06 Management of Patient requiring analgesia

Question 1

what are reasons to use the PCA/PCEA for pain management?

Answer 1

• Reported better patient satisfaction with post operative pain control
• Patient in control and can maintain a more steady state of pain relief
• Fewer pulmonary complications
• With pain under better control, can cough and deep breath more effectively
• Earlier ambulation – reducing other complications
• Hospital stays may be shortened

Question 2

What’s Safe Practice for Pain Management?

Answer 2

• Not a push-button approach – more a process than a piece of equipment
• Use proper patient selection
• Meticulous attention to selection of dose, dosing interval, lockout interval/max dose, and other special features such as loading or bolus doses and continuous monitoring while in use
• Proper patient education
• Adequate patient monitoring

Question 3

What is the Pt Selection like for PCA?

Answer 3

Patient Selection – awake, alert patient must be able to understand concept and willing to follow instruction using PCA, able to push the activation button independently. PCA by proxy not recommended and if used, must be tightly controlled with detailed guidelines.

Common side effects of opiods (d/t activation of the mU receptor)

• Constipation
• N/V
• Sedation and confusion
• Resp. depression
• Decreased BP
• Itching
• Constricted pupils

Question 4

Avoid use of PCA in what situations?

Answer 4

Avoid use in:

• Infants and young children < 8 years (some < 5years)
• Confused older adults
• Patients with significant risk for oversedation – who might this be?
• Patients taking medications that potentiate effect of opioids – benedryl, phenergan, benzos, some muscle relaxants

Question 5

what happens if pt’s rr <8?

whose is at risk?

Answer 5

• If patient develops respiratory depression (RR <8), discontinue the infusion. Be prepared to:
• administer Naloxone (Narcan) per orders
• If the person requires assisted ventilation, support with bag-valve-mask ventilation as needed (1 breath every 6 seconds) until Narcan can be given.

Who is at risk?

• Opioid niave
• Patients getting other meds that increase sedation (synergistic effect)
• Elders
• Patients with OSA – increased sedation leads to decreased breathing and increased CO2 retention

Question 6

When is the epidural used?

Answer 6

Continuous epidural analgesia is utilized for effective pain management after:

Thoracic surgery

Abdominal surgery

Orthopaedic surgery

Obstetrics for labor

It works by blocking transmission of pain at the spinal cord.

Question 7

advantages to PCEA?

Answer 7

Less pain

Smooth, continuous pain relief

Earlier ability to walk and move around

More alert and aware of surroundings

Easily adjustable

Faster return to normal lung function (especially beneficial to patients with lung disease) Advantages:

Better toleration of the coughing and deep breathing exercises following surgery

Decreased risk of thromboembolic formation (deep venous thrombosis)

Earlier return of bowel function. Shorter length of hospital stay

Question 8

PCEA Side effects?

Answer 8

Possible Side Effects

Itching – “pruritis”

Nausea

Vomiting

Drowsiness

Tingling or numbness in extremities

Infection

Cerebral spinal fluid (CSF) leak

Headache