Patient Controlled Analgesia PCA Infusions - PowerPoint PPT Presentation

1 / 26
About This Presentation
Title:

Patient Controlled Analgesia PCA Infusions

Description:

The PCA device is able to provide incremental doses and/or ... Most surgical patients and trauma victims would be considered ... short....smile! PCA ... – PowerPoint PPT presentation

Number of Views:8078
Avg rating:3.0/5.0
Slides: 27
Provided by: warr6
Category:

less

Transcript and Presenter's Notes

Title: Patient Controlled Analgesia PCA Infusions


1
Patient Controlled Analgesia (PCA) Infusions
2
Definitions
  • The patient controlled analgesia (PCA) device is
    a method of providing intravenous (IV) and
    subcutaneous (SC) opioids that will potentially
    improve pain management for the patient and
    provide a better sense of personal control over
    pain. The PCA device is able to provide
    incremental doses and/or continuous infusion
  • Opioid Naïve Those patients who have not been
    taking opioids regularly. Most surgical patients
    and trauma victims would be considered opioid
    naïve (McCaffery Pasero, 1999).
  • Opioid Tolerant Those patients who have used
    opioids regularly for approximately 7 days or
    more (McCaffery Pasero, 1999)

3
PCA and RN Responsibility
  • RNs managing patients with a PCA infusion must
    have completed the annual pain competency. Annual
    competency will demonstrate equipment competency.
  • RNs may administer PCA per MD order and
  • a. Initiate PCA infusion,
  • b. Change PCA syringe,
  • c. Bolus via the PCA pump (ALL rescue doses must
    be delivered through pump)
  • d. Discontinue an infusion.

4
PCA and RN Responsibility
  • Two RNs must perform and document independent
    double checks and verify orders per medication
    policy when initiating or changing administration
    of PCA medication.
  • Instruct patient/family on correct use of the
    PCA pump, using age and language appropriate
    materials. Emphasize that only the patient,
    including children, are to administer the
    incremental dose. Staff who become aware of PCA
    supplementation by anyone other than the patient
    should report this to physician and document
    clearly. Document all patient education on
    appropriate form.

5
Monitoring and Documentation
  • The 24-hour pain management flow sheet is
    considered procedure for monitoring and
    documentation of this policy. Specific
    documentation instructions are provided on the
    flow sheet.

6
Disposal of Unused Med
  • Any unused medication remaining in the PCA pump
    should be wasted, witnessed, and appropriately
    documented per medication policy

7
Continuous (basal) Infusions
  • Pulse Oximetry mandatory for 1st 24 hrs
  • For pediatric population, consider continuous
    pulse oximetry for high risk groups, such as
    patients less than 5 years of age and opiod naïve.

8
Side Effects of Opioids
  • Constipation
  • Nausea
  • Vomiting
  • Pruritis
  • Sedation
  • Respiratory Depression

9
Assessment
  • Respiratory rate assessment includes RATE,
    DEPTH and RHYTHM.

10
PCA Risk Factors for Respiratory Depression
  • age greater than 70 years
  • basal infusion with IV/PCA
  • renal, hepatic, pulmonary, or cardiac
    impairment
  • sleep apnea (suspected or history)
  • concurrent central nervous system depressants
  • Obesity
  • upper abdominal or thoracic surgery
  • IV PCA bolus gt1 mg.
  • (Hagle, et al, 2004)

11
Nocturnal Monitoring
  • Nocturnal Hypoxia is a risk
  • Assess rate, depth and rhythm of respirations
    while patient is ASLEEP!
  • Do not awaken and then assess!
  • Patients with induced respiratory depression or
    over sedation can easily be stimulated to a
    higher level of consciousness and an increased
    respiratory rate! (Nurse Advise-ERR, 1/2005)

12
Pediatric Considerations
  • Risk factors for respiratory depression with
    IV/PCA include Less than 2 months of age
    hemodynamic instability renal insufficiency
    hepatic dysfunction IV PCA Morphine continuous
    infusion of more than 20 micrograms/kg/hr
    concomitant administration of sedatives,
    hypnotics, and antihistamines and concurrent use
    of continuous background or basal opioid
    infusions.
  • Contraindications to Pediatric PCA use
    Inability to activate device understand
    concepts of self-administration understand and
    report pain relief obtained and hemodynamic
    instability, which may cause opioid-induced
    hypotension and cardiovascular effects.
  • Cognitive, developmental, and physical ability
    considerations Child must understand concepts of
    stimulus (pain), response (pushing button), and
    delayed result (pain relief). Goal is pain
    control and relief, not elimination of pain.

13
Adult Pain Management Flow Sheet
  • Slides 14 and 15 are pages from the Adult Pain
    Management Flow Sheet which should be used to
    answer questions 8, 9 10.
  • If you would like additional information on PCA
    Infusions pleas click on the following policy
    link
  • Policy C-55 PCA Infusion

14
Ella Says
  • Life is short.smile!

15
(No Transcript)
16
(No Transcript)
17
PCA Question 1
  • 1. Patients who have not been taking opiods
    regularly are referred to as
  • A. Opiod tolerant
  • B. Opiod naïve
  • C. Opiod free
  • D. Sober

18
PCA Question 2
  • 2. RNs may
  • A. Initiate a PCA infusion
  • B. Change the PCA syringe
  • C. Bolus via the PCA pump
  • D. All of the above

19
PCA Question 3
  • 3. When initiating or changing doses in the PCA
    pump the RN must perform an independent double
    check with another RN
  • A. T
  • B. F

20
PCA Question 4
  • 4. A 14 yo has a PCA pump. Who may operate the
    pump to administer incremental doses to this
    patient?
  • A. The patients parents
  • B. The patients legal guardian
  • C. The patient
  • D. All of the above

21
PCA Question 5
  • 5. Any unused medication remaining in the
  • the PCA pump should be wasted
  • and witnessed like any other narcotic waste
  • A. T
  • B. F

22
PCA Question 6
  • 6.Side effects to monitor when a patient is on
    PCA therapy include
  • A. Nausea, vomiting
  • B. Pruritis
  • C. Sedation, respiratory depression
  • D. All of the above

23
PCA Question 7
  • 7. The nurse should assess rate, depth and
    rhythm of respirations while the patient is
    asleep because
  • A.Patients on PCA therapy are at risk for
    nocturnal hypoxia
  • B.Nocturnal hypoxia can only be assessed while
    patient is sleeping
  • C.Both A and B
  • D.None of the above

24
PCA Question 8
  • 8. According to the Adult Pain Management Flow
    sheet, monitoring the sedation score of patients
    receiving PCA therapy is vital because sedation
    precedes respiratory depression.
  • A. True
  • B. False

25
PCA Question 9
  • 9. According to the Pain Management Flow sheet
    after initiation of PCA therapy, the patients
    pain score, respiratory rate and sedation score
    should be monitored
  • A. q1h x 12, q 2h x12, then q 4h
  • B. q 30 min x 12, then q 4 hours
  • C. q 2h x 12, q 4h x 12 then q 8h
  • D. q1h x 4 then q 4h

26
PCA Question 10
  • 10. According the Adult Pain Management Flow
    Sheet after initiation of PCA therapy oxygen
    saturation should be monitored
  • A. Continuously for first 24 hours
  • B. At least every 4 hours after first 24 hours
  • C. ½ hour after any order change
  • D. All of the above
Write a Comment
User Comments (0)
About PowerShow.com