Fundamentals of Nursing Q 516
A first-day postoperative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take?
A. Deliver the bolus dose per standing order.
B. Contact the physician to increase the dose.
C. Try non-pharmacological comfort measures.
D. Assess the pain for location, quality, and intensity.
Correct Answer: D. Assess the pain for location, quality, and intensity.
Assess the pain for changes in location, quality, and intensity, as well as changes in response to medication. This assessment will guide the next steps. Patient-controlled analgesia is used to treat acute, chronic, postoperative, and labor pain. A variety of medications can be used for patient-controlled analgesia and are administered intravenously (IV), through an epidural or peripheral nerve catheter, and transdermally.
Option A: The goal of PCA is to efficiently deliver pain relief at a patient’s preferred dose and schedule by allowing them to administer a predetermined bolus dose of medication on-demand at the press of a button. Each bolus can be administered alone or coupled with a background infusion of medication.
Option B: The initial loading dose can be titrated by a nurse to reach the minimum effective concentration (MEC) of the desired medication. The bolus or demand dose is the dose of medication delivered each time the patient presses the button. A lockout interval is the time after a demand dose in which a dose of medication will not get administered even if the patient presses the button; this is done to prevent overdosing.
Option C: The use of PCA has been proven to be more effective at pain control than non-patient-controlled opioid injections and results in higher patient satisfaction. PCA has also been found to be preferred by nurses because it allows for a reduction in their workload. PCA will enable patients to be in more control over their pain and helps them shift toward a more internal locus of control over their care.