Questions and Answers
What is referred pain?
Referred pain occurs when visceral nerve fibers synapse at a level in the spinal cord close to fibers that supply specific subcutaneous tissues in the body.
What therapeutic effects does codeine provide?
Analgesic and antitussive
What is the best response by the nurse to a patient worried about returning to work after surgery?
What action by the nurse is a priority if a patient receiving methadone has a respiratory rate of 10 breaths/min?
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What effect of codeine should the nurse discuss with a patient receiving it for pneumonia?
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What is the most important reason for the nurse to record baseline vital signs before administering IV morphine?
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What is a possible reason for a patient complaining of increased pain after the placement of a new transdermal opioid patch?
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If a 15 mg dose of oxycodone is equivalent to a 10 mg dose of parenteral morphine, the equivalent intravenous dose of morphine is _____ mg.
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Which action of naloxone causes reversal of respiratory depression?
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What principle explains how massage therapy helps with pain?
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What are the adverse effects of Chrysanthemum parthenium?
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Which medicine may be part of the treatment plan to prevent complications from acetaminophen toxicity?
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Why should a patient prescribed sufentanil increase fluid intake?
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What is the nurse's best action if a patient continues to complain of severe pain after receiving morphine?
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What is the best response by the nurse to a patient afraid of epidural analgesia because of paralysis?
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Which medication should the nurse administer for a patient with respiratory depression due to morphine sulfate?
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What is the priority action for a patient with a respiratory rate of 6 breaths/min in the PACU?
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Which assessment is essential for monitoring a patient receiving opioid analgesics?
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What should the nurse do if a patient receiving fentanyl has a respiratory rate of 6 breaths/min?
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What type of pain is associated with gallstones?
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Which medication will assist a patient recovering from narcotic addiction?
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What pain inference can be made about a patient with cholecystitis who reports back and scapular pain?
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What is the equivalent dose of IV fentanyl for 24 hours if a patient is receiving 20 mg of hydrocodone orally every 4 hours?
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Study Notes
Acetaminophen Concerns
- Regular use of acetaminophen can lead to hepatotoxicity, indicated by elevated serum bilirubin levels (normal < 1.2 mg/dL).
- A serum bilirubin of 3.2 mg/dL signals the need for therapy change.
Oxycodone Extended Release (ER) Teaching
- Instruct patients to swallow oxycodone ER whole; do not crush or dissolve to prevent rapid absorption and possible toxicity.
- Increased patient dose without consulting a healthcare provider can lead to overdose.
Naltrexone Hydrochloride Contraindications
- Naltrexone is contraindicated in patients with hepatitis or liver dysfunction due to potential severe complications.
Morphine Sulfate Cautions
- Use morphine cautiously in asthma patients as it can trigger bronchoconstriction through histamine release.
- Conditions like cancer and anorexia can alter morphine's pharmacokinetics due to protein binding issues.
Indicators of Morphine Sulfate Effects
- Drowsiness is a primary adverse effect of morphine sulfate, while it does not cause insomnia or hyperactive bowel sounds.
- Monitoring for nausea and vomiting as these can occur from irritation of the gastrointestinal tract.
Equianalgesic Dosing
- Morphine is the standard for equianalgesia; doses of other opioids must be converted to morphine equivalent dosages for effective pain relief.
Acetaminophen Overdose Effects
- Symptoms of overdose include nausea, vomiting, and elevated liver enzymes. It does not affect vision or hearing.
Opioid Antagonist for Overdose
- Naloxone is administered to reverse adverse effects from opioid analgesics, not to be confused with acetylcysteine, which treats acetaminophen overdose.
Primary Indication for Morphine
- Morphine's primary use is for moderate to severe pain relief and can also ease anxiety during acute myocardial infarction.
Signs of Morphine Overdose
- Pinpoint pupils are indicative of a potential morphine overdose; does not relate to blood in urine or increased heart rate.
Phenothiazine in Combination Therapy
- Phenothiazines are prescribed alongside fentanyl to manage nausea, not to address respiratory depression or gastrointestinal side effects.
Safe Use of Morphine
- Morphine is appropriate for patients in severe pain (e.g., cancer) with stable vital signs; caution is needed in patients with renal impairment or respiratory issues.
Types of Pain
- Superficial pain originates from the skin and mucous membranes, while visceral pain comes from internal organs.
Pain Management Strategies
- Administering analgesics around the clock ensures better pain control compared to as-needed administration.
Opioid Agonists-Antagonists
- Nalbuphine, butorphanol, and buprenorphine display mixed effects as agonists and antagonists, while fentanyl and tapentadol are full agonists.
Acetylcysteine Administration
- Acetylcysteine is essential following an acetaminophen overdose and should be started within 12 hours of ingestion.
Fentanyl Transdermal Patch
- Fentanyl patches are suitable for patients with persistent severe pain due to cancer, not for acute or mild pain.
Naltrexone and Substance Use History
- Naltrexone's effectiveness depends on patient history of alcohol and previous opioid use, as it helps maintain an opioid-free state.
Assessing Codeine Effectiveness
- Assess the effectiveness of codeine for cough suppression within half an hour due to its fast onset of action.
Fentanyl Patch and Pain Management
- Consult a healthcare provider if pain persists after applying a fentanyl patch, as it takes several hours to reach effective levels.
Codeine for Non-Pain Indications
- Codeine is utilized for its antitussive effects, not for direct pain relief or immune support.
Addressing Patient Anxiety
- Active listening and acknowledging patient concerns about returning to work enhance therapeutic communication and address anxiety-related pain.
Respiratory Depression Monitoring
- A respiratory rate of 10 breaths/min following methadone administration warrants immediate assessment and potential intervention for opioid-related respiratory depression.### Patient Assessment and Medication Administration
- Assess patients with less than normal respiratory rates immediately; unresponsive patients require administration of an opioid antagonist like naloxone without delay.
- It is critical to reassess abnormal findings without unnecessary delay.
Codeine Use in Pneumonia
- Codeine serves both analgesic and antitussive purposes, making it suitable for pneumonia patients.
- It does not act as an expectorant, immunostimulant, or immunosuppressant.
Morphine Administration
- Baseline vital signs are crucial before administering intravenous morphine to prevent respiratory depression.
- Morphine may cause rapid respiratory depression, especially in postoperative patients due to residual anesthesia effects.
Transdermal Opioid Patch Considerations
- Hair on the application site can hinder drug absorption from a transdermal patch, reducing effectiveness.
- Precautions include applying the patch to a clean, nonhairy area and not overlapping with the previous patch location.
Opioid Conversion Calculations
- 80 mg of oral oxycodone is equivalent to approximately 107 mg of intravenous morphine, using equianalgesic dose conversions.
Naloxone's Mechanism
- Naloxone binds to opioid receptors, displacing agonists without activating them, effectively reversing respiratory depression caused by opioids.
Massage Therapy for Pain Relief
- Massage activates large sensory nerve fibers that block pain stimuli by closing the spinal gate, as per the gate control theory of pain.
Adverse Effects of Feverfew
- Chrysanthemum parthenium (feverfew) can cause nausea, joint pain, and muscle stiffness but not skin rashes or blurred vision.
Preventing Acetaminophen Toxicity
- Acetylcysteine is critical in preventing hepatotoxicity from high doses of acetaminophen, helping to protect liver function.
Managing Opioid-Induced Constipation
- Increased fluid intake is recommended for patients on sufentanil to help prevent constipation caused by opioid therapy.
Pain Management and Medication Adjustment
- In cases of persistent severe pain despite recent opioid administration, consulting a primary care provider for further pain management options is essential.
Addressing Epidural Concerns
- Educating patients about the absence of a needle in epidural analgesia can alleviate fears and encourage cooperation in care practices.
Respiratory Depression in Postoperative Care
- For respiratory rates falling to 8 breaths/min, naloxone should be administered as it counters the effects of opioids like morphine.
Monitoring Respiratory Rate
- Continuous monitoring of respiratory rate is crucial for patients on opioids due to the risk of serious respiratory depression.
Responding to Fentanyl Effects
- Administering naltrexone hydrochloride is appropriate for reversing respiratory depression caused by fentanyl.
Understanding Visceral Pain
- Gallbladder pain is classified as visceral pain due to its origin in internal organs and smooth muscles.
Methadone for Narcotic Addiction Recovery
- Methadone effectively helps patients manage withdrawal symptoms and cravings associated with narcotic addiction.
Recognizing Referred Pain
- In cholecystitis patients, back and scapular pain is identified as referred pain due to misinterpretation of nerve signals.
Responding to Opioid Toxicity
- Immediate administration of naloxone is necessary for patients exhibiting respiratory depression from opioid overdose.
Identifying Adverse Effects of Morphine
- Hallucinations, slow pupil reaction, and altered consciousness indicate severe adverse effects of morphine sulfate and require prompt attention.
Managing Opioid-Induced Constipation
- Lactulose is an effective treatment for constipation resulting from opioid therapy.
Mitigating GI Side Effects of Opioids
- Patients should increase dietary fluid and fiber intake to prevent constipation related to opioid analgesic use.### Nursing Priorities in Opioid Management
- Assessing blood gases is crucial when a patient exhibits respiratory depression due to opioid use.
- Reassessing the patient in an hour is inappropriate if immediate assessment findings indicate an abnormality.
- Administer a narcotic antagonist, such as naloxone, if the patient is unresponsive due to opioid overdose.
- Prioritize assessing the patient’s neurologic status to identify changes caused by opioid effects.
Methadone and Opioid Adverse Effects
- Methadone hydrochloride is an opioid analgesic primarily used for pain management.
- Respiratory depression is a significant adverse effect associated with opioid administration.
- A respiratory rate below normal should prompt immediate further assessment.
Naltrexone Hydrochloride Contraindications
- Naltrexone hydrochloride is contraindicated in patients with hepatitis or liver dysfunction due to potential severe complications.
- This medication is metabolized in the liver, making it hazardous for patients with liver issues.
- It is safe to administer naltrexone in patients with anemia, asthma, or diabetes, as it does not affect hemoglobin levels or respiratory and blood sugar functions.
Overdose Indicators for Morphine Sulfate
- Key indicator of morphine sulfate overdose is pinpoint pupils, a common reaction to opioid toxicity.
- In the case of overdose, the presence of blood in urine, a heart rate of 110 beats/min, or a respiratory rate of 28 breaths/min are not typically associated with morphine toxicity.
- Continuous monitoring of pupillary reaction is important after morphine sulfate administration to detect overdose early.
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Description
This quiz focuses on analgesic drugs as discussed in Pharmacology Chapter 10. It includes flashcard questions about patient assessments and potential therapy adjustments relevant to acetaminophen use. Test your knowledge on safe medication practices and drug effects in patients.
