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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is managing the care of a postoperative client who is receiving intravenous (IV) morphine via a patient-controlled analgesia (PCA) pump. Which of the following nursing actions are appropriate for this client? Select all that apply.

  1. Verify the patient-controlled analgesia (PCA) pump programming and medication parameters with a second registered nurse.Answer
  2. B
    Delegate the assessment of the client's sedation level and pain relief to the unlicensed assistive personnel (UAP).
  3. Ensure that naloxone and emergency resuscitation equipment are readily available at the client's bedside.Answer
  4. D
    Authorize the client's family members to push the PCA dosing button while the client is asleep to maintain continuous pain control.
  5. Assess the client's respiratory rate, oxygen saturation, and level of sedation at established regular intervals.Answer
  6. F
    Connect a newly prescribed intravenous (IV) piggyback antibiotic to the PCA tubing Y-site based solely on the visual clarity of both solutions.

Answer

The correct actions are to verify the PCA pump settings with a second registered nurse, ensure naloxone is readily available at the bedside, and regularly assess the client's respiratory rate, oxygen saturation, and sedation level.
Safe management of a PCA pump requires a multifaceted approach to prevent medication errors and respiratory depression. This includes performing an independent double-check of pump parameters with a second nurse, continuously assessing the client's respiratory and neurological status, and maintaining immediate access to the reversal agent naloxone. These actions directly uphold physiological integrity and patient safety.

Step-by-Step Solution

1
Identify the primary risks associated with intravenous opioid administration via a PCA pump.
The main risks are oversedation and life-threatening respiratory depression.
Understanding the risks directs the nurse toward the necessary safety and monitoring interventions.
2
Evaluate the administrative safety protocols for PCA pumps.
The pump settings and medication dosage must be verified by two registered nurses.
Independent double-checks catch programming errors before the medication reaches the client.
3
Determine the necessary bedside emergency equipment.
An opioid antagonist (naloxone) and resuscitation equipment must be immediately accessible.
Rapid reversal of opioid toxicity is critical if respiratory depression occurs.
4
Analyze the delegation and operational safety rules of PCA therapy.
Assessments cannot be delegated to UAPs, and family members cannot push the PCA button (PCA by proxy).
Assessments require nursing judgment, and PCA safety relies on the client being awake enough to self-administer the dose.
5
Evaluate IV compatibility principles for parenteral therapies.
A drug reference must always be consulted before administering medications together.
Visual inspection cannot detect all forms of chemical incompatibility, which could cause harm or drug inactivation.

Key Concept

Safe administration, monitoring, and complication management of parenteral opioid analgesics via Patient-Controlled Analgesia (PCA).
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Topics

Pharmacological and Parenteral Therapies

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