A client who had abdominal surgery is receiving patientcontrolled analgesia (PCA) intravenously to manage pain. The pump is programmed to deliver a basal dose and bolus doses that can be accessed by the client with a lock-out time frame of 10 minutes. The nurse assesses use of the pump during the last hour and identifies that the client attempted to self-administer the analgesic 10 times. Further assessment reveals that the client is still experiencing pain. What should the nurse do first?
- Monitor the client’s pain level for another hour.
- Determine the integrity of the intravenous delivery system.
- Reprogram the pump to deliver a bolus dose every 8 minutes.
- Arrange for the client to be evaluated by the health care provider.
The Correct Answer and Explanation is :
The correct answer is 2. Determine the integrity of the intravenous delivery system.
Explanation:
In this case, the client is experiencing pain despite attempting to self-administer analgesia multiple times. The first step in managing this situation is to assess whether there is an issue with the intravenous (IV) delivery system. This is crucial because if there is a problem with the pump, catheter, or the IV line (such as occlusion, kinking, or dislodgement), the medication may not be effectively reaching the client, causing inadequate pain control. The nurse should inspect the IV site for signs of complications (such as swelling, redness, or infiltration) and check the integrity of the IV system to ensure the medication is being delivered correctly. If the system is intact and functioning properly, the nurse can then consider other interventions.
Why not the other options?
- Monitor the client’s pain level for another hour: Although monitoring the client’s pain is important, simply waiting another hour would not address the root of the issue. The fact that the client is still in pain despite repeated attempts to administer the medication suggests that there might be an underlying issue with the delivery system, which needs to be ruled out immediately.
- Reprogram the pump to deliver a bolus dose every 8 minutes: Reprogramming the pump is not appropriate without first determining whether the medication is being delivered at all. Changing the settings might lead to overdose or other complications if the issue lies with the delivery system rather than the dosing intervals.
- Arrange for the client to be evaluated by the healthcare provider: While a healthcare provider may need to be involved later if pain persists, the immediate priority is to ensure that the pain management system is functioning properly. If the IV system is faulty, no amount of reprogramming or additional medication will help.
By checking the IV system’s integrity first, the nurse can identify any mechanical issues that may be preventing the client from receiving adequate analgesia, ensuring that appropriate interventions can follow.