PCA/epidurals Flashcards
what is a PCA pump
patient controlled analgesia
it is a drug administration system that enables the pt to self administer opioids on a PRN basis
what is the rationale for a child to receive a PCA pump
children are worried about shots therefore if they know if they say they will have pain, they will get a shot.
so the PCA pump helps the child feel safe and more likely to report pain because they know they won’t give a shot
what is the rationale for a PCA pump
- allows pt to be in charge of when they get their pain meds (within the time frame)
- gives less medication thus fewer side effects
- patient doesn’t have to wait for nurse
- pts who are given control can manage and ambulate sooner
who is able to have a PCA pump
- the pt must be able to understand the relationship between pain and pushing the button to relieve pain
- has to have the ability to push the button
- children 5yrs and older
what are # of PCA attempts
-the number of times the pt is pushing the button whether med is given or not.
can indicate the pt is having too much pain and the med is not effective.
or if the pt is not pushing the button enough and the pt is verbally reporting pain- can be caused by fear of medication and education needs to take place.
what is necessary to have to start, alter, stop the PCA pump
the key for the pump.
it is needed to do everything with PCA pump
what memory does the PCA store
- the amount of time the pt pushes the button
- the number of times medication was administered
- the total amount of medication administered
- volume given & volume remaining
what typical meds will you see in a PCA pump
Morphine 1mg/mL
Hydromorphone 0.2mg/mL
when does the pt have the greatest need for pain control
the 1st 24 hours after sx.
where is the PCA normally started
by the anesthesiologist in PACU
-you do sometimes start them on the floor though
what should be avoided when pt is on a PCA pump
other narcotics and sedatives
what is the goal for pain control on PCA pump
less than 2/10
what can happen if someone else pushes the PCA button for the pt (if the pt is sleeping etc.)
respiratory depression and/or life threatening sedation
pt has to be cognitively aware about pressing the button
what should you assess for when a pt is on a PCA pump
Baseline assessment: allergies vitals LOC Level of pain respiratory status pulse ox bowel function IV site compatible IV fluids
how often should vitals be assessed post op on PCA
per facility protocol
Q15min X4
Q1h x2hrs
Q4H
how often should you assess pts pain
q2hr
if the pca has to be increased may want to assess pain q1h
what must you have when administering a PCA
a maintenance IV of at least 20-30mLs
what can happen to body functions when you have epidural
urinary retention
unable to ambulate(safety issues)
respiratory depression (especially if catheter going wrong direction)
spinal leak- needing blood patch
what can opioids with preservatives cause with epidurals
it can cause spinal leaks
what is the duration of action for duramorph
up to 24 hours
how much duramorph can be administered in 24hrs`
a continuous infusion
2-4mg/24hrs
may be increased 1-2 mg/day and up to 30mg/day
what should you assess when a person has an epidural
- vitals & pulse
- assess respiratory depression
- pain levels
- LOC
- level of sedation
- Motor response- especially to lower extremities
- level of sensation- touch and prick sensation
- orthostatic hypotension
- bladder function-assess for urine retention
- make sure pump system is correct and everything is in place.
why would a pt with an epidural need IV access
in case of respiratory depression or other problem.
they would need an accesss point to give emergency meds
