The client who receives morphine sulfate IV by PCA tells the nurse the pain level is 8 out of 10. Which is the best intervention for the nurse?
1. Check volume of morphine in PCA syringe.
2. Check frequency of client-controlled dosing.
3. Collaborate with provider to increase basal rate.
4. Instruct family to activate client-controlled dose.
2
2. The PCA dose includes a basal rate to establish and maintain a therapeutic mor-phine serum level and a supplemental dose of morphine, the client-controlled dose, for client pain management. The nurse checks the frequency of client self-dosing to gather additional information for a nursing assessment. If the client is not supple-menting the basal dose, the nurse instructs the client to use the client-controlled dose by directing the client to depress the PCA button for pain control. The nurse allows 30 minutes to 1 hour to evaluate the plan. If the client is using the PCA properly, the client may benefit from an increased basal rate
1. If the client is depressing the PCA button, the syringe of morphine can be empty; however, the PCA has an alarm to indicate low volume and the nurse monitors the volume for narcotic control and for I&O, so it is unlikely an empty syringe will be the problem.
3. Collaborating with the provider to increase the PCA dose is premature because the nurse has not completed an assessment and has not implemented nursing interven-tions that potentially resolve the client's pain.
4. The nurse avoids instructing the family to assist the client because PCAs are for client use only, and families are unauthorized users of the client's PCA.
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