question

What are the advantages of PCA and epidural analgesia? (Name 6)

answer

1) More satisfactory pain relief for patient (relief before pain gets too bad) 2) shorten's hospital stay 3) better able to deep breath and ambulate which means less post-op complications 4) Patient maintains control over pain 5) patients use LESS pain medication on PCA 6)reduced Nurse time/intervention by reduces the number of IM/IV administrations required

question

Name 3 concerns / safety issues related to PCA / epidural use.

answer

Potential overdosing caused by: 1) Not good/dangerous for some patients (i.e. * children UNDER 5 years of age; * OLD, CONFUSED patients; * OBESE patients; * patients with SLEEP APNEA; * patients with RESPIRATORY ISSUES; * patients who are taking DRUGS THAT CAN POTENTIATE the effect of their medication such as muscle relaxants, anti-emetics or sleep medication 2) PCA by proxy (i.e. perhaps when the patient is already sedated, someone other than the patient can push the button and deliver the medication, for example the over concerned partner or family member) 3) pump problems 4) human errors

question

Discuss principles and safety features of PCA / epidural pump operation.

answer

The prescribed and programmes LOCKOUT interval prevents overdosing as the PCA device prevents more than a specified dose being delivered within the LOCKOUT time interval.

question

Describe safe and competent nursing care of the client receiving PCA/ epidural analgesia

answer

8.

question

Describe the nursing assessments that monitor client response to PCA/epidural analgesia.

answer

1) The nurse monitors how many times the patient pushes the PCA button. If the patient pushes the button more than twice the prescribed dose interval either the DOSE is increased if possible, OR the DOSE INTERVAL is shortened. The results of these assessments are reviewed daily.

question

What are some nursing assessments to monitor a client receiving PCA/ epidural analgesia

answer

1) Vital signs (VS) 2) pain rating 3) type of pain 4) oxygen saturation 5) mental status 6) level of sedation 7) adverse reactions such as itching or nausea

question

Name some nursing interventions to help ensure patient safety when receiving epidural analgesia.

answer

nurses should: 1) maintain be proficient using the PCA pumps in the facility 2) PCA orders should always be written on PREPRINTED order sets 3) develop a list of patients who are good candidates for PCA and those who are NOT 4) When initiating PCA, transferring a patient to a new unit, or restarting or changing the dosage the pump TWO nurses must INDEPENDENTLY verify the patient ID, drug and concentration, pump settings and the line and site where the PCA will be infused.

question

What are the negative physiological consequences of Pain? (Name 5)

answer

1) ↑ BP & ↑ HR (a stress response) 2) ↑Blood Glucose (a stress response) 3) ↑ respirations and sometimes shallow breathing (a stress response) 4) ↑ ability of blood to clot (a stress response) 5) ↓ disturbed/deprived SLEEP

question

What comprises a complete order for PCA, i.e. name everything the prescriber must include in the order.

answer

1) Medication name 2) dose 3) concentration 4) demand (bolus) dose interval: This is measured in the TIME between each doses. For example 1 dose per 8 minutes 5) LOCK OUT interval: the ordered time within which the PCA will NOT release any more than the prescribed dosage. 6) nursing interventions 7) treatment of side effects

question

Name two drugs that a NON anesthesiologist can order for pain. Name them from weakest to strongest

answer

Dilaudid Morphine

question

Name THREE drugs that an anesthesiologist can order for pain. Name them from weakest to strongest

answer

Dilaudid Morphine FENTANYL (e.g. for cancer patients)

question

1) PCA refers to a PROCESS?/ EQUIPMENT? 2) Describe the above

answer

1) process 2) patient, nurse, pharmacist, prescribing physician

question

A) What is the dose interval usually for post-op pain? B) What is the usual lock out interval for post-op pain medication?

answer

A) 6-8 minutes B) the maximum dosage in a specified timeframe: i.e. 1 HOUR lockout at 10mg

question

Name 3 places in a hospital where you might see PCA?

answer

post-op Oncology

question

Which is a dose of medication? 1mg/mL or 1mg?

answer

1mg (the other one is a concentration)

question

Explain what is the outcome of the nurse monitoring how many times the patient pushes the PCA button.

answer

If the patient pushes the button more than twice the prescribed dose interval the prescriber might either increase the DOSE OR shorten the DOSE INTERVAL

question

1) How often are the PCA orders are reviewed? ) How often are PCA orders renewed?

answer

1) daily 2) every 3 days

question

1) What does it mean to say that a PCA can deliver a basal IV infusion? 2) What patients are likely to receive these?

answer

1) CONTINUOUS (in addition to the extra doses the patient can also administer) 2) patients who are used to receiving opiods, such as oncology patients

question

1) What is meant by a bolus dose? 2) How is this administered?

answer

1) an EXTRA, dose administered through the PCA device on top of the basal or PCA dosing. This might be given just before a painful procedure for example or say one mg each hour. 2) with a code or key (depending on the PCA machine)

question

PCA?/ BOLUS?/ BASAL doses are used mainly for patients in oncology who are used to receiving opiods.

answer

basal

question

Name types of patients who are NOT good candidates for PCA.

answer

1) children UNDER 5 years of age 2) OLD, CONFUSED patients 3) OBESE patients 4) patients with SLEEP APNEA 5) patients with RESPIRATORY ISSUES 6) patients who are taking DRUGS such as muscle relaxants THAT CAN POTENTIATE the effect of their medication such as muscle relaxants, anti-emetics or sleep medication

question

When does PCA work best?

answer

When the patient is NOT IN PAIN. This means that they may be given pain medication BEFORE the PCA is set up.

question

If a patient's pain was not sufficiently reduced prior to being connected to PCA what would happen? What should the nurse do?

answer

They would NEVER catch up wit pain relief. Check the order or contact the physician to see if a bolus dose could be administered to 'reset' the pain cycle.

question

If someone activated the PCA by proxy, effectively they have overridden the ___? of the PCA. There may be exceptions for parents of children to operate the PCA pump...check hospital policy.

answer

IMPORTANT SAFEGUARD

question

What is a common design flaw of some PCA devices.

answer

the PCA button looks like a call light and the patient may be pushing the call light thinking that they are activating the PCA.

question

When MDs are teaching patients about how to use the PCA it is a good idea for the nurse to do what _____.

answer

be in the room so that they can reinforce teaching when the MD leaves. Remember, when patients are sick their cognition is not there.

question

Name some SERIOUS human errors in programming a PCA that nurses should be cautious of (Name 5)!

answer

1) confusing mL with mg 2) confusing PCA BOLUS doses with BASAL doses 3) Loading PCA dose where BASAL rate SHOULD HVE BEEN entered 4) Wrong lock out setting 5) Wrong concentration selected

question

Sometimes patients in pain hit the PCA button repeatedly without waiting for the dose to work. What design feature on some PCAs prevents this?

answer

a bell or light that sounds when the button is pushed to reassure the patient that a dose is on its way.

question

Name some nursing interventions to help ensure patient safety when receiving epidural analgesia.

answer

...

question

When should a nurse monitoring a patient receiving PCA call the doctor? Name 6 situations

answer

call MD if: 1) RR (respirations) <10/min 2) somnolence (sleepy) or confusion 3) sudden hypotension (i.e. sudden drop in BP), lightheadedness, dizziness 4) over sedation 5) inadequate analgesia 6) persistent nausea/emesis (aka vomiting) or purities (rash) (sometimes these symptoms pass on their own, but may not, in which case you should contact the prescriber.

question

A) How often should the nurse monitor a patient receiving PCA? B) What happens to the monitoring frequency is something (interval, dose, etc) changes on the PCA?

answer

A) if pt receiving PCA: * RN monitor every 30 minutes * between 2-6 hrs --> RN monitor every 2 hours * > 6 hours --> RN monitor very 4 hours B) start monitoring intervals all over again

question

What should a nurse do if a patient goes into respiratory depression or is unresponsive whilst using PCA?

answer

* STOP PCA * contact MD/House Officer (Resident) * stimulate patient (try to arouse saying "take a deep breath, take a deep breath") * administer reversal for opiod, e.g. Narcan 0.1mg IVP *Apply 100% oxygen

question

What is the drug, dosage and route for the reversal med of opiod?

answer

Narcan 0.1mg by IV push

question

What patients receive Epidural block

answer

L & D used for surgical procedures

question

Epidural can be can?/ cannot? be regulated with PCA

answer

can

question

If vital signs are RED on Simchart what should the student nurse do?

answer

tell the primary care nurse. (it may just indicate that a PRN med should be given)

question

What is a cystoscopy

answer

a scope of the bladder

question

a nerve block in a shoulder IS?/ IS NOT? a kind of epidural

answer

is not

question

What position should a patient be in to receive an epidural?

answer

sitting up, bent forward.

question

What cavity should the epidural needle be in for correct placement in the back? Between what vertebra? What space is too DEEP for epidural placement?

answer

In the epidural space at L3 the duramater, subarachnoid space and spinal chord are all too DEEP.

question

The epidural is a SENSORY?/ MOTOR?/ SYMPATHETIC block?

answer

all three, but we do not want too much motor or parasympathetic, mainly sensory

question

how can you tell if the epidural needle has gone too deep?

answer

spinal fluid leaks out

question

What happens to the patient if the epidural needle is inserted too deep?

answer

they have more motor and sympathetic block than desired.

question

Where in relation to the spinal cord is the epidural needle inserted

answer

below the spinal cord

question

What happens after the epidural needle is inserted into the patient's back?

answer

a catheter is left behind and the medication flows into this catheter

question

When is it too late to give a laboring woman an epidural?

answer

What she is > 5cm dilated

question

For what patients is an epidural CONTRAINDICTED (Name 6 patient situations)

answer

* patients who refuse * patients with coagulation defects * patients with hypovolemia * patients with infection * patients with allergy to meds * fetal condition that demands birth sooner than epidural can become effective

question

Why would you NOT give an epidural to a patient who is hypovolemic?

answer

because epidural blocks the sympathetic response, which blocks the body's ability to raise blood pressure. Low blood pressure in combination with low blood volume is dangerous

question

How does an epidural effect urination?

answer

it reduced the urge to urinate, so monitor urinary output/distention

question

Name 5 adverse physiological effects of epidurals

answer

1) hypotension 2) bladder distention 3) prolonged 2nd stage of labor (pushing stage) 4) migration of catheter 5) fever (with an epidural this does NOT indicate infection)

question

How do you make the tubing of an PCA epidural?

answer

"PCEA" -> Patient Controlled Epidural Analgesic

question

What health care professional administers a systemic narcotic in an epidural?

answer

ONLY the anethesiologist NOT AN RN!!!

question

How long is IV access kept in an epidural line?

answer

6 hours AFTER the epidural has been discontinued (just in case it needs to be restarted)

question

What urinary intervention is done for a patient who has had an epidural?

answer

straight cath PRN for urinar retention

question

How do you position a client who is receiving an epidural?

answer

with the HOB raised 30 degrees

question

What monitoring is done for an epidural?

answer

same as for a PCA

question

What kind of dressing is used for an epidural?

answer

transparent dressing

question

What signs would required a nurse to notify the anesthesiologist? (Name 10!!)

answer

1) RR < 8 breaths / min 2) HR < 45 beats / min 3) systolic blood pressure 101 5) change in mental status 6) significant otor weakness 7) inadequte pain relief 8) unrelieved nausea/vomiging or itching 9) pump malfuncton 10) leakage, bleeding or signs of infection at catheter site.

question

Do we want an epidural effect to be systemic?

answer

NO! Only regional

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