Patient-Controlled Analgesia
Patient-controlled analgesia (PCA) is a drug delivery system providing IV analgesia, usually morphine, when the patient presses a call bell at the end of a cord. Analgesia is provided at the level and time needed by the patient. The device prevents the patient from accidentally overdosing by imposing a lockout time between doses, usually 6 to 10 minutes. During this interval, the patient won’t receive any analgesic, even if he pushes the button.
PCA offers several advantages. It eliminates the need for IM analgesics, provides pain relief tailored to each patient’s size and pain tolerance, gives the patient a sense of control over pain, and
allows the patient to sleep at night with minimal daytime drowsiness. It also improves postoperative deep breathing, coughing, and ambulation and reduces opioid use compared with patients who don’t receive PCA.
allows the patient to sleep at night with minimal daytime drowsiness. It also improves postoperative deep breathing, coughing, and ambulation and reduces opioid use compared with patients who don’t receive PCA.
Learning About Isometric Exercises
Patients can strengthen and increase muscle tone by contracting muscles against resistance (from other muscles or from a stationary object, such as a bed or a wall) without joint movement. These exercises require only a comfortable position—standing, sitting, or lying down—and proper body alignment. For each exercise, instruct the patient to hold each contraction for 2 to 5 seconds and to repeat it three to four times daily, below peak contraction level for the first week and at peak level thereafter.
Neck Rotators
The patient places the heel of his hand above one ear. Then he pushes his head toward the hand as forcefully as possible, without moving the head, neck, or arm. He repeats the exercise on the other side.
Neck Flexors
The patient places both palms on his forehead. Without moving his neck, he pushes his head forward while resisting with his palms.
Neck Extensors
The patient clasps his fingers behind his head, then pushes his head against his clasped hands without moving his neck.
Shoulder Elevators
Holding his right arm straight down at his side, the patient grasps his right wrist with his left hand. He then tries to shrug his right shoulder, but prevents it from moving by holding his arm in place. He repeats this exercise, alternating arms.
Shoulder, Chest, and Scapular Musculature
The patient places his right fist in his left palm and raises both arms to shoulder height. He pushes his fist into his palm as forcefully as possible without moving either arm. Then, with his arms in the same position, he clasps his fingers and tries to pull his hands apart. He repeats the pattern, beginning with the left fist in the right palm.
Elbow Flexors and Extensors
With his right elbow bent 90 degrees and his right palm facing upward, the patient places his left fist against his right palm. He tries to bend his right elbow further while resisting with the left fist. He repeats the pattern, bending his left elbow.
Abdomen
The patient assumes a sitting position and bends slightly forward, with his hands in front of the middle of his thighs. He tries to bend forward further, resisting by pressing his palms against his thighs.
Alternatively, in the supine position, he clasps his hands behind his head. Then he raises his shoulders about 1” (2.5 cm), holding this position for a few seconds.
Back Extensors
In a sitting position, the patient bends forward and places his hands under his buttocks. He tries to stand up, resisting with both hands.
Hip Abductors
While standing, the patient squeezes his inner thighs together as tightly as possible. Placing a pillow between his knees supplies resistance and increases the effectiveness of this exercise.
Hip Extensors
The patient squeezes his buttocks together as tightly as possible.
Knee Extensors
The patient straightens his knee fully. Then he vigorously tightens the muscle above the knee so that it moves his kneecap upward. He repeats this exercise, alternating legs.
Ankle Flexors and Extensors
The patient pulls his toes upward, holding briefly. Then he pushes them down as far as possible, again holding briefly.
PCA is typically given to patients postoperatively as well as to terminal cancer patients and others with chronic diseases. To receive PCA therapy, a patient must be mentally alert, able to understand and comply with instructions and procedures, and have no history of allergy to the analgesic. PCA therapy is contraindicated in patients with limited respiratory reserve, a history of drug abuse or chronic sedative or tranquilizer use, or a psychiatric disorder.1
Equipment
PCA system and system-specific tubing ▪ syringe with prescribed medication ▪ alcohol pads ▪ compatible IV solution ▪ gloves ▪ tape ▪ naloxone ▪ oxygen administration setup and equipment.
Preparation of Equipment
Several types of PCA systems are available, so follow the manufacturer’s instructions for setting up the device. Obtain the medication and verify the medication order.2 Gather equipment and bring it to the patient’s bedside. Plug the PCA device into an electrical outlet; if the device is battery-operated, make sure that the battery is fully charged and working.
Implementation
