lab quiz 3 Flashcards
patient-controlled analgesia (PCA)
allows pts to administer medication when they want it, providing fast relief and higher pt satisfaction
indications for PCA
- Post-op pain
- Severe acute pain
- Exacerbation of chronic pain
PCA meds
- morphine
- hydromorphone
- fentanyl
PCA side effects
- nausea, upset stomach, vomiting
- itching
- dry mouth, constipation
- urinary retention, *drowsiness, *altered breathing
airway maneuver
- sit head of bed up
- administer oxygen
- remove pillows
- nose pointed up, head tilted back (sniffing position)
PCA pt education
- educate before procedure
- educate on use for pain management/how to use
- educate on side effects and complications
Assess pt competence: PCA
- must be able to physically locate and press the button
- only pt can press the button
monitor for side effects: PCA
- primary concerns: over-sedation, respiratory distress
- what to assess: alert/awake/orientation, muscle strength, breathing pattern, deep breathing, nausea, constipation, vitals
non-pharmacologic interventions: PCA
- splinting
- positioning
- distraction
- guided imagery
- relaxation
- ice/heat
- music
PCA pump settings
- loading (initial dose)
- basal rate
- bolus (demand) dose
- lockout (time) interval
- hour limit (max dose)
PCA documentation
- med name
- dose/drug concentration
- PCA pump settings
- patient response
- vital signs (oximetry and capnography)
- IV status
- total vol infused
- PCA results (demands, delivered doses)
- patient education
epidurals
catheter located in the epidural space just outside of the spinal cord which provides anesthesia (numbness) and pain relief to the lower half of the body
indications for epidurals
- labor and delivery
- blunt trauma
- surgeries (abdominal, orthopedic, vascular)
- angina
- pancreatitis
- severe pain management
patient-controlled epidural analgesic (PCEA)
offers pain relief more effectively by administering pain meds into epidural space upon pt demand
epidural assessment
dermatomes - important to ensure there is no numbing above nipple line (indicates diaphragm is numb –> impaired breathing)
epidural meds
- anesthetics (bupivacaine, ropivacaine)
- analgesics (opioids - morphine, hydromorphone, fentanyl)
epidural side effects
- incontinence, retention
- itching
- nausea
- decreased motor strength/sensation
- altered LOC
- altered breathing
epidural complications
- Positional headache
- Systemic or local infection
- Hypotension
- Temporary or permanent nerve damage
- Additional: catheter displacement, bleeding, or drainage
Positional headache
occurs when the catheter moves beyond epidural space and punctures dura membrane → CSF leak
epidural safety considerations
- educate pt on placement, use, pain management, PCEA, side effects and complications
- assist with insertion
- assess and monitor: baseline before insertion
- ensure proper epidural and PCEA set-up
- head of bed at 30 degrees or more
epidural documentation
- Med name
- Doses and drug concentration
- PCEA pump settings
- Pt response
Conscious (moderate) sedation: purpose
- reduce anxiety
- induce amnesia, and provide pain relief for patients during various tests and procedures (not general anesthesia)
Conscious (moderate) sedation: indications
- minor procedures
- cardioaversions
- dental procedures
- scopes
- bone/joint realignment
Conscious (moderate) sedation: meds
benzos and opioids
