1. Assessing Pain What is pain? Do you believe that “perception is reality”? What are EB clinical practice guidelines?? What if client non-verbal, or you do not speak the same language? Pain vs suffering 1

2. Assessing Pain Location Intensity Quality Onset, duration & recurrence Manner of expressing pain Precipitating factors Alleviating factors Effects on ADL (C&DB, ambulating) 2

3. INS Standards of Practice, 2011 The nurse shall: be competent in the care of patients receiving PCA. have knowledge of the appropriate drugs used with PCA, including: – pharmacokinetics and equianalgesic dosing – contraindications, side effects and their management – appropriate administration modalities – anticipated outcomes. 3

4. INS Standards of Practice, 2011 The patient and caregiver shall be educated in the use of PCA. The patient’s and caregiver’s comprehension and ability to comply with procedures shall be evaluated and documented prior to, and on initiation of therapy. The use of infusion devices shall adhere to manufacturers’ directions for use. 4

5. Definitions Anesthesia Analgesia 5

6. Equianalgesia “approximately equal analgesia” Used when switching from 1 pain med or route to another – Standard: Morphine, 10 mg IM/IV or 30 mg po – Chart: Craven, p. 1202, Table 44-3 6

7. Patient Controlled Analgesia Self-delivery of narcotics Goal: constant plasma level IV, SQ, epidural Acute or chronic pain Philosophy of care 7

8. Patient Criteria Alert Able to comprehend instructions Physically able to push button Acute or chronic pain No allergy to medication ordered 8

9. Advantages Pump infuser can be used – get pain med quicker Shown to be safe and effective Patient more relaxed when have more control Analgesia more effective when serum level constant Postop patients can avoid peak & trough Patients shown to ambulate sooner after abdominal surgery. Better pain control= better able C&DB 9

10. Potential Side Effects(opioids) Oversedation Hypotension Respiratory depression Urinary retention Nausea/vomiting Constipation pruritus 10

11. Factors that reduce patient safety Improper patient selection Pump problems Programming errors – Standards require 2 nd signature on initiation “PCA by proxy” 11

12. Parts to PCA order 1.Name of drug 2.Concentration (mg/ml) of drug 3.Loading dose (Bolus) 4.Mode Continuous infusion (Basal) PCA (patient activated) Combination 5.PCA dose 6.lockout interval (Delay) 7.Hour limit (1 or 4 hour limit) 12

13. Equipment PCA pump Key PCA tubing Syringe/cassette of medication Patent, running IV 13

14. Teaching Teach before procedure Button Can't overdose (lockout) Family/friends should not operate Report to you if ineffective 14

15. Teaching Report side effects Goals of therapy Return demonstration 15

16. Assessment Pain level Sedation level Respiratory rate Other side effects History of attempt/injections 16

17. Ineffective Pain Management First: look at history Pain r/t ineffective medication – Is there a titration order? Pain r/t knowledge deficit 17

18. Documentation Q 4 h Assessment # attempts / # injections Amount of drug infused Amount of drug in syringe 18