The patient who receives morphine sulfate intravenously by patient-controlled analgesia (PCA) tells the nurse that the pain level is 8 on a scale of 0 to 10 . Which is the best intervention for the nurse?

Question

a. Check the volume of morphine in the PCA syringe.
b. Check the frequency of patient-controlled dosing.
c. Collaborate with the provider to increase basal rate.
d. Instruct the family to activate the pa-tient-controlled dose.

Answer 1

B
The PCA dose includes a basal rate to establish and maintain a therapeutic morphine serum level and a supplemental dose of morphine, the patient-controlled dose, for patient pain management. The nurse checks the frequency of patient self-dosing to gather additional information for a nursing assessment. If the patient is not supplementing the basal dose, the nurse instructs the pa-tient to use the patient-controlled dose by directing the patient to depress the PCA button for pain control. The nurse allows 30 minutes to 1 hour to evaluate the plan. If the patient is using the PCA properly, the patient may benefit from an increased basal rate. If the patient is depressing the PCA button, the syringe of morphine may be empty; however, the PCA has an alarm to indi-cate low volume, and the nurse monitors the volume for narcotic control and intake and output (I&O), so it is unlikely that an empty syringe will be the problem. Collaborating with the provider to increase the PCA dose is premature because the nurse has not completed an assessment or implemented nursing interventions that potentially resolve the patient's pain. The nurse avoids instructing the family to assist the patient because PCA is for patient use only, and families are unauthorized users of the patient's PCA.