PCA Administration

Question 1

A patient with second-degree burns has been receiving hydromorphone through patient-controlled analgesia (PCA) for a week. The patient wakes up frequently during the night complaining of pain. What action by the nurse is most appropriate?

a. Administer a dose of morphine every 1 to 2 hours from the PCA machine while the patient is sleeping.
b. Consult with the health care provider about using a different treatment protocol to control the patient’s pain.
c. Request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain.
d. Teach the patient to push the button every 10 minutes for an hour before going to sleep, even if the pain is minimal.

Answer 1

ANS: B
PCAs are best for controlling acute pain. This patient’s history indicates chronic pain and a need for a pain management plan that will provide adequate analgesia while the patient is sleeping. Administering a dose of morphine when the patient already has severe pain will not address the problem. Teaching the patient to administer unneeded medication before going to sleep can result in oversedation and respiratory depression. It is illegal for the nurse to administer the morphine for a patient through PCA.

Question 2

The nurse is caring for a 1-day postoperative patient who is receiving morphine through patient-controlled analgesia (PCA). What action by the nurse is a priority?

a. Check the respiratory rate.
b. Assess for nausea after eating.
c. Inspect the abdomen and auscultate bowel sounds.
d. Evaluate the sacral and heel areas for signs of redness.

Answer 2

ANS: A
The patient’s respiratory rate is the highest priority of care while using PCA medication because of the possible respiratory depression. The other information may also require intervention but is not as urgent to report as the respiratory rate

Question 3

The health care provider orders a patient-controlled analgesia (PCA) machine to provide pain relief for a patient with acute surgical pain who has never received opioids in the past. Which nursing actions regarding opioid administration are appropriate at this time (select all that apply)?

a. Assess for signs that the patient is becoming addicted to the opioid.
b. Monitor for therapeutic and adverse effects of opioid administration.
c. Emphasize that the risk of some opioid side effects increases over time.
d. Teach the patient about how analgesics improve postoperative activity levels.
e. Provide instructions on decreasing opioid doses by the second postoperative day.

Answer 3

ANS: B, D
Monitoring for pain relief and teaching the patient about how opioid use will improve postoperative outcomes are appropriate actions when administering opioids for acute pain. Although postoperative patients usually need a decreasing amount of opioids by the second postoperative day, each patient’s response is individual. Tolerance may occur, but addiction to opioids will not develop in the acute postoperative period. The patient should use the opioids to achieve adequate pain control, and so the nurse should not emphasize the adverse effects

Question 4

A postoperative 68-year-old opioid-naive patient is receiving morphine by patient-controlled analgesia (PCA) for postoperative pain. What is the rationale for not initiating the PCA analgesic with a basal dose of analgesic as well?

a. Opioid overdose
b. Nausea and itching
c. Lack of pain control
d. Adverse respiratory outcomes

Answer 4

d. Use of a basal dose may increase the risk of serious respiratory events in opioid-naive patients and those at risk for respiratory difficulties (older age, existing pulmonary disease, etc.). Overdose is not expected, as the dosages are calculated and the PCA pump is programmed to prevent this. Nausea and itching are common side effects but not related to a basal dose of analgesic. A lack of pain control would not be expected with or without a basal dose. The nurse would be assessing the patient and notify the physician if a lack of pain control occurs but, again, this is not related to receiving a basal dose of analgesic via PCA pump.
* NEVER use Basal Rates on Opioid -Naive, ONLY USE DEMAND DOSE!*