Question

The nurse is admitting a 68-year-old patient with a history of ovarian cancer to the medical unit. She had surgery 2 months ago and has had pain ever since the surgery. She reports that she has been taking oxycodone at home, but that the pain is “never gone”

After consideration of her history and her pain management specialist recommends patient-controlled analgesia (PCA); the PCA therapy is explained and an infusion is started with morphine as a basal infusion as well as interval self-dosing. The nurse selects the Pasero Opioid Induced Sedation Scale (POSS) to assess the patient for response to the new and additional opioid medication. Complete the table below by filling in the appropriate interventions that nurse would use for each observation for POSS.

S = Sleep, easy to arouse

1 = Awake and alert

2 = Slightly drowsy, easily aroused

3 = Frequently drowsy, arousable, drifts off to sleep during conversation

4 = Somnolent, minimal or no response to verbal and physical stimulation

Answer 1

Pasero Opiod induced Sedation Scale(POSS): This scale is a valid, reliable tool used to assess sedation while administering opiod medications to manage pain.

Pasero Opiod induced Sedation Scale(POSS)

POSS SCALE	INTERVENTIONS
S= Sleep, easy to arouse	Acceptable status of the patient; no acton is necessary;may increase opiod dose if needed for the patient.
1= Awake and alert	Acceptable status of the patient; no action is necessary; may increase opiod dose if needed for the patient.
2= Slightly drowsy, easily aroused	Acceptable status of the patient; no action is necessary; may increase opiod dose if needed for the patient.
3 = Frequently drowsy, arousable, drifts off to sleep during conversation	Unacceptable status of the patient ; Nurse should monitor the respiratory rate and sedation level closely until sedation level is stable at less than 3 and respiratory level is satisfactory.Nurse should notify the anesthetist or physician regarding patient condition so necessary action to decrease the doseage can be done.
4 = Somnolent, minimal or no response to vebal and physical stimulation	Unacceptable state of patient; stop the opioid and naloxone should be administered by notifying the phsician or anesthetist; continue to monitor the respiratory rate of the patient and sedation level. monitor the response of the patient until patient returns to level 3 and respiratory status is satisfactory.