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Soru

Zorluk: ZorAccident, Error, and Injury Prevention

A registered nurse is preparing to initiate a patient-controlled analgesia (PCA) pump with intravenous morphine for a client who is two hours post-operative. To ensure client safety and prevent medication errors, which of the following actions should the nurse perform? (Select all that apply.)

  1. Verify the pump settings, medication concentration, and client identification independently with a second registered nurse.Cevap
  2. Assess the client's cognitive and physical ability to understand instructions and independently press the dosing button.Cevap
  3. C
    Delegate the initial assessment of the client's baseline sedation level and respiratory rate to the unlicensed assistive personnel (UAP).
  4. D
    Administer a prescribed intravenous push antiemetic through the PCA line without verifying drug compatibility with the morphine infusion.
  5. Maintain continuous pulse oximetry or capnography monitoring to detect early signs of respiratory depression.Cevap
  6. F
    Calculate the required weight-based loading dose using an estimated body weight provided by the client's family members.

Cevap

The nurse must verify pump settings with a second registered nurse, assess the client's cognitive and physical ability to use the PCA independently, and maintain continuous respiratory monitoring.
Patient-controlled analgesia (PCA) involves high-alert medications (opioids) that pose a significant risk for overdose and respiratory depression. Safe initiation requires an independent double-check by two registered nurses to prevent programming and calculation errors. The nurse must also ensure the client is cognitively intact and physically capable of pressing the button themselves, as PCA by proxy is strictly prohibited. Furthermore, continuous pulse oximetry or capnography is critical to monitor for adverse effects such as hypoxia or hypoventilation.

Adım Adım Çözüm

1
Identify the high-risk nature of patient-controlled analgesia (PCA).
Recognize that IV opioids pose a significant risk for respiratory depression and require strict safety protocols.
High-alert medications have a narrow therapeutic index and high potential for client harm if a medication error occurs.
2
Evaluate mandatory error-prevention steps prior to initiating the infusion.
Confirm the requirement for an independent double-check by two RNs and the use of an actual measured weight for dose calculation.
Independent verification and precise math calculations prevent pump programming and dosage errors.
3
Analyze safe delegation and ongoing monitoring requirements.
Determine that baseline assessments cannot be delegated to UAP, and continuous capnography/pulse oximetry is necessary.
Only registered nurses hold the scope of practice for initial clinical assessments, and continuous monitoring mitigates the risk of unrecognized respiratory failure.
4
Review standards for intravenous line safety.
Identify that checking IV compatibility is mandatory before administering any secondary medication into the PCA line.
Incompatible drugs can crystallize in the tubing, preventing the analgesic from reaching the client or causing an embolus.

Anahtar Kavram

Patient-Controlled Analgesia (PCA) Safety and Medical Error Prevention
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Konular

Accident, Error, and Injury Prevention

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