The PCA's Role in Changing Patient Conditions

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The PCA's Role in Changing Patient Conditions

Changing Patient Conditions: Your Role as a UAA

ABOUT DISCOVERN

Case Study 1

A 25-year-old female underwent surgical reconstruction of the right fractured femur. Currently, she is on PCA pump morphine post-op. She is drowsy and the food services notified the RN of her drowsiness and incoherence. CERT team was initiated and the ABG results are as follows:

Normal Ranges

7.26

(7.35-7.45)

PaO₂

(80-100)

PaCO₂

(35-45)

HCO₃

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 52 – High – Culprit of the change
HCO₃ – 25 – Normal

Results

Respiratory Acidosis

Discussion: In this case, respiratory depression is being caused by the side effects of Morphine. As a result, the body is no longer exhaling CO₂ at an acceptable rate, causing the CO₂ level to be high at 52. The CO₂ levels in the body are increasing and thereby altering the pH.

NOTE: If this process were to occur chronically, the body would eventually COMPENSATE by adjusting the HCO₃ levels.

Analysis

Case Study 2

ABG values of A 33-year-old male post-op day 3 are as follows:

Normal Ranges

7.32

(7.35-7.45)

PaCO₂

(35-45)

HCO₃

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 40 – Normal CO₂ tension
HCO₃ – 20 – Low – Culprit of the change

Results

Metabolic Acidosis

Discussion: This patient is in metabolic acidosis. In this case, a clinical picture would be necessary to further determine the cause. From his blood gas analysis, we can recognize that the changes in his pH are due to a metabolic component, rather than respiratory. The surgery can cause a pH imbalance due to dehydration, trauma to certain tissues, or kidney disease.

Analysis

Case Study 3

A 27-year-old male patient is admitted with complaints of shortness of breath, chest tightness, and tingling of fingers and mouth. No past medical history. ABG results are as follows:

Normal Ranges

7.49

(7.35-7.45)

PaO₂

(80-100)

PaCO₂

(35-45)

HCO₃

(22 – 26)

(-2 to +2)

pH – 7.49 – High – Alkalosis

Cause of change in pH

PaCO₂ – 25 – Low – Culprit of the change
HCO₃ – 22 – Normal
BE – +2 – Normal

Results

Respiratory Alkalosis

Discussion: Respiratory alkalosis is most commonly caused by hyperventilation. During hyperventilation, the patient is breathing too fast and releasing too much CO2. As a result, the PaCO2 level is low and the pH is high. Treatment for this patient would include slowing their breathing and treating the underlying reason for the hyperventilation.

Analysis

Case Study 4

A 58-year-old female admitted with complaints of profuse vomiting and abdominal distention in the last 24 hours. CT scan reveals a large mass causing bowel obstruction. ABG results are as shown below:

Normal Ranges

7.51

(7.35-7.45)

PaO₂

(80-100)

PaCO₂

(35-45)

HCO₃

(22 – 26)

(-2 to +2)

Analysis

pH – 7.51 – High – Alkalosis

Cause of change in pH

PaCO₂ – 42 – Normal
HCO₃ – 30 – High – Culprit of the change

Results

Metabolic Alkalosis

Discussion: Metabolic alkalosis in this patient is most likely related to bowel obstruction, which is causing vomiting and excessive fluid loss. The bicarbonate level is high as the blood is more concentrated from free fluid loss and the kidneys are unable to eliminate the excess hydrogen ions. As a result, more bicarbonate is produced.

FROM OUR TEAMS

The PCA's Role in Changing Patient Conditions

By LaToya C. Clower, MSN, RN, CVRN-BC

2 MIN READ

The ability of nursing staff to recognize changes in a patient's condition remains vital in the healthcare setting. From critical care to acute care, the primary role of the nurse for every patient is to treat the response to illness, observe and monitor the response to medical treatment, and maintain the ability to recognize and acknowledge any noticeable signs of deterioration. However, the Patient Care Assistant (PCA) plays a unique and vital role in information-sharing behaviors with the bedside nurse (Saiki et al., 2020).

As a patient's condition changes, the PCA has a dynamic role in the crucial observation of recognizing subtle changes. Knowing a patient's baseline is a great starting point. Specifically, this refers to recognizing any negative changes in the patient's baseline vital signs, behavior, mobility, or even mental status changes. Vitals signs including blood pressure, heart rate, temperature and respiratory rate all play a significant role when monitoring a patient for hemodynamic stability. Early detection of noticeable changes, and immediate reporting of those observations to the nurse, will ensure that the appropriate interventions are taken and often prevent further deterioration and potential fatality of patients (Saiki, et al. 2020).

As PCAs are empowered to report changes in a patient's condition to the nurse, utilizing closed-loop communication for abnormal observations remains key. The PCA must be prompt, direct and specific, avoiding any delays in communication. Overall, this will improve patient outcomes, enhance communication, and help to save the lives of many patients (Saiki et al., 2020).

Reference:

Saiki, M., Takemura, Y., Kunie, K. (2020). Nursing assistants' desired roles, perceptions of nurses' expectations and effect on team participation: A crosssectional study. Journal of Nursing Management. (p. 1-9).

FROM OUR TEAMS

Changing Patient Conditions: Your Role as a UAA

PRACTICE

De-Escalating Sepsis

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