A patient on a PCA reports shallow respirations. What is the priority action?

• A. Assess respiratory rate and sedation level; adjust analgesia or switch to alternative analgesia; notify the provider.
• B. Discontinue PCA immediately without assessment.
• C. Notify the provider and document.
• D. Increase analgesic dose and monitor.

Answer: (C)

Shallow respirations in a patient using a PCA signal possible opioid-induced respiratory depression, a potentially life-threatening situation that requires urgent medical management. The priority action is to notify the provider and document. Telling the physician about the change in respiratory status gets orders in place to address the problem—whether that means adjusting or stopping the PCA, giving reversal therapy if needed, or switching to a different analgesia method. Documentation is essential for tracking the patient’s condition, the symptoms observed, and the interventions taken, which supports safe and continuous care.

While assessing respiratory rate and sedation level is important, the immediate and most critical next step is to alert the provider so appropriate orders can be written and carried out. Increasing the analgesic dose would worsen respiratory depression and is not appropriate without orders. Discontinuing the PCA without assessment or without provider input could remove essential pain control and again isn’t the correct initial move.