Pharmacology Analgesic Question #3

Question

The nurse is providing pre-surgery instructions to a client and discusses side effects of using client controlled analgesia (PCA). The nurse explains that risk of respiratory depression with the PCA will be reduced because:

Answers

  1. the drugs utilized are not respiratory depressants, and only for pain.
    • This answer is not correct because pain medications used in client controlled analgesia (PCA) are opioids and will cause respiratory depression. Nevertheless, the advantage of use of PCA with opioids is that due to the availability of consistent, controllable, smaller doses, the peak action in the serum is minimal or eliminated, therefore maximizing pain control and minimizing the risk of overdose.

  2. the peak action in the serum is minimal or eliminated.
    • This answer is correct because with use of client controlled analgesia (PCA) the health care provider prescribes the analgesia medication with specific parameters and doses programmed, with limits and maximum doses. This is utilized to help achieve optimal pain control, with less risk of overdose with CNS and respiratory depression due to the availability of consistent, controllable, smaller doses. The peak action in the serum is minimal or eliminated, therefore maximizing pain control and minimizing the risk of overdose.

  3. the drug has a large dose given over 4 hours.
    • This answer is not correct because with PCA, the health care provider prescribes the analgesia medication with specific parameters and doses programmed, with limits and maximum doses. An initial loading dose may be prescribed to achieve pain control, then consistent, controllable, smaller doses are provided through PCA. This is utilized to help achieve optimal pain control, with less risk of overdose with CNS and respiratory depression.

  4. timing of the drug is set to have periods of no medication.
    • This answer is not correct because although there is a limited, maximum amount of pain medication available over a certain period of time, the intent is to not have the client without pain medication available certain times. Instead, PCA is designed to help achieve optimal pain control through consistent smaller doses, while having less risk of overdose with CNS and respiratory depression. There could be lock-out periods once the client has maxed out the designated prescribed PCA dose. Breakthrough pain should be reported to the health care provider if this becomes a consistent problem.

Overview

Client controlled analgesia (PCA) has several advantages, including decreasing the risk of respiratory depression due to the small doses minimizing peak serum drug levels.

Learning Outcomes

Client controlled analgesia (PCA) is a way to administer pain medication by allowing the client to self administer their own prescribed pain medication. The health care provider prescribes the analgesia medication with specific parameters and doses programmed, with limits and maximum doses. This is utilized to help achieve optimal pain control, with less risk of overdose with CNS and respiratory depression due to the availability of consistent, controllable, smaller doses. When a pump is used, the nurse sets up the lockable pump with a vial of the prescribed pain medication and programs the pump as prescribed, with a loading dose for immediate relief and a smaller, designated amount that can be released during a certain time when the client pushes the button to receive the pain control. There is a controlled, maximum amount that can be administered within a certain time period. The peak action in the serum is minimal or eliminated, therefore maximizing pain control and minimizing the risk of overdose.

Test Taking Tip

Respiratory depression can be gradual and subtle such as a gradual decrease in respiratory rate, oxygen saturation, and restlessness. Careful monitoring by the nurse is imperative when any central nervous system depressant is administered.