The nurse prepares PCA for a postoperative client in the postanesthesia recovery unit (PACU). To rule out contraindications to therapy, which should the nurse assess before the client receives PCA? (Select all that apply.)
1. Consider client cognitive level.
2. Evaluate client communication.
3. Confirm two separate IV infusions.
4. Determine client physical ability.
5. Assess for history of constipation.
6. Verify client medication allergies.
1, 2, 4, 6
1. The nurse assesses the client's cognitive level to verify suitability of PCA for pain management. If the client cannot understand instructions, PCA will have little value to the client in managing pain.
2. The nurse evaluates communication to ensure client ability to relate pain levels effectively; if the client does not speak English or is cognitively impaired, the nurse establishes a method of nonverbal communication to determine pain level and effec-tiveness of therapy.
4. The nurse ensures the client's ability to depress the PCA button.
6. The nurse checks client allergies to medication before initiating PCA to prevent hypersensitivity reactions.
3. One IV infusion is sufficient for PCA if the infusion is continuous or only infuses the PCA. If PCA is infused through the same tubing as intermittent infusions, the nurse risks bolus administration of the opioid and, possibly, the local anesthetic agent; this increases the risk of respiratory depression.
5. Constipation does not contraindicate the use of PCA.
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