Learning Objectives -Discuss patient and family teaching necessary when PCA is prescribed -Differentiate the ypes of patients who are potential candidates to use patient controled analgesia (PCA) -Initiate appropriate actions if the patient experiences si

Learning Objectives -Discuss patient and family teaching necessary when PCA is prescribed -Differentiate the ypes of patients who are potential candidates to use patient controled analgesia (PCA) -Initiate appropriate actions if the patient experiences side effects or complications from PCA therapy -Demonstrate the ability to recall the PCA "history" and programmed prescription using the programming functions of the PCA infusion pump -Discuss the prarameters for patient assessment and documentation using the PCA flow sheet, included calculating PCA medication dosages -Identify the classification of nursing personnel who may set up and program a PCA machine What is a PCA? Patient Controlled Analgesia (PCA) -IV device that allows pt. to take active role in pain control Pt. has control over when to receive Med Why do we use PCA -better pain control -improved patient satisfaction Pressing button delivers pain medicine -a predetermined dose of narcotic analgesic delivered Who can use this? -Patient must be mentally, emotionally, and physically able to assess his/her own pain needs -Children 7 years of age or older who have normal cognitive development -Use cautiously with patients with history of drug/ETOH abuse, respiratory distress and elederly How does it work? -MD order: medication, amount, delivery mode -Nurse programs machine -Patient and family education -Patient presses button to receive medication -Lockout Delivery Mode Depending on MD order -continuous (rare used with epidural) -bolus -both All modes set up with NS infusing Medications *-Morphine sulfate: 1mg/mL in 30cc NS = 30mg -Fentanyl: 10mcg/mL in 30cc NS = 300mcg -Dilaudid: 0.2mg/mL in 30cc NS = 6mg Always have Narcan available Rules (for patient) -Always put sign in room -Always give patient rules and information -Pt is the ONLY person who can press button -Do not press if dizzy or sleepy -Do not eat if you a re sleepy -Do not take any other home medications -No other narcotics Side Effects -nausea -itching -drowsiness -urinary retention -constipation -hallucinations -slow rate of breathing -over sedation Is my patient too sleepy? Is your patient obtunded? (Not able to arouse with vigorous stimulation) -stop PCA -call RRT -administer Narcan as ordered -monitor patient and support as needed Is your patient arousable but over sedated when unstimulated? -stop PCA -administer Narcan as ordered -notify MD -monitor patient closely What if my patient still complains of pain -Assess patient first -Check the pump -Call physician for additional orders Assessment & Documentation *-RR, HR, B/P, sedation level, pain score *-Boluses attempted/delivered & total *-Dose received -Q1 HR x 4 hours when PCA started or after any change in programming -Q4 hrs as long as PCA on -Repeat Q1 HR if changes of dose or frequency PCA Pointers -Assess your patient -Student responsible for checking pump settings and medication being delivered -Student not to clear out pump -Student will not set up pump but may discontinue pump with supervision -Student will document in Cerner if you are documenting on your patient PCA Math Problems PCA Ordered: Morphine 1mg/mL in 30 mL syringe Loading dose: 0 Continuous Dose: 1mg/hr Demand dose: 1mg Lockout: 5 minutes 4 hour limit: 30mg What is the maximum dose that ht is patient could possibly receive in 1 hour? 13mg More Math PCA Ordered: Dilaudid 0.2mg/mL in 30mL syringe Loading dose: 0 Continuous Dose: 0 Demand dose: 0.4mg Lockout: 10 minutes 4 hour Limit: 4mg What is the maximum dose over 1 hour? 2.4mg