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N362: Practice of Nursing III > Week 4: Nursing Management of the Client with Post Operative Pain > Flashcards

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

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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
Q

What sort of things must the nurse do in order to ensure maintenance of cardiovascular stability

A

monitor all indicators of CV status

assess all IV lines

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26
Q

What sort of things can occur if post op cardiovascular stability goes unstable

A

potential for hypotension, shock

potential for hemorrhage

potential for HTN and dysrhythmia

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27
Q

Indicators of Hypovolemic Shock

A

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

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28
Q

Another job of the PACU nurse is relieving ___ and ___

A

pain and anxiety

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29
Q

Ways that the nurse can relieve the patient of pain and anxiety

A

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)

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30
Q

Ways to control NV

A

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

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31
Q

What are some special gerontology considerations when dealing with elderly patients post op

A

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

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32
Q

Modified Aldrete Score

A

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

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33
Q

What things are needed in order to be discharged from PACU

A

Muscle Activity

Good Respirations

Good Circulation and BP

Awake and Conscious

Good and Normal O2 Saturation

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34
Q

How often is the Aldrete score taken

A

every 15 minutes while in the PACU

To be discharged it must score between 7-8 (or per facility protocol)

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35
Q

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?

A

procedure done

anesthesia used

blood loss, drains, dressings, IVs

Pt orientation, VS, and pain control

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36
Q

When should airway assessments be done upon arrival to the post-PACU unit?

A

every 30 m for the next 2 hours –> then every 4 hours for 24 hours –> then every shift

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37
Q

When doing the airway assessments what things should the nurse be looking at

A

Look at artificial airways

Pulse Ox

Rate, rhythm, And Quality

Breath Sounds: Adequacy, Symmetry, Adventitious Sounds

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38
Q

When there is an abnormal CXR post op what should be done first?

A

Compare it to preop CXR

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39
Q

Are ABGs often ordered post op?

A

They are not routinely ordered unless there is a problem and suspect of Abnormal ABGs

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40
Q

What is a majorly vital thing to teach patients post op to prevent respiratory conditions

A

Cough, Turn, Deep Breathes

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41
Q

When can atelectasis occur post op?

A

Usually it occurs 24-48 hours post op

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42
Q

What is the most common cause of fever/temp in the first 24 hours following surgery

A

atelectasis (resp. complications)

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43
Q

What factors post op lead to atelectasis

A

not C+DB

not using IS

decreased lung volume

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44
Q

What may be found upon assessment if the post op patient has atelectasis

A

If dyspnea, increased resp. rate

Crackles

Increased Tempearture

Productive Cough and Chest Pain

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45
Q

Interventions for Post Op Atelectasis

A

Reposition every 1-2 hours

Encourage C+DB and IS

Early ambulation and fluid intake

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46
Q

When does pneumonia usually occur post op?

A

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

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47
Q

Pulmonary Embolus are ___ ___

A

medical emergencies

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48
Q

Where does the pulmonary embolus originate from

A

it comes from the lower extremity DVT that creeps into the venous system and moves through the heart to the lungs

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49
Q

What does the outlook compare between small and large emboli?

A

Small = often survive

Large - Stat Code

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50
Q

What can be seen on assessment of someone with pulmonary emboli

A

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

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51
Q

Interventions for Pulmonary Emboli

A

Notify Physician

Monitor VS

O2, IV status, maybe a foley Cath if ordered

Tests may be ordered like ABG, CXR, CT Scan, Lung Scan

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52
Q

Risk Factors for Resp Complicqations

A

Obesity

Smoking (undergoing anesthesia particularly)

Pre Existing Resp Disease (Comorbidities)

Elderly

High Location of Incision

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53
Q

Potential causes of resp complications

A

IMMOBILITY

pain

fear

infective organisms

narcotic analgesics and anesthesia

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54
Q

How can narcotic analgesics and anesthesia cause resp complications

A

decrease pulmonary function

decrease ciliary function

decrease mucus clearing

aspiration of vomitus

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55
Q

Respiratory Nursing Interventions

A

1 - PREVENTION

early ambulation

position changes

C+DB 10xHour; Use of IS

Fluids

Avoid abdominal distention

bronchitis / pneumonia: cool mist, steam, expectorants, antibiotics

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56
Q

What should the nurse look at regarding the post op cardiovascular system

A

VS

cardiac monitoring

peripheral vascular assessment

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57
Q

How often do PACU nurses v Unit Nurses check VS

A

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

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58
Q

VS changes of ___% need to be reported

A

25

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59
Q

Decreased VS may indicate what

A

myocardial depression

fluid volume deficit

shock

hemorrhage

med effects

hypothermia

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60
Q

Increased pulse post op may indicate what

A

pain

shock

hemorrhage

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61
Q

When doing the peripheral vascular assessment, what should you be aware of

A

what the persons position in surgery was

peripheral pulse assessment - v important

capillary refill

absence of edema

tingling sensation

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62
Q

Why is a tingling sensation concerning during a post op peripheral vascular assessment

A

it may indicate a life or limb emergency

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63
Q

What are some concerning cardiovascular complications that can occur post operatively

A

Thrombophlebitis

Cardiovascular Shock

HTN

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64
Q

To prevent thrombophlebitis…

A

use SCDs when non ambulatory

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65
Q

Cardiovascular Shock

A

insufficient blood circulation to vital organs

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66
Q

Types of Cardiovascular Shock

A

Hypovolemic

Sepsis

Anaphylaxis

Cardiogenic

Transfusion Reaction

Neurogenic

PE

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67
Q

What things can be assessed if the patient is entering cardiovascular shock

A

cool, pale moist skin

rapid weak thready pulse

increased respirations

decreased BP

decreased level of consciousness

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68
Q

Why are there so many short acting IV meds to control BP post op?

A

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

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69
Q

When doing the neurological assessment post op, what should be done to check general cerebral functioning?

A

LOC - eye opening, ability to respond, orientation

Compare to baseline

Elderly considerations

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70
Q

When doing the neurological assessment post op ,what should be done for motor and sensory assessment

A

Particularly important after spinal or epidural anesthesia - cant ambulate if you cannot feel

movement of the extremities

compare to baseline information

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71
Q

What about fluid and electrolyte balance should be assessed post op

A

I&Os

Daily weights

Fluid volume deficit

Fluid volume excess

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72
Q

In a health person I ___ O generally

A

equals (generally)

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73
Q

What is the typical intake and output of an adult

A

I = 2400cc/day

O - 1400cc urine + 500-1000cc insensible loss through sweat, resp. etc

74
Q

What is the typical Intake and output of a child

A

Varies with size!!!

125-150 cc/kg in first year

then 1250-1500cc per day

75
Q

What are some abnormal losses of fluid (I&O) associated with surgery

A

NPO status

vomiting

drainage from tubes and drains

NG suctioning

fever

hyperventilation with pain and anxiety

diaphoresis

76
Q

Oliguria

A

Decreased urine r/t sodium and water retention

77
Q

Why check for distended bladder post op?

A

Narcotics decrease urination urge which may cause oliguria/urinary retention

78
Q

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

A

750 cc

30 cc per hour with 720 cc per day

79
Q

Polyuria

A

increased urine due to third day diuresis (post op)

a large amount of urine is released - increased by 100%

1500-3000cc is normal

80
Q

What may be causing weight loss post op?

A
  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
Q

Starvation can lead to loss of how much per week

A

half a pound a week

82
Q

When does fluid overload occur post op?

A

When replacement is too vigorous in

this is especially for patients at risk such as with renal, cardiac, or pulmonary problems

83
Q

What would be seen upon assessment during fluid overload

A

moist crackles

cough

increased respiration

increased pulse rate

increased BP

84
Q

What can fluid overload lead to

A

pulmonary edema and CHF

85
Q

With fluid overload, particularly what groups cannot tolerate large volumes too quickly

A

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
Q

For how many hours post op are we most concerned about urinary retention

A

8 hours post op

87
Q

Causes of Post Op Urinary Retention

A

bladder atony from anesthesia

narfcotics

operative trauma

age

disease (BPH)

lac of privacy

positioning

bedpan use

pain

88
Q

What is seen on assessment of someone with Urinary Retention post op

A

voiding that resumes (normally) 6-8 hours post op

feelings of fullness and distension

small frequent voids

89
Q

How much is the first output in 48 hours post op compared to after?

A

1550 cc first then 2000-3000 ccs per day

90
Q

Urinary Retention interventions

A

stimulate patient by warming pan, run water

help to assume a normal position as possible

privacy

bladder scan

catheterize (last result)

91
Q

When can a UTI occur post op

A

usually it would occur later - 5 days post op

92
Q

Causes of Post Op UTI

A

stasis with immobility

atony

catheterizations

hygiene

93
Q

What is seen upon assessment if a patient has a UTI

A

fever

dysuria

frequency

small amounts of output

94
Q

Interventions for UTIs

A

prevention

monitor temp

increase fluids to 2000-30000 cc/day

I&O

keep urine acidic

catheterization

meds

95
Q

What are the major GI system complications that can occur post op

A

NV

GI Peristalsis –> Constipation or Paralytic Ileus

96
Q

A paralytic ileus is a ___ intestinal tract

A

“frozen”

97
Q

What can cause constipation post op

A

narcotics

decreased mobility

different/less intake

98
Q

Paralytic Ileus

A

atony of intestines with no peristalsis

99
Q

Causes of Paralytic Ileus

A

anesthesia

excessive handling of bowel during surgery

decreased potassium

distention with air swallowing, GI secretions, large amounts of fluid trapped

infection

100
Q

What can be assessed/seen if someone has a paralytic ileus

A

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
Q

Interventions for Paralytic Ileus

A

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
Q

What are the 3 phases of wound healing

A
  1. Inflammation Phase
  2. Proliferation Phase
  3. Maturation Phase
103
Q

Inflammation Phase

A

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
Q

We worry about infection of a surgical wound after …

A

the third day (inflammation phase)

105
Q

Proliferation Phase

A

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
Q

Maturation Phase

A

2-3 weeks to a year from surgery

wound has increased strength and healing

still no heavy lifting!

107
Q

3 types of Healing

A

Primary Secondary and Tertiary Intention

108
Q

Primary Intention

A

Wounds edges closely approximated, minimal trauma and contamination, heals without complications

ex: knee incision post op

*so it is closed by the surgeon

109
Q

Secondary Intention

A

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
Q

Tertiary Intention

A

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
Q

When does alteration in skin integrity and wound infection usually occur post op

A

usually occurs 3 days post op

112
Q

What occurs in the first 48 hours before wound infection on the 3rd day post op?`

A

Hemorrhage may be occurring - this leaves open the greatest risk of infection after 2 days post op

113
Q

What are the causes of wound infection post op

A

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
Q

Nursing Assessments for Wound Infection

A

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
Q

What can sudden profuse discharge of serosanguinous material from a surgical wound indicate?

A

Dehiscence or Evisceration

116
Q

When is Dehiscence and Evisceration of a surgical wound most likely to occur

A

6-8 days post op

117
Q

Dehiscence

A

partial or complete separation of wound tissues

usually occurs 6-8 days post op

118
Q

Evisceration

A

dehiscence plus viscera protruding through the wound

usually occurs 6-8 days post op

a medical emergency

119
Q

Predisposing factors for dehiscence and evisceration

A

excessive coughing

straining and infection

those already under wound infection

urgent surgeries

poor nutrition

120
Q

Emergency treatment for Dehiscence

A

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
Q

Emergency Treatment for Evisceration

A

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
Q

Nursing Interventions to Promote Wound Healing

A

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
Q

When do you need and not need an order for a post-op dressing?

A

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
Q

Purpose of Surgical Drains

A

prevent accumulation of fluid in wound area

decreases chance of drainage infecting incision

125
Q

What should the nurse do regarding drains?

A

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
Q

What to do for wound irrigation and cleaning

A

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
Q

What is extremely important to wound healing

A

circulation and oxygenation - adequate circulation needed to deliver nutrients and oxygen to tissues

128
Q

Delayed wound healing occurs with what factors

A

vascular disease

obesity

DM

CV disease

edema

nicotine use

poor nutrition

infection

129
Q

___ is one of the most important factors to wound healing

A

nutrition (assess it pre op and post op)

130
Q

What are the major nutritional factors needed for wound healing

A

Protein and Calories

Water

Vitamin C

Thiamine, Niacin, Riboflavin, Folic Acid, B12

Vitamin K

Iron

131
Q

Why is protein needed for wound healing

A

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
Q

Why is water needed for wound healing

A

maintains homeostasis

replaces losses through vomiting and hemorrhages

133
Q

Why is Vitamin C needed for wound healing

A

capillary formation

tissue synthesis and wound healing through collagen formation

need for antibody formation

134
Q

Why is thiamine, niacin, riboflavin, folic acid, and Vit B12 important for wound healing

A

red blood cell maturation

*antibiotics can impede this though

135
Q

Why is vitamin K important for healing

A

clotting

136
Q

Why is Iron important for wound healing

A

to replace iron through blood loss (anemia)

137
Q

It is important to look at what history for wound healing

A

ETOH History

138
Q

Nursing interventions for Wound Healing

A

Monitor nutrition levels - need vitamin B and C after 2 days on IVs

May need TPN

monitor diet progression

139
Q

Psychological Concerns Post Op to Explore

A

surgical diagnosis and prognosis

support systems

body image disturbance

ineffective coping

hopelessness, powerlessness

spiritual distress

grieving process

140
Q

What are some Discharge Planning Referrals that may be made Post Op

A

Home care

meals on wheels

special equipment

transportation assistance

support groups

141
Q

What sorts of things should be taught in discharge teaching

A

type of diet

activity level

bathing

complications - temp, drainage, pain

report complications

medication teaching; prescriptions

follow up appointments

pain management

142
Q

Types of Pain

A

Acute (ex: post operative)

Chronic (nonmalignant)

Cancer Related Pain

143
Q

Definition of Pain

A

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
Q

Factors that Influence Pain

A

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
Q

__ is the fifth vital sign

A

Pain

146
Q

__ should always bee assessed alongside VS

A

pain

147
Q

Patients need to be involved in __ care decisions

A

pain

148
Q

Patients have a right to appropriate pain ___ and ___

A

assessment and management

149
Q

Pain is assessed in __ patients

A

ALL

150
Q

What sort of factors are looked at in the pain assessment

A

location

intensity

timing

quality - pt describes how the pain feels using their words

aggravating/alleviating factors

151
Q

What are some pain assessment tools commonly seen

A
  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
Q

Preoperatively - what is done for the patient regarding pain

A

educate patient about pain assessment methods and management

assess pain with VS on admission

153
Q

Intraoperatively - what is done for the patient regarding pain

A

anesthesia management

154
Q

Postoperatively - what is done for the patient regarding pain

A

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
Q

Methods of Pain Management

A

Oral

IV via IV push or PCA

IM

Nerve Block

Epidural

Local Anesthesia Pump

Rectal - rarely used ; children

156
Q

IV via IV push or PCA pain management can come in what forms

A

Opioid analgesics - morphine, dilaudid (hydromorphone), fentanyl

IV acetaminophen - i.e. Ofitmev (given over 15 min)

157
Q

Oral pain management can come in what forms

A

Non opioid - acetaminophen or NSAIDS

Opioids - oxycodone (percocet), hydrocodone (vicodin)

Combinations of the two

158
Q

It is important to keep what in mind regarding characteristics of first line opioids

A

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
Q

Adverse Effects of Opioids

A

Constipation - assess bowel movement frequently

NV

Pruritis

Hypotension

Sedation

Delirium

Respiratory depression

160
Q

What is the #1 adverse effect of opioids

A

Respiratory Depression

Less common, but most feared side effect - be sure to monitor your pt for rate, depth, regularity of respirations

161
Q

To prevent opioid induced resp. depression, avoid giving them when the pt is what?

A

Sedated or has low BP

162
Q

Alternative Methods of Pain Management: Physical modalities

A

reposition the pt

ambulation

application of heat or cold

massage

163
Q

Alternative Methods of Pain Management: Cognitive and Behavioral

A

relaxation breathing

imagery

music

distraction

communication - encouragement

164
Q

PCA

A

Patient controlled analgesia

an interactive method allowing pt to self treat pain

programmed and pt specific

165
Q

Pros of PCA

A

provides optimum pain relief via IV infusion

hope to have minimal SE

pt has control

better in some ways than IM injection

166
Q

Cons of PCA

A

BIG safety issues (ex: they should control it not family deciding when)

167
Q

Why is PCA better than IM injection

A

Steady serum levels of medication

easier C and DB

early ambulation

improved pain relief and shortened hospital stay

168
Q

Why is PCA always “piggy backed” to a primary line and has a clamp on the line?

A

PCA always goes back to a primary line and has a clamp to prevent them from using all the opioids at once

169
Q

Nursing Assessment: What to know when monitoring a patient with PCA

A

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
Q

What is the maximum dose period for PCA

A

4 hour maximum - 5-30 mL

171
Q

What medication is often used PCA

A

morphine, fentanyl, dilaudid (opioids)

172
Q

Loading Dose

A

the initial volume or amount administered to raise blood levels to therapeutic range (mL) in PCA

173
Q

Lockout Interval

A

length of time in which additional dosing is not possible on PCA (0-99 min)

174
Q

Safety Issues with PCA

A

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
Q

Epidural Analgesia

A

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
Q

With epidural orders, whose orders supersedes the surgeons

A

Anesthesia’s orders

177
Q

Typical Epidural Analgesia Orders

A

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
Q

Nursing management/interventions for Epidurals

A

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
Q

What is the difference between Epidural PRN dosing vs Around the Clock Dosing

A

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
Q

Narcan

A

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

N362: Practice of Nursing III (15 decks)

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