What is your nursing responsibility on patient with patient controlled analgesia?
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2020-02-19T14:01:28+11:00 2020-02-19T14:01:28+11:00 Share This StoryPrint This StoryPain management is a core component of nursing care. Uncontrolled pain can have many negative effects on the individual and therefore as nurses this must be one of our priorities in provision of care.To effectively manage pain, we must first understand the pathophysiology of pain, how to complete effective pain assessments and implement strategies to decrease the experience of pain for the individual. Patient Controlled Analgesia (PCA) is effective for pain management and can be used in many settings so it is essential for nurses who are caring for patients using PCA to be educated on its use and potential complications. Pain is a highly subjective experience. It can be impacted by biological, psychological and social experiences and therefore is extremely personalised to the individual. Pain is a common occurrence and can be quite debilitating for the person experiencing it. The International Association for the Study of Pain describes pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. (1) Pain experiences can be categorised as acute, chronic or cancer-related depending on its duration. (1) Pain can also be described based according to its etiology. Nociceptive pain can be caused by ischaemia, trauma, chemical irritants and extremes of temperature and is due to stimulation of the nociceptors (peripheral nerve fibres). Neuropathic pain results from damage or malfunction of nerve fibres in the peripheral or central nervous systems and is often described as a burning sensation or pins and needles. Psychogenic can be complex pain that is not fully acknowledged or understood and exists in the absence of known pathophysiology and is associated with mental and emotional behaviours. It includes ‘Phantom’ pain and referred pain. (2) Unrelieved pain can have many negative impacts on the individual. It can affect the pulmonary, cardiovascular, gastro-intestinal, endocrine and immune systems. Patients with unrelieved chronic pain often experience an increase in disability along with increased levels of depression, fatigue and anger. The body’s response to stress causes an increased metabolic rate, increased cardiac output, impaired insulin response, increased production of cortisol and increased retention of fluids. Chronic pain, as a stressor, also causes this response in a person. (1) The pain pathway There are four steps which occur along the pain pathway:
Nociceptors are peripheral receptors that respond to tissue-damaging or potentially tissue damaging stimuli. These are located throughout our body and are essential components in the pain pathway. The mechanisms regarding the physiology and psychology of pain are not fully understood however there are several theories regarding pain including: Biomedical model, Gate control theory and Biopsychosocial models (discussed in detail within the online tutorial). (3) An accurate pain assessment is needed in order to provide effective pain management. Because pain is a very subjective experience, the best measure of pain is a valid self-report of the pain. Patients can indicate pain in a number of ways including verbal reports on pain and non-verbal cues including grimacing. Therefore, an effective pain assessment relies on communication between the nurse and the patient. When assessing an individual’s pain, the following guideline may be used:
Pain should be assessed on movement as well as at rest and always remember to evaluate any pain management strategies used. (4) Management of pain
The World Health Organization (WHO) developed a guide to pharmacological management of pain which consists of a 3-step ladder.
What is Patient-Controlled Analgesia (PCA)? PCA allows the patients to control the administration of their own medication within the safety parameters set by the doctor or nurse practitioner. This can be done by intravenous, subcutaneous, epidural or oral routes and can be used in either a hospital or home setting. Generally when we think of the term PCA, we envision PCA infusions post operatively. However this term is used for the general process in which the individual determines when and how much analgesia they receive, regardless of the drug or route used. A PCA pump can allow a continuous infusion of medication, also known as the basal rate, to infuse into the patient. Then in addition to this, a patient can have extra medication or bolus doses when they are experiencing increased pain by pressing a button linked to the PCA pump. Safety measures for this type of analgesia include the use of a lock-out function. This stops the patient from having unsafe levels of the medication by programming a timer on the PCA pump to stop the individual from having additional doses of the medication until a specified time period has elapsed. So no matter how many times they press the button in that time period, no additional medication will be administered. Patients who use a PCA often achieve better pain relief and have greater patient satisfaction than those having conventional opioid analgesia. The goal is to achieve a therapeutic level of analgesia and to allow the patient to maintain that level by using the PCA pump. (6) In this tutorial, we discuss the use of a PCA as a PCA pump being used via an intravenous route. Reading the complete tutorial will give you two hours of Continuing Professional Development (CPD) hours. It covers pain, pain assessments and management, PCA and medication, prescribing requirements, safe use, patient education, complications, ceasing the PCA and medications errors. To access the course go to the ANMF’s Continuing Professional Education (CPE) website or follow this link http://anmf.cliniciansmatrix.com References:
Related PostsThis site uses Akismet to reduce spam. Learn how your comment data is processed. What nursing care is required for patients with a PCA?Monitoring requirements should be developed for patients who are receiving PCA. At a minimum, the patient's level of pain, alertness, vital signs, and rate and quality of respirations should be evaluated every four hours. The staff must be alert for signs of oversedation.
What patient teaching should the patient receive regarding the use of the PCA patient controlled analgesia pump?The PCA pump is safe to use because you receive medication by pressing the button when you feel pain, but the pump won't give you the drug if it's not time to receive another dose yet. Remember, no one should press the button on the PCA pump except you. When the pump is empty, an alarm lets the nursing staff know.
What observations are required when caring for a patient with a PCA?The following observations should be recorded on the general observation chart:. Sedation score, respiratory rate and heart rate: 1 hourly until the PCA is ceased. ... . Pain score: 1 hourly while awake (using developmentally appropriate scale e.g. Wong-Baker Faces scale, Numeric scale, FLACC scale or PAT score).. Which patient would benefit most from the use of a patient controlled analgesia pump?Children as young as age 7 can benefit from PCA if they understand the idea behind the PCA and can follow instructions. But people who are confused, disoriented, or unresponsive can't use PCA.
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