PCA
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| 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
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| 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.
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| 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.
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| What are some common Meds for PCA use? | * Morphine (Most common, Most studied)
* Hydromorphone (Dilaudid)
* Fentanyl (30-40 X more potent than morphine)
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| 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)
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| 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
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| 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.
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| 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.
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| What are some side effects or complications with PCAs? | * RESPIRATORY DEPRESSION
* Nausea/Vomiting
* Pruritis
* Over-sedation
* Cardiac arrest
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| What is the antidote for PCAs? | Naloxone or Narcan.
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| 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.
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| 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
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| 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
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