PCA, Glasgow Coma Scale, Canadian Neurological Stroke Scale

1. PCA, Glasgow Coma Scale, Canadian Neurological Stroke Scale

2. Patient controlled Analgesia • Breaks the pain cycle • Gives the control to the patient (often using less narcotic) • Avoids peaks and valleys • Decreases chance of errors • Decreases nursing workload

3. Mechanics of the various systems of PCA • RN programs pump according to Dr’s orders in dose increments( 2 nurse check) • Minimum interval between doses (lock out period) • Client initiates dose by pressing hand held button • IV is tkvo or at a regular rate • Usually morphine/ fentanyl/ demerol

4. Who is a candidate for PCA? • Must need parenteral meds • Must have a willingness to operate pump • Mentally alert and competent • Able to follow instructions

5. who Isn’t • Patients with chronic pulmonary disease (predisposition to respiratory depression) • History of drug abuse • Major psychiatric disorders • Children (some) • Some elderly etc

6. RPN Role: Assessment Documentation (pca assessment and sedation score) Reporting tolerance & changes, + & - RN role: Program pump Ongoing assessment Documentation Maintenance of medication syringes in the pump roles

7. Assessment • Baseline vital signs • Ongoing comparison to baseline • Allergies • Assess pain and sedation level • Volume delivered and attempts made

8. Teaching • Usually done pre-op so the patient understands how it works • Should provide both written and verbal instructions (how to notify staff if inadequate control, change in pain intensity, machine malfunction, alarms

9. Pain Team • Usually comprised of and RN/Nurse Practitioner with Pain Management training • MD- usually an Anesthetist

10. Neuro assessments -CVA To assess state of neurological impairment & pick up subtle changes • PupillaryResponse : • Mentation: • Motor Function: Expressive or Receptive • Vital Signs *refer to handouts- Canadian Neurological Stroke Scale and Neurological Observation Record

11. Pupillary response • Size • Shape • Reaction to light • Ability to move together • Equal bilaterally?

12. Mentation • LOCalert/drowsy • Orientationoriented/disoriented • Speechnormal receptive deficit- unable to understand written or spoken words expressive deficit – understands but unable to write or speak effectively

13. Motor Function-Expressive • Face -smile • Arm -proximal • Arm -distal • Leg -proximal • Leg -distal

14. Motor Function-Receptive • Face mimic grin or watch expression with pressure to sternum • Arms place arms outstretched @ 90 • Legs place thighs toward body

15. Vital Signs • Assess resp. watch for cheyne-stokes, rate and rhythm • Watch for widening pulse pressure(difference between systolic and diastolic pressure) • Can signifiy increased Intrcranial Pressure or ICP

16. Glasgow Coma Scale • Assess depth and duration of coma & impaired consciousness • Used for acute brain injury D/T: -traumatic injury -vascular injury -infections -metabolic disorders(hypoglycemia, renal failure, ketoacidosis, hepatic failure)

17. Glasgow coma scale

18. Head Injury Classification (GCS) COMA: No eye opening, No ability to follow commands,No word verbalizations • Death less than 3 • Severe H I 3 to 8 • Moderate H I 9 to 12 • Mild H I 13 to 15 • Normal 15

19. Learning activities • Complete Neurological Stroke Scale on your partner and switch • Complete Glasgow Coma Scale on your partner and switch