A patient with second-degree burns has been receiving hydromorphone through patient-controlled analgesia (PCA) for a week. The patient wakes up frequently during the night complaining of pain. What action by the nurse is most appropriate?
a. Administer a dose of morphine every 1 to 2 hours from the PCA machine while the patient is sleeping.
b. Consult with the health care provider about using a different treatment protocol to control the patient's pain.
c. Request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain.
d. Teach the patient to push the button every 10 minutes for an hour before going to sleep, even if the pain is minimal.
ANS: B
PCAs are best for controlling acute pain. This patient's history indicates chronic pain and a need for a pain management plan that will provide adequate analgesia while the patient is sleeping. Administering a dose of morphine when the patient already has severe pain will not address the problem. Teaching the patient to administer unneeded medication before going to sleep can result in oversedation and respiratory depression. It is illegal for the nurse to administer the morphine for a patient through PCA.
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