Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Skills 4 > Epidurals and PCA > Flashcards

Epidurals and PCA Flashcards

1
Q

How often do we check BP and pulse when someone is on PCA?

A
  1. On initiation
  2. 15 min
  3. Q 30 min x2
  4. Q 1 hr x2
  5. Q 4 hrs
  6. PRN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How often do we check RR, sedation score, O2, Nausea and Pruitis, and pain scale when someone is on PCA?

A
  1. On initiation
  2. 15 min
  3. Q 30 min x2
  4. Q 1 hr x8
  5. Q 4 hrs (while on PCA)
  6. PRN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If basal infusion is ordered or epidural analgesia has been given, how often do we check vitals?

A
  1. On initiation
  2. 15 min
  3. Q 30 min x2
  4. Q 1 hr x8
  5. Q 4 hrs (while on PCA)
  6. PRN
    + Q1 hr for 24 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do we know someone has mild respiratory depression and what do we do?

A

RR is less than or equal to 10 resps per min

or

sedation score of 3

stop PCA
notify MD
encourage deep breathing
5L/minute via nasal prongs
assess RR, sedation and O2 q 5 min
resume PCA at lower dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do we know someone has severe respiratory depression and what do we do?

A

RR is less than or equal to 8 resps per min

or

sedation score of 4

stop PCA
notify MD
encourage deep breathing
10L/minute via partial rebreathe
naloxone
assess RR, sedation and O2 q 5 min
resume PCA at lower dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Drug info for naloxone
class
MOA
Indications
Contraindications
Precautions and side effects
Administration

A

Opioid antagonist/antedote for opioid overdose

MOA: competes with opioid antagonist in the receptor and blocks it

indications: opioid overdose, complete or partial reversal (and respiratory depression)

contraindications: careful with people who are opioid dependent- could precipitate acute abstinence syndrome

Precautions and side effects:
withdrawl reaction
N&V, sweating, tachycardia, increased BP, tremulousness

Administration: IM/SC, IV infusion - dilute 4 mcg/mL in D5W or NS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What do PCA orders include?

A
  1. Type of narcotic & concentration for the recipe
  2. PCA dose (doc ordered, usually a range)
  3. Lockout interval
  4. continuous rate (basil) vs no continuous rate (bolus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is included on epidural orders?

A
  1. APS writes them
  2. Bag ingredients (combo of drugs)
  3. infusion range (ml/hr)
  4. parameters for vitals
  5. instructions when to call APS
  6. frequency of assessments for nurses
  7. PRN meds for side effects
  8. orders to hold meds while on epidural
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 2 nursing priorities for epidurals?

A
  1. assess the dressing
  2. prevent dislodgement
  3. maintain infusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how do we maintain infusion?

A
  1. safety checks (patient to pump)
  2. mix epidural bags (high risk meds)
  3. change epidural infusion bag
  4. increase/decrease rates
  5. Stop infusions
  6. complete transition of care form at each shift change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which systems do we assess for side effects from epidural?

A

1 CNS
2. central venous system
3. respiratory
4. GI
5. GU
6. Integumentary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 3 severe complications from epidural?

A
  1. respiratory depression
  2. Hypotension
  3. sedation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what assessment tools do we use when someone has an epidural?

A

sedation scale
bromage score
sensory blocking testing
pain assessment tool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

do we give other opioids or CNS depressants while a person is on epidural and why or why not

A

no because of risk of respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do we do if someone has hypotension while on epidural?

A
  1. stop the epidural
  2. raise legs above heart
  3. IV solution change to NS
  4. administer 10L partial rebreathe
  5. vitals q 5 min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What meds usually get held due to risk of hypotension while on epidural?

A

hypertensives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do we discontinue an epidural?

A
  1. check if they are on anticoag therapy - usually discontinue it several hours before
  2. remove catheter slowly with constant tension
  3. stop if there is resistance
  4. Inspect tip for intactness and document in IPN
  5. monitor for signs of epidural hemotoma for 24 hours
  6. keep patient on IV infusion for at least 4 hours post removal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do we monitor for epidural hematoma?

A
  1. sensation and motor block testing
  2. CWCM
  3. back pain
  4. extremity weakness
  5. numbness & tingling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How often and long do we monitor for epidural hemotoma after removal?

A

Q4 hrs for 24 hours

20
Q

who is an appopriate candidate for PCA?

A
  1. mental capacity
  2. physically capable to press button
21
Q

What is loading dose?

A

When you initiate the PCA to get therapeutic faster in surgery (rare)

22
Q

what is bolus dose

A

what the patient gets - phycician ordered

23
Q

lockout interval

A

how long they have to wait to get another dose - usually 5-10 min

24
Q

what is basal infusion?

A

background dose of meds per hour in addition to button
- not for opiate naive

25
Q

what is demands?

A

how many times patient pushed button

26
Q

what is goods?

A

how many times medication was dispensed

27
Q

what is total?

A

how many mg or mcgs they received

28
Q

What must all PCA’s have in order to get the meds to the patient?

A

a carrier solution with a Y connector

29
Q

what is an epidural for?

A

giving small doses of opioid analgesic and local anaesthetics into epidural space to relieve pain

30
Q

what do opioids do in epidurals?

A

modulate the conduction of pain impulses of the dermatomes

31
Q

what do local anethetics do with epidurals?

A

block sodium channels which blocks transmission of nerve impulses just before the sensory nerves enter the spinal cord

32
Q

what are some signs that the epidural has migrated to the blood vessel?

A

tinnitus
*tingling lips
metalic taste
blurred vision
confusion
slurred speech
seizure
cardiovascular collapse

33
Q

what do we clean with if epidural tubing gets disconnected?

A

2 % aqueous chlorhexidine only
cover tubing ends with sterile gauze
notify APS and in house anaesthesiologist

34
Q

what are 2 common side effects of epidurals?

A

N&V
pruritus

35
Q

if a patient can lift heels off the bed, what bromage score is this?

A

0

36
Q

what Bromage score do we notify APS?

A

greater than 1

37
Q

how often do we monitor epidural infusion rate?

A

Q1 hr

38
Q

what is the average depth of catheter insertion?

A

12 cm

39
Q

how many hours should we not give anticoags after epidural removal?

A

2-4 hours
10-12 hours for LWMH

40
Q

what are the 3 opioid analgesics via epidural?

A

Fentanyl
hydromorphone
morphine

41
Q

how long do patients have to receive intravenous infusion after catheter removal?

A

until max drug action time has elapsed
or
4 hours post removal

42
Q

what are the 2 local anaesthetic agents?

A
  1. bupivacaine
  2. Ropivacaine
43
Q

What is the purpose of PCA?

A

pain control that’s continuous and safe and free from unwanted side effects

43
Q

what is the rationale for PCA use?

A

better absorption of meds administered

44
Q

what is the first line antiemetic for N&V with PCA?

A

maxeran (metoclopramide)

45
Q

what is the number one safety concern with PCA use?

A

respiratory depression

46
Q
A

Skills 4 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions