Week 4: Nursing Management of the Client with Post Operative Pain Flashcards

1
Q

Potential Post Op Functional Complications

A

weakness

fatigue

functional decline

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2
Q

Potential Post Op Urinary Complications

A

acute urinary retention

UTI

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3
Q

Potential Post Op Neurologic Complications

A

delirium

stroke

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4
Q

Potential Post Op Gastrointestinal Complications

A

Constipation

Paralytic Ileus

Bowel Obstruction

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5
Q

Potential Post Op Wound Complications

A

infection

dehiscence

evisceration

delayed healing

hemorrhage

hematoma

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6
Q

Potential Post Op Respiratory Complications

A

atelectasis

pneumonia

pulmonary embolism

aspiration

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7
Q

Potential Post Op Cardiovascular Complications

A

shock

thrombophlebitis

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8
Q

The intensity of the stress response is dependent on what

A

pain

fear before and after surgery

anesthesia type and amount

degree of tissue trauma (can show third spacing)

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9
Q

Generally how long does the stress response last

A

3-5 days

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10
Q

How many phases of Post Op Recovery are there

A

3

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11
Q

Phase 1 of Post Op Recovery

A

PACU (AKA PAR, recovery room)

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12
Q

Phase 2 of Post Op Recovery

A

If outpatient the recovery continues in amb-surg or and outpatient unit

If inpatient recovery occurs on a post op surgical unit in the hospital

nurses are actively involved in this phase

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13
Q

Phase 3 of Post Op Recovery

A

discharge

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14
Q

What is the goal for nurses in the PACU

A

to provide care until the patient has recovered from the effects of anesthesia

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15
Q

What should be seen as “Stable” to say a patient has recovered from anesthesia/surgery in the PACU?

A

Oriented

Stable VS (every 15 m)

Shows no evidence of hemorrhage or other complications

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16
Q

The PACU nurse should review…

A

pertinent and baseline information upon admission to unit

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17
Q

The PACU nurse should assess.

A

airway, respirations, cardiovascular function, surgical site, function of CNS, IVs, all tubes and equipment

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18
Q

The PACU nurse should reassess VS…

A

and patient status every 15 minutes or more frequently if needed (or per facility protocol)

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19
Q

The PACU nurse should transfer…

A

report to another unit or discharge to home

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20
Q

In the PACU what sort of assessment is done

A

Focused Assessment

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21
Q

What aspects are included in the PACU Focused Assessments

A

Airway

Breathing

Mental Status

Surgical Incision Site

VS

IV Fluids

Tubes and Drains

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22
Q

What is the #1 priority for the nurse following a patient having surgery

A

Maintaining a Patent Airway (necessary to maintain ventilation and oxygenation)

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23
Q

What sort of things must the nurse do in order to ensure maintenance of a patent airway

A

watch for stridor, wheezing, sounds that may indicate partial obstruction (laryngospasm)

provide supplemental O2 prn

assess breathing by placing hand near face to feel movement of the air

keep HOB 15-30 degrees unless contraindicated

may requiring suctioning

if N/V turn head to the side

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24
Q

What is the #2 priority for the nurse following a patient having surgery

A

Maintaining Cardiovascular Stability

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25
What sort of things must the nurse do in order to ensure maintenance of cardiovascular stability
monitor all indicators of CV status assess all IV lines
26
What sort of things can occur if post op cardiovascular stability goes unstable
potential for hypotension, shock potential for hemorrhage potential for HTN and dysrhythmia
27
Indicators of Hypovolemic Shock
Pallor Cool and Moist Skin Rapid Respirations!!! Cyanosis rapid Weak and Thready Pulse !!! Decreasing Pulse Pressure Low BP Concentrated urine *these are immediate indications of fluid loss somewhere*
28
Another job of the PACU nurse is relieving ___ and ___
pain and anxiety
29
Ways that the nurse can relieve the patient of pain and anxiety
assess patient comfort control the environment (quiet, low lights, noise level, decrease stimulation, positioning) administer analgesics as indicated; usually short acting opioids IV (advocate for the patient)
30
Ways to control NV
intervene at first indication of nausea medications (usually anti emetic via IV since they usually cannot eat) assessment of post operative nausea, vomiting risk, prophylactic treatment
31
What are some special gerontology considerations when dealing with elderly patients post op
decreased physiologic reserve monitor carefully and frequently increased confusion (dt age and meds) dosage of meds hydration status increased likeliness of post op confusion and delirium hypoxia HTN and hypoglycemia reorient as needed pain (need different doses and types) - also consider respiration after giving pain medications particular attention to mental status
32
Modified Aldrete Score
Scoring chart needed in order to guide discharge from the PACU It measures Activity, Respiration, circulation, consciousness, and O2 Sat (ARC-CO2) from 0-2
33
What things are needed in order to be discharged from PACU
Muscle Activity Good Respirations Good Circulation and BP Awake and Conscious Good and Normal O2 Saturation
34
How often is the Aldrete score taken
every 15 minutes while in the PACU To be discharged it must score between 7-8 (or per facility protocol)
35
What will the PACU nurse give the nurse on the receiving unit report on when switching from phase 1 to 2 for inpatient surgery recovery?
procedure done anesthesia used blood loss, drains, dressings, IVs Pt orientation, VS, and pain control
36
When should airway assessments be done upon arrival to the post-PACU unit?
every 30 m for the next 2 hours --> then every 4 hours for 24 hours --> then every shift
37
When doing the airway assessments what things should the nurse be looking at
Look at artificial airways Pulse Ox Rate, rhythm, And Quality Breath Sounds: Adequacy, Symmetry, Adventitious Sounds
38
When there is an abnormal CXR post op what should be done first?
Compare it to preop CXR
39
Are ABGs often ordered post op?
They are not routinely ordered unless there is a problem and suspect of Abnormal ABGs
40
What is a majorly vital thing to teach patients post op to prevent respiratory conditions
Cough, Turn, Deep Breathes
41
When can atelectasis occur post op?
Usually it occurs 24-48 hours post op
42
What is the most common cause of fever/temp in the first 24 hours following surgery
atelectasis (resp. complications)
43
What factors post op lead to atelectasis
not C+DB not using IS decreased lung volume
44
What may be found upon assessment if the post op patient has atelectasis
If dyspnea, increased resp. rate Crackles Increased Tempearture Productive Cough and Chest Pain
45
Interventions for Post Op Atelectasis
Reposition every 1-2 hours Encourage C+DB and IS Early ambulation and fluid intake
46
When does pneumonia usually occur post op?
Usually 3 days post op - it is one of the first resp. illnesses to occur It can be due to infection, aspiration, immobility, or hypostatic pneumonia
47
Pulmonary Embolus are ___ ___
medical emergencies
48
Where does the pulmonary embolus originate from
it comes from the lower extremity DVT that creeps into the venous system and moves through the heart to the lungs
49
What does the outlook compare between small and large emboli?
Small = often survive Large - Stat Code
50
What can be seen on assessment of someone with pulmonary emboli
sudden dyspnea (from SOB) anxiety (from SOB) sudden sharp chest pain (or upper abdominal pain) cyanosis tachycardia weak and rapid pulse drop in BP pink frothy sputum
51
Interventions for Pulmonary Emboli
Notify Physician Monitor VS O2, IV status, maybe a foley Cath if ordered Tests may be ordered like ABG, CXR, CT Scan, Lung Scan
52
Risk Factors for Resp Complicqations
Obesity Smoking (undergoing anesthesia particularly) Pre Existing Resp Disease (Comorbidities) Elderly High Location of Incision
53
Potential causes of resp complications
IMMOBILITY pain fear infective organisms narcotic analgesics and anesthesia
54
How can narcotic analgesics and anesthesia cause resp complications
decrease pulmonary function decrease ciliary function decrease mucus clearing aspiration of vomitus
55
Respiratory Nursing Interventions
#1 - PREVENTION early ambulation position changes C+DB 10xHour; Use of IS Fluids Avoid abdominal distention bronchitis / pneumonia: cool mist, steam, expectorants, antibiotics
56
What should the nurse look at regarding the post op cardiovascular system
VS cardiac monitoring peripheral vascular assessment
57
How often do PACU nurses v Unit Nurses check VS
PACU: every 15 min until stable (4 checks) Unit: every 30 min for 2 hours, then every 4 hoursx 24 hours, then every 8 hours *look for upward and downward trends*
58
VS changes of ___% need to be reported
25
59
Decreased VS may indicate what
myocardial depression fluid volume deficit shock hemorrhage med effects hypothermia
60
Increased pulse post op may indicate what
pain shock hemorrhage
61
When doing the peripheral vascular assessment, what should you be aware of
what the persons position in surgery was peripheral pulse assessment - v important capillary refill absence of edema tingling sensation
62
Why is a tingling sensation concerning during a post op peripheral vascular assessment
it may indicate a life or limb emergency
63
What are some concerning cardiovascular complications that can occur post operatively
Thrombophlebitis Cardiovascular Shock HTN
64
To prevent thrombophlebitis...
use SCDs when non ambulatory
65
Cardiovascular Shock
insufficient blood circulation to vital organs
66
Types of Cardiovascular Shock
Hypovolemic Sepsis Anaphylaxis Cardiogenic Transfusion Reaction Neurogenic PE
67
What things can be assessed if the patient is entering cardiovascular shock
cool, pale moist skin rapid weak thready pulse increased respirations decreased BP decreased level of consciousness
68
Why are there so many short acting IV meds to control BP post op?
Since the patient is NPO it is IV and the patient is not yet stable enough for longer acting meds HTN hx can be concerning here
69
When doing the neurological assessment post op, what should be done to check general cerebral functioning?
LOC - eye opening, ability to respond, orientation Compare to baseline Elderly considerations
70
When doing the neurological assessment post op ,what should be done for motor and sensory assessment
*Particularly important after spinal or epidural anesthesia - cant ambulate if you cannot feel* movement of the extremities compare to baseline information
71
What about fluid and electrolyte balance should be assessed post op
I&Os Daily weights Fluid volume deficit Fluid volume excess
72
In a health person I ___ O generally
equals (generally)
73
What is the typical intake and output of an adult
I = 2400cc/day O - 1400cc urine + 500-1000cc insensible loss through sweat, resp. etc
74
What is the typical Intake and output of a child
*Varies with size!!!* 125-150 cc/kg in first year then 1250-1500cc per day
75
What are some abnormal losses of fluid (I&O) associated with surgery
NPO status vomiting drainage from tubes and drains NG suctioning fever hyperventilation with pain and anxiety diaphoresis
76
Oliguria
Decreased urine r/t sodium and water retention
77
Why check for distended bladder post op?
Narcotics decrease urination urge which may cause oliguria/urinary retention
78
With oliguria, a patient can hold on to about ___cc of urine after 1-2 days, but __cc per hour is normal with a total of ___ cc being produced
750 cc 30 cc per hour with 720 cc per day
79
Polyuria
increased urine due to third day diuresis (post op) a large amount of urine is released - increased by 100% 1500-3000cc is normal
80
What may be causing weight loss post op?
1. Decreased intake from NPO status with only IV left to replace 2. Dehydration with polyuria 3. Increased BMR (due to healing and increased temp() 4. Protein and fat catabolism: starvation
81
Starvation can lead to loss of how much per week
half a pound a week
82
When does fluid overload occur post op?
When replacement is too vigorous in this is especially for patients at risk such as with renal, cardiac, or pulmonary problems
83
What would be seen upon assessment during fluid overload
moist crackles cough increased respiration increased pulse rate increased BP
84
What can fluid overload lead to
pulmonary edema and CHF
85
With fluid overload, particularly what groups cannot tolerate large volumes too quickly
the very young and very old in children and infants a small margin of error exists so small IO changes have greater effect on FE
86
For how many hours post op are we most concerned about urinary retention
8 hours post op
87
Causes of Post Op Urinary Retention
bladder atony from anesthesia narfcotics operative trauma age disease (BPH) lac of privacy positioning bedpan use pain
88
What is seen on assessment of someone with Urinary Retention post op
voiding that resumes (normally) 6-8 hours post op feelings of fullness and distension small frequent voids
89
How much is the first output in 48 hours post op compared to after?
1550 cc first then 2000-3000 ccs per day
90
Urinary Retention interventions
stimulate patient by warming pan, run water help to assume a normal position as possible privacy bladder scan catheterize (last result)
91
When can a UTI occur post op
usually it would occur later - 5 days post op
92
Causes of Post Op UTI
stasis with immobility atony catheterizations hygiene
93
What is seen upon assessment if a patient has a UTI
fever dysuria frequency small amounts of output
94
Interventions for UTIs
prevention monitor temp increase fluids to 2000-30000 cc/day I&O keep urine acidic catheterization meds
95
What are the major GI system complications that can occur post op
NV GI Peristalsis --> Constipation or Paralytic Ileus
96
A paralytic ileus is a ___ intestinal tract
"frozen"
97
What can cause constipation post op
narcotics decreased mobility different/less intake
98
Paralytic Ileus
atony of intestines with no peristalsis
99
Causes of Paralytic Ileus
anesthesia excessive handling of bowel during surgery decreased potassium distention with air swallowing, GI secretions, large amounts of fluid trapped infection
100
What can be assessed/seen if someone has a paralytic ileus
absence of bowel sounds for 3-4 days post op or may develop after liquid diet NV post op not flatus or bowel sounds abdominal discomfort/distention
101
Interventions for Paralytic Ileus
NPO, OOB Walking NG LOW intermittent suction always unless specific order rectal tube decreased air swallowing IV for fluids, K replacement Meds - Reglan (metoclopramide) H2 blockers, proton pump inhibitors
102
What are the 3 phases of wound healing
1. Inflammation Phase 2. Proliferation Phase 3. Maturation Phase
103
Inflammation Phase
occurs from surgery to 4-6 days out the wound is weak, prone to hemorrhage, sutures hold the wound together, it is normally red, swollen for 1-2 days
104
We worry about infection of a surgical wound after ...
the third day (inflammation phase)
105
Proliferation Phase
occurs after 4-6 days to 2 weeks out from surgery highly vascular connective tissue and granulation tissue occur to make the wound stronger
106
Maturation Phase
2-3 weeks to a year from surgery wound has increased strength and healing still no heavy lifting!
107
3 types of Healing
Primary Secondary and Tertiary Intention
108
Primary Intention
Wounds edges closely approximated, minimal trauma and contamination, heals without complications ex: knee incision post op * so it is closed by the surgeon
109
Secondary Intention
wound edges not approximated. Seen with infected wounds, or those with excessive trauma or tissue loss. Granulation tissue leaves a larger scar ex: pressure injury * it is left open to heal bottom up
110
Tertiary Intention
occurs with deep wounds that have not been sutured early or break down and re-sutured later; may decide to delay suturing if infected, 2 opposing granulation surfaces brought together ex: an abdominal surgical dehiscence * left open and then closed later once healing bottom up
111
When does alteration in skin integrity and wound infection usually occur post op
usually occurs 3 days post op
112
What occurs in the first 48 hours before wound infection on the 3rd day post op?`
Hemorrhage may be occurring - this leaves open the greatest risk of infection after 2 days post op
113
What are the causes of wound infection post op
contamination obesity diseases like diabetes lengthy surgery - increased stress and decreased resistance history of steroids, radiation, anti neoplastic meds which may drop WBC age debility malnutrition
114
Nursing Assessments for Wound Infection
check for approximation of suture line assess for fever and chills check for bleeding, odor, drainage, pain, redness, edematous skin at incision site, suture tension observe for sudden, profuse discharge of serosanguinous material
115
What can sudden profuse discharge of serosanguinous material from a surgical wound indicate?
Dehiscence or Evisceration
116
When is Dehiscence and Evisceration of a surgical wound most likely to occur
6-8 days post op
117
Dehiscence
partial or complete separation of wound tissues usually occurs 6-8 days post op
118
Evisceration
dehiscence plus viscera protruding through the wound usually occurs 6-8 days post op a medical emergency
119
Predisposing factors for dehiscence and evisceration
excessive coughing straining and infection those already under wound infection urgent surgeries poor nutrition
120
Emergency treatment for Dehiscence
put patient in bed avoid coughing and straining elevate HOB to decrease strain on incision clean incision and apply saline moist dressing contact provider
121
Emergency Treatment for Evisceration
dehiscence protocols and: cover viscera with a saline soaked sterile towel or dressings call MD STAT, likely back to OR IV antibiotics as ordered
122
Nursing Interventions to Promote Wound Healing
Prevention - wash hands, use clean and sterile technique monitor temp assess incisions and wounds every shift clean wounds properly dressings drains assess retention sutures assess for factors that may affect wound healing
123
When do you need and not need an order for a post-op dressing?
You usually need an order to change a post op dressing - if the dressing is wet and there is no order, you reinforce the dressing and notify the provider If you change it and there is purulent drainage, clean the wound then request a C&S If RN scope of practice, you may apply a saline (or wound wash) wet to dry dressing without provider order, or follow hospital protocol order or provider order
124
Purpose of Surgical Drains
prevent accumulation of fluid in wound area decreases chance of drainage infecting incision
125
What should the nurse do regarding drains?
MUST know fi drain is present Monitor COCA - color odor consistency amount consider how man days post op for coca - what is normal progression monitor increases/decreases in drainage MUST clean around wounds daily and replace dry drain gauze (or other ordered product) MUST assess skin around the drain every shift
126
What to do for wound irrigation and cleaning
flush out infected wound routine wound care always requires a vigorous cleaning use spray wound cleansers, saline, hospital product of choice medicate for pain prior to wound care purpose: to remove infected exudate, promote healthy tissue growth, prep wound for product use
127
What is extremely important to wound healing
circulation and oxygenation - adequate circulation needed to deliver nutrients and oxygen to tissues
128
Delayed wound healing occurs with what factors
vascular disease obesity DM CV disease edema nicotine use poor nutrition infection
129
___ is one of the most important factors to wound healing
nutrition (assess it pre op and post op)
130
What are the major nutritional factors needed for wound healing
Protein and Calories Water Vitamin C Thiamine, Niacin, Riboflavin, Folic Acid, B12 Vitamin K Iron
131
Why is protein needed for wound healing
tissue repair, restore blood volume and loss plasma proteins from exudates or bleeding if deficient = weight loss, delayed healing, edema r/t decreased antibody formation work with the dietician to plan appealing, high protein meals
132
Why is water needed for wound healing
maintains homeostasis replaces losses through vomiting and hemorrhages
133
Why is Vitamin C needed for wound healing
capillary formation tissue synthesis and wound healing through collagen formation need for antibody formation
134
Why is thiamine, niacin, riboflavin, folic acid, and Vit B12 important for wound healing
red blood cell maturation *antibiotics can impede this though
135
Why is vitamin K important for healing
clotting
136
Why is Iron important for wound healing
to replace iron through blood loss (anemia)
137
It is important to look at what history for wound healing
ETOH History
138
Nursing interventions for Wound Healing
Monitor nutrition levels - need vitamin B and C after 2 days on IVs May need TPN monitor diet progression
139
Psychological Concerns Post Op to Explore
surgical diagnosis and prognosis support systems body image disturbance ineffective coping hopelessness, powerlessness spiritual distress grieving process
140
What are some Discharge Planning Referrals that may be made Post Op
Home care meals on wheels special equipment transportation assistance support groups
141
What sorts of things should be taught in discharge teaching
type of diet activity level bathing complications - temp, drainage, pain report complications medication teaching; prescriptions follow up appointments pain management
142
Types of Pain
Acute (ex: post operative) Chronic (nonmalignant) Cancer Related Pain
143
Definition of Pain
Whatever the patient says it is Highly subjective - only the client can ID and describe what they feel elusive, complex, a defense mechanism, universal, and yet the exact mechanisms remain a mystery
144
Factors that Influence Pain
past exp with pain anxiety level culture age gender expectations about pain relief tolerance to medications and substance use - tolerance can determine the amount of medication needed to help
145
__ is the fifth vital sign
Pain
146
__ should always bee assessed alongside VS
pain
147
Patients need to be involved in __ care decisions
pain
148
Patients have a right to appropriate pain ___ and ___
assessment and management
149
Pain is assessed in __ patients
ALL
150
What sort of factors are looked at in the pain assessment
location intensity timing quality - pt describes how the pain feels using their words aggravating/alleviating factors
151
What are some pain assessment tools commonly seen
1. Numeric Rating Scale 2. Wong Baker FACES pain scale - good for nonverbal and children 3. FLACC - for children - face legs activity consolability crying 4. VAS (Visual Analog Scale) - 10 cm line with word anchors from no pain to worst pain
152
Preoperatively - what is done for the patient regarding pain
educate patient about pain assessment methods and management assess pain with VS on admission
153
Intraoperatively - what is done for the patient regarding pain
anesthesia management
154
Postoperatively - what is done for the patient regarding pain
Immediate post op (PACU)- assess on arrival and throughout PACU stay - IV pain meds Phase 2 Post Op (On Unit) - assess on arrival; reassess depending on pt stability / hospital policy/protocol; may be done q10 min if pt unstable or may be q4 or q8 when stable/24 hours post op
155
Methods of Pain Management
Oral IV via IV push or PCA IM Nerve Block Epidural Local Anesthesia Pump Rectal - rarely used ; children
156
IV via IV push or PCA pain management can come in what forms
Opioid analgesics - morphine, dilaudid (hydromorphone), fentanyl IV acetaminophen - i.e. Ofitmev (given over 15 min)
157
Oral pain management can come in what forms
Non opioid - acetaminophen or NSAIDS Opioids - oxycodone (percocet), hydrocodone (vicodin) Combinations of the two
158
It is important to keep what in mind regarding characteristics of first line opioids
you wanna know how long things last and when they kick in based on what you are doing (ex: PT v wound care) ex: Morphine and Hydromorphone kick in much faster than Fentanyl usually, but Morphine may last the longest - all depending on route given- fentanyl may be good for temp relief
159
Adverse Effects of Opioids
Constipation - assess bowel movement frequently NV Pruritis Hypotension Sedation Delirium Respiratory depression
160
What is the #1 adverse effect of opioids
Respiratory Depression Less common, but most feared side effect - be sure to monitor your pt for rate, depth, regularity of respirations
161
To prevent opioid induced resp. depression, avoid giving them when the pt is what?
Sedated or has low BP
162
Alternative Methods of Pain Management: Physical modalities
reposition the pt ambulation application of heat or cold massage
163
Alternative Methods of Pain Management: Cognitive and Behavioral
relaxation breathing imagery music distraction communication - encouragement
164
PCA
Patient controlled analgesia an interactive method allowing pt to self treat pain programmed and pt specific
165
Pros of PCA
provides optimum pain relief via IV infusion hope to have minimal SE pt has control better in some ways than IM injection
166
Cons of PCA
BIG safety issues (ex: they should control it not family deciding when)
167
Why is PCA better than IM injection
Steady serum levels of medication easier C and DB early ambulation improved pain relief and shortened hospital stay
168
Why is PCA always "piggy backed" to a primary line and has a clamp on the line?
PCA always goes back to a primary line and has a clamp to prevent them from using all the opioids at once
169
Nursing Assessment: What to know when monitoring a patient with PCA
Monitor: Med use, Sedation levels, accuracy of prescription that is programmed into PCA pump, LOC (notify MD if somnolent), VS - call MD if respirations <12, Degree of pain relief - call MD if not effective Must know and adhere to agency policy/protocol Must document minimum of every 4 hours
170
What is the maximum dose period for PCA
4 hour maximum - 5-30 mL
171
What medication is often used PCA
morphine, fentanyl, dilaudid (opioids)
172
Loading Dose
the initial volume or amount administered to raise blood levels to therapeutic range (mL) in PCA
173
Lockout Interval
length of time in which additional dosing is not possible on PCA (0-99 min)
174
Safety Issues with PCA
PCA by proxy Improper patient selection - patient must understand PCA and be physically able to push the button themselves Inadequate monitoring inadequate patient education inadequate clinician education drug product mix ups device design flaws prescribing errors
175
Epidural Analgesia
pain management by infusing analgesia and/or local anesthetic continuously through epidural catheter administered via IV infusion pump into epidural space at a rate and quantity specified by anesthesiologist
176
With epidural orders, whose orders supersedes the surgeons
Anesthesia's orders
177
Typical Epidural Analgesia Orders
Anesthesia > Surgeon Orders Resume post op pain orders only after infusion discontinued Hold anticoagulants until anesthesia is called as per order ex: 200 mL bag of Bupivacaine (or other med order) and NACL - amount, concentration, rate prescribed
178
Nursing management/interventions for Epidurals
Elevate HOB >30 degrees if opioid infusion Pulse Ox O2 per protocol Pain and sedation scale Bladder distention Epidural catheter insertion site and dressing - assess but DO NOT CHANGE I&O Monitor function and sensory block Know the medication the pt is receiving PRN Meds
179
What is the difference between Epidural PRN dosing vs Around the Clock Dosing
PRN - intervals of pain at ordered times Around the clock - pain meds for ongoing post op pain or chronic pain - maintains concentration of medication in the blood and is used when pain threshold is a constant
180
Narcan
Naloxone - Narcotic Antagonist Action: Blocks opioid receptors and is used to reverse the narcotic effect of anesthesia or in the case of an overdose A nurse's friend