PCA PATIENT CONTROLLED ANALGESIA EXAM QUESTIONS AND ANSWERS 2024

What is a PCA? Patient Controlled Analgesia IV device that allows patients to take active role in pain control. What does PCA do for the patient? Allows patient control over when to receive medication. Why do we use PCA? *better pain control *improved patient satisfaction What does pressing the PCA button do? Delivers a predetermined dose of narcotic analgesic medication. Who can use PCA? *patient who is mentally, emotionally, and physically able to assess his/ her pain needs *children 7 years and older *use cautiously with patients with history of drug/ETOH abuse, respiratory distress, and elderly. How does a PCA pump work? *MD order- med, amount, delivery mode *nurse programs machine- double verify *patient and family education *patient presses button to receive med *lockout PCA Delivery Modes Continuous- rarely see this alone on PCA Bolus- only receive med when button pushed Both- often small amount continuous with button bolus in addition *All modes require NS infusing to push med through lines* PCA Medications Morphine Sulfate Fentanyl Dilaudid Always have Narcan available Morphine Sulfate 1 mg/ml in 30cc NS = 30mg Fentanyl 10 mcg/ml in 30cc NS = 300 mcg Dilaudid 0.2 mg/ml in 30cc NS = 6mg Biggest danger for opioid patients? Respiratory depression What is the purpose of Narcan? Antagonist to narcotics. Has a short half-life (30 min)... still under influence of narcotic when narcan wears off. PCA rules for patient? Always put sign in room: NO OTHER NARCOTICS Always give patient rules and information. Patient is the ONLY person who can press button. Do NOT press is dizzy or sleepy. Do NOT eat if you are sleepy (aspiration). Do NOT take any other home medications. Narcotics Side Effects Nausea (Zofran) Itching (Benadryl) Drowsiness Urinary Retention Constipation (Miralax, Colace, Senna) Hallucinations Slow Breathing Rate Oversedation!! Obtunded State of being unable to arouse with vigorous stimulation. What to do if patient is too sleepy? 1. stop PCA 2. call RRT 3. administer Narcan as ordered 4. monitor patient and support as needed What to do if patient is arousable but oversedated when unstimulated? 1. stop PCA 2. administer Narcan as ordered 3. notify MD 4. monitor patient closely What if my patient still complains of pain, even though on PCA? 1. Assess Patient: s/s of pain, VS, location, alternate cause/ source 2. Check Pump: pump report of usage/ frequency and confirm delivery of med to patient... check line 3. Call physician for additional orders PCA Assessment and Documentation Every hour x 4 then q 4 hours RR, HR, B/P, Sedation Level, Pain Score Boluses attempted/ delivered and total Dose received For changes in dosage/ frequency, repeat q 1 hour x 4 then q 4 hours PCA Pointers to Remember 1. Assess patient 2. Check pump settings and medication delivery 3. Students do NOT clear pumps 4. Students do NOT set up pumps 5. Students MAY discontinue pump with supervision