Pain

What is the nurse's responsibility when administering epidural analgesia?

1.

PCA should be used for what patients?

1. Alert and capable of controlling the pump 2. Safe for children as young as 4 years old

Advantages of PCA

1. Consistent analgesic blood level is maintained 2. Delivered intravenously or epidurally so that absorption is faster and more predictable 3. Patient is in charge of own pain management 4. Patient tends to use less medication 5. Patient can ambulate sooner, which promotes less pulmonary complications. 6. Higher patient satisfaction

Disadvantages of PCA

1. Pump malfunction 2. Pump could need prompting 3. Unauthorized people could push the button

Advantages of Epidural Analgesia

1. Quick onset 2.

What is the nurse's responsibility related to PCA administration?

1. Setting up the PCA system 2. Ensuring that it is working properly 3. Have another nurse check the patient's ID, drug dose & concentration, pump settings, and infusion tubing/site

PCA should NOT be used for what patients?

1. confused older patients 2. infants and very young children 3. cognitively impaired patients 4. patients with conditions for which oversedation poses a significant health risk (asthma and sleep apnea) 5. patients who are taking other medications that potentiate opioids

Epidural Analgesia short duration of action is

2 hours

Epidural analgesia rapid onset of action is

5 minutes

Loading dose

Administered to raise blood levels to a therapeutic level and control the pain

What's epidural analgesia?

It is used to provide pain relief during immediate postoperative phase and chronic pain situations

Epidural analgesia acts directly on the _______ _______ in the spinal chord

Opiate receptors

Basal dose

Set rate that the pump delivers

PCA by proxy

Someone other than the patient accessing the pump

Lock-out

The programmed interval between doses This is commonly every hour, occasionally every 4 hours

Demand dose

When the button is pushed. Usually every 6 to 8 minutes.

The nurse is caring for a client who is receiving morphine via a patient-controlled analgesia (PCA) pump. The nurse notes that the client's respiratory rate is 10 breaths per minute. The client is somnolent, with minimal response to physical stimulation. The nurse should prepare to administer which of the following medications? a) Intravenous naloxone (Narcan) b) Intravenous flumazenil (Romazicon) c) Oral modafinil (Provigil) d) Nebulized albuterol (Proventil)

a) Intravenous naloxone (Narcan)

A client reports severe pain following a mastectomy. The nurse would expect to administer what type of pain medication to this client? a. Opioid analgesics b. NSAIDs c. Nonopioid analgesics d. Corticosteroids

a. Opioid analgesics

Which of the following statements accurately describes a consideration when using a patient-controlled analgesia (PCA) pump to relieve client pain? a) This approach can only be used with oral analgesics. b) The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval. c) A PCA pump must be used and monitored in a health care facility. d) The PCA pump is not effective for chronic pain.

b) The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval.

A client is scheduled for abdominal surgery and states that he is afraid of postoperative pain. The best nursing action is to inform the client a. How anxiety could increase his pain perception b. That medication will be prescribed for pain relief c. That the nurse will notify the surgeon of his fear d. About activities that would distract him from pain

b. That medication will be prescribed for pain relief

Which statements accurately describes a consideration when using a patient-controlled analgesia (PCA) pump to relieve client pain? a. This approach can only be used with oral analgesics. b. The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval. c. A PCA pump must be used and monitored in a health care facility. d. The PCA pump is not effective for chronic pain.

b. The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval.

When assessing a patient on PCA therapy, the nurse finds the patient to be somnolent, with minimal or no response to physical stimulation, scoring a 4 on the sedation scale. What is the recommended intervention in this situation? a) Stop the infusion and report the incident to the nurse manager in charge; follow the protocol of oxygen and naloxone administration. b) Stop the PCA infusion, check the medication level, and restart the infusion at a lower dose. c) Stop the medication infusion immediately and notify the primary care provider; prepare to administer oxygen and a narcotic antagonist, such as naloxone (Narcan). d) Stop the PCA infusion, increase the frequency of sedation and respiratory rate monitoring to every 15 minutes, arouse the patient, and encourage deep breathing.

c) Stop the medication infusion immediately and notify the primary care provider; prepare to administer oxygen and a narcotic antagonist, such as naloxone (Narcan).

Which nursing intervention should a nurse perform when caring for a client who is prescribed opiate therapy for pain? a. Avoid caffeine or other stimulants, such as decongestants b. Monitor weight, vital signs, and serum glucose concentration c. Do not administer if respirations are less than 12/min d. Monitor blood counts and liver function tests

c. Do not administer if respirations are less than 12/min

The nurse is administering a narcotic analgesic for the control of a newly postoperative client's pain. What medication will the nurse administer to this client? a. Acetaminophen (Tylenol) b. Ibuprofen (Motrin) c. Fentanyl (Duragesic) d. Midazolam (Versed)

c. Fentanyl (Duragesic)

A nurse is assessing a client's pain. The nurse notes which database finding that is indicative of acute pain? a. Decreased pulse rate b. Pupil constriction c. Increased blood pressure d. Decreased respiratory rate

c. Increased blood pressure

Which of the following is a disadvantage to using the IV route of administration for analgesics? a. Slower entry into bloodstream b. No risk of respiratory depression c. Short duration d. Long duration

c. Short duration

A client has been admitted to a post-surgical unit with a patient-controlled analgesia (PCA) system. Which statement is true of this medication delivery system? a. Use of opioid analgesics in a PCA is contraindicated due to the risk of respiratory depression. b. An antidote is automatically delivered if the client exceeds the recommended dose. c. The dose that is delivered when the client activates the machine is preset. d. Thorough client education is necessary to prevent overdoses.

c. The dose that is delivered when the client activates the machine is preset.

A client reports pain and requests the prescribed pain medication. When entering the client's room, the client is laughing with visitors and does not appear to be in pain. What is the appropriate action by the nurse? a. Hold the pain medication. b. Reassess the client's pain in 30 minutes. c. Contact the client's health care provider. d. Administer the pain medication.

d. Administer the pain medication. Pain is considered to be present whenever the client states it is. Therefore, the nurse should administer the client's pain medication.

A client who is 1 day postoperative is using a morphine patient-controlled analgesia (PCA) pump. The client is confused and disoriented. What is the priority intervention by the nurse? a. Check the pulse rate and blood pressure. b. Check for shortness of breath, signifying a pulmonary embolism. c. Check whether the client is self-administering a bolus too frequently. d. Check respiratory rate and depth as well as oxygen saturation levels.

d. Check respiratory rate and depth as well as oxygen saturation levels.

The nurse is administering an analgesic to an older adult patient. Why is it important for the nurse to assess the patient carefully? a. Older people metabolize drugs more rapidly. b. Older people have increased hepatic, renal, and gastrointestinal function. c. Older people have lower ratios of body fat and muscle mass. d. Older people are more sensitive to drugs.

d. Older people are more sensitive to drugs.

Which of the following is a true statement with regards to the nursing process of pain control? a. Nonverbal expressions of pain are reliable indicators of the quality of pain. b. Formulate treatment plans based on behaviors. c. Usually all patients exhibit the same pain behaviors. d. The use of physiologic signs to indicate pain is unreliable.

d. The use of physiologic signs to indicate pain is unreliable.

Besides controlling pain of the postabdominal surgery client with narcotics, the nurse suggests to the client that he: a. describe the pain. b. think about the next dose. c. focus on pain relief. d. use distraction.

d. use distraction.