First of all, any patient on a paralytic must be deeply sedated. Imagine being awake and paralyzed; that is patient abuse.

An ARDS patient on APRV must be paralyzed as that mode means a high rate and continuous high airway pressure to recruit the alveoli.

It is extremely uncomfortable and this patient should also be deeply sedated. Turning off the paralytic and sedation is a medical management decision in this situation.

It would be dangerous to turn off the paralytic if the patient is post op and has a huge open abdominal wound.

It would also be contraindicated to turn off the paralytic if the patient is receiving therapeutic hypothermia, although PRN paralytic for shivering are recommended rather than paralytic gtts.

Never turn off a paralytic to do an assessment. Your assessment is to do a train of four or BIS monitor reading every four hours at a minimum. Watch the respiratory rate on the vent as well. If the patient is breathing above the set rate, he is not paralyzed. Again I can not stress this enough, do not do a sedation vacation on a paralyzed patient.

In most situations in which the patient is only on sedation, I do wake them up briefly to assess the ability to follow commands and purposeful movements.

My assessment of unresponsiveness in a vented patient and could mean cerebral edema, anoxic brain injury or cerebral

hemorrhage. I have found all of these situations during my assessment.

I feel that most patients should be awakened from sedation every 12 hours. If they don't wake up, that needs to be reported. The patient needs a head CT.

Always assess pupils corneals gag and cough as well. If you have any further questions please let me know.

spma1234 · Jan 24, 2018

agreed with going to educator since nurse/preceptor on floor has a different answer for diff patient lol