In all age groups, there
is great variability in the doses of opioids needed to produce pain relief,
even among patients with identical surgical procedures. This variability highlights
the need for analgesic orders to include:
provisions for supplementary
doses,
use of intravenous
boluses and infusions to provide rapid relief of severe pain, and
the need for careful
patient monitoring.
Elderly patients
and those with central nervous system disease should be observed carefully
during dose titration to minimize adverse effects.
Assess the source, quality,
and severity of the patient’s pain and keep in mind that pain is a subjective
experience. A patient’s report of pain should be believed.
Use non-opioid analgesics
when possible.
Giving an opioid along
with a non-opioid may increase analgesic effects and allow a lower dose of
opioid to be given.
Monitor the patient’s
vital signs and mental status regularly. Report if the pulse is below 50 beats
per minute in adults or 110 beats per minute in infants.
Monitor for decreased
respirations.
Opioids may decrease
the patient’s cough reflex. Therefore, it is important to have the patient
turn, cough, and deep breath regularly to prevent atelectasis.
Give the opioid drug
at least 30-60 minutes prior to activities or painful procedures.
Monitor the patient closely
when an opioid is given as sedation for a painful procedure.
Opioids may also cause
urinary retention. Monitor the patient’s intake and output, palpate the
suprapubic area of the abdomen for bladder distention, ask the patient about
any voiding problems, pain in the bladder area, a sensation of not completely
emptying the bladder, or any unusual odors in the urine.
If the patient is confined
to bed, use side rails and safety measures to prevent a fall when receiving
opioids. Provide assistance with ambulation and transfers.
Instant
Feedback:
Patients
generally respond in a similar way to the same doses of opioids.
Nurses can help patients achieve
the benefits of opioids, while reducing adverse effects by ensuring that patients
follow these guidelines:
Take pain medications
before pain becomes too severe.
Avoid alcohol in any
form.
Don’t take over-the-counter
medications without approval. Many contain small amounts of alcohol and some
may interact unfavorably with the prescribed drug.
Opioids can cause drowsiness
and dizziness; use caution when operating a motor vehicle or performing other
tasks that require mental alertness.
Rise slowly from a lying
to a sitting position and dangle before standing to minimize orthostatic effects.
Store all drugs in a
safe place, out of the reach of children and away from the bedside to prevent
accidental overdose.