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PCA use


What are the important Teaching concepts when teaching Pt. about PCA meds? * Demonstrate how it works * press button to deliver additional bolus if needed * Tell client that after each dose, must wait a minimum amount before they get the next dose (Lockout). * client returns demo before starting * Pain scale * Only Pt. push
What do you need when setting up for PCA? * Physicians order * Gloves, PPE * PCA pump, tubing, key * IV kit, tubing, catheter, fluids * Extension set w/Leur-lock adapter * Analgesic med cartridge & injector * PCA Admin. Record * PCA booklet for Pt.
What are the steps in administering PCA? * Check ID * Establish IV access for PCA * Assemble PCA vial injector and infuser pump * Program infuser for continuous infusion plus a bolus dose * Independent double check by 2nd RN.
What are some common Meds for PCA use? * Morphine (Most common, Most studied) * Hydromorphone (Dilaudid) * Fentanyl (30-40 X more potent than morphine)
What are some dose calculations needed with a PCA? * Know mg/mL or micrograms/ml of drug * Basal or continuous rates * Bolus Rate (depends on Pt. tolerance and drug) * Lockout TIme (avoid stacking)
What are the steps with a RN administered bolus w/PCA? * Open door, set dose volume to dose ordered * Set lockout interval to 00 * Administer dose * Set dose back to original order * Set lockout interval to original order * Close and lock door
What three main components are involved in Monitoring PCA use? * Evaluate client's response (getting enough?) * Remind them to notify staff with alarms or pain increases and only pt. to operate. * Assess and document per policy.
What would you include in your assessment with a PCA? * Pain onset, pattern description, location, intensity. * Amount and type of pain medications administered * Sedation level of client * Interventions, levels of pain relief.
What are some side effects or complications with PCAs? * RESPIRATORY DEPRESSION * Nausea/Vomiting * Pruritis * Over-sedation * Cardiac arrest
What is the antidote for PCAs? Naloxone or Narcan.
How do you terminate a PCA infusion? * Close clamp * Unlock & open door * Remove injector or cassette and disconnect. * OFF button * Record amount of narcotic remaining * Dispose of remaining w/witness and co-signature.
How are PCA safetly controlled in oversedation? Patient is then unable to press the button for more meds, this is why only the patient should control it
What is required of the patient for a PCA to be considered safe? Patient must be cognitively, physically,and phsycologically capable of understanding the concepts of the PCA
Created by: zj mepn