EXAM 3 Pain Management Opioid

Question 1

Opioid receptors are located where

Answer 1

Opioid receptors are located in the brain, brain stem and spinal cord

Question 2

Normally, when pain impulses are transmitted along sensory pathway, neurotransmitters are

Answer 2

are released to carry the pain impulse to the CNS

Question 3

When opioid receptors are occupied (by an opioid), then the neurotransmitters are

Answer 3

are not released = which creates a decreased pain interpretation.

Question 4

Opioid Agonist what do they do

Answer 4

1. occupying same opiate receptors as Endorphins (natural painkiller)
2. Prevents release of neurotransmitters
3. Elevates pain threshold (decreased pain interpretation)
4. Bind well to the receptor site-causes a response
5. Alters perception of pain, which causes a reduction in pain sensation

Question 5

Opioid Agonist Examples

Answer 5

Demerol and Fentanyl

Question 6

Opioid Agonist-antagonist are referred to

Answer 6

mixed agonist (has properties of both the agonist and antagonist)

Question 7

What Occupies opioid receptor sites while blocking transmission of pain sensation and Actually causes a weaker neurologic response than a full agonist.

Answer 7

Opioid Agonist-antagonist

Question 8

Examples of Opioid Agonist-antagonist

Answer 8

Stadol and Nubain

Question 9

What counteract the effects of opioid analgesics

Answer 9

Opioid Antagonists

Question 10

Antagonist compete with who and reverse what?

Answer 10

• Compete with opioids at receptor sites
• Reverse depressant effects of the opioid analgesics, not only will reverse side effects but will reverse pain control as well.

Question 11

Opioid Analgesics are______substances used to treat ___________.

Answer 11

1. controlled

2. moderate to severe pain

Question 12

Major adverse reaction of opioids

Answer 12

depressant effect on CNS, especially the respiratory system

Question 13

Opioids are_________ that must be regulated by the____________

Answer 13

• controlled substances

- FDA to prevent over-prescribing

Question 14

Controlled Substances are considered

Answer 14

Habit forming and addictive substances.

Can cause physical and psychological addiction.

Question 15

Opioid Analgesics

Answer 15

come from raw opium

Question 16

Examples of Opioid Analgesics

Answer 16

Morphine, Codeine, and drugs as a result of chemically altering Morphine.

Question 17

Action and Examples of Semi-synthetic and Synthetic Analgesics

Answer 17

Similar Action to Morphine, just not a morphine derivative.

Examples = Demerol, Fentanyl, Methadone

Question 18

Morphine Sulfate is a Prototype or

Answer 18

“model” opioid

Question 19

Opium Sulfate route of admission

Answer 19

PO, IV, IM, SC , PR and Transdermal

Question 20

Most common drag for PCS because it maintains even pain control is

Answer 20

Morphone Sulfate

Question 21

Side effects of Morphine Sulfate

Answer 21

Rash, Respiratory Depression, Bradycardia and Consitpation

Question 22

What is natures way of controlling pain

Answer 22

Opium Poppy/ Morphine Sulfate

Question 23

Uses of Opioids

Answer 23

1. Effective for moderately severe to severe pain
2. Relief of Severe cough (Codeine)
3. Pulmonary Edema (Morphine)
4. Obstetric Analgesia
5. Pre-operative to lessen anxiety and sedate

Question 24

Actions of Morphine on CNS

Answer 24

drowsiness, euphoria, sedation, mental clouding (degree depends on dose)

Question 25

Actions of Morphine on eye

Answer 25

Miosis = pupil constriction (pinpoint)

Question 26

Actions of Morphine on Respiratory

Answer 26

depression of rate and depth of respirations and aggravation of asthma

Question 27

Actions of Morphine on Cough reflex

Answer 27

suppress cough (especially Codeine)

Question 28

Actions of Morphine on GI Tract

Answer 28

Slow peristalsis in stomach, small and large intestine | Decrease in gastric, pancreatic and biliary secretions

Question 29

Actions of Morphine on Gallbladder

Answer 29

possible spasm (especially Morphine)

Question 30

Actions of Morphine on GU Tract

Answer 30

Spasms or contraction of bladder (urinary retention

Question 31

Actions of Morphine on Integumentary

Answer 31

itching and rash

Question 32

Opioid Adverse Reaction

Answer 32

Physical dependence Withdrawal symptoms. Opioid tolerance Due to legal and ethical obligation, we need to address the patient’s pain because it takes priority over concerns about drug addiction or physical dependence.

Question 33

Adverse Reactions symptoms of withdrawal early signs

Answer 33

Yawning, perspiring, tearing, nasal drainage

Question 34

Adverse Reactions symptoms of withdrawal later signs

Answer 34

``` Gooseflesh Abdominal cramps Bone and muscle pain (rebound pain) N,V,D Mydriasis (dilation of pupil) Intense craving for drug Agitation Elevated blood pressure, tachycardia Seizures ```

Question 35

Contraindications opioids

Answer 35

Known hypersensitivity Acute bronchial asthma or upper airway obstruction .

Question 36

Opioids use cautiously in individuals with

Answer 36

Head injury, morbid obesity, and sleep apnea.

Question 37

Opioid Precautions

Answer 37

1. Caution in the elderly can cause extreme confusion and hallucinations 2. Patients with undiagnosed abdominal pain 3. Liver disease

Question 38

Opioids cause increased CNS depressant when given with:

Answer 38

``` Alcohol Antihistamines Antidepressants Sedatives Phenothiazines ```

Question 39

Respiratory depression risk after

Answer 39

general anesthesia if medicated too soon

Question 40

Nursing Process - Opioids | Assessment

Answer 40

Health history, allergy history, current meds Type, location, intensity of pain Blood pressure, pulse, respiration Location and type of pain important If on Patient controlled analgesia (PCA) make sure patient understands how it works.

Question 41

Withhold med if Respiratory rate is

Answer 41

10/min or below, significant decrease in BP or increase in Pulse rate

Question 42

Nursing DX

Answer 42

Pain Risk for injury (elderly) Constipation (if there is)

Question 43

Nursing Process Planning (Goals)

Answer 43

``` Relief of pain Understanding use of PCA device Absence of injury Adequate nutrition intake Understanding of compliance of Rx regimen ```

Question 44

Interventions –Relieving Pain

Answer 44

Assess patient about 30 min after med Optimize pain relief period Good time for getting patient out of bed, ambulating, coughing, leg exercises

Question 45

Nursing Process Interventions | Relieving Chronic Severe Pain

Answer 45

Morphine = most widely used 30-60 mg orally q 4 hr (less resp depression with oral form) Fentanyl patch (72 hr patch) Brompton cocktail (mixture of oral narcotic and other meds In severe pain concern should be relieving pain not preventing addiction.

Question 46

Encourage to cough and deep breathe ______ (post op patients) to prevent_________

Answer 46

1. Every 2 hours | 2. Pooling of secretions, hypostatic pneumonia

Question 47

Monitor for resp rate of

Answer 47

10/min or below

Question 48

Oral route and patches have a slower or faster build up

Answer 48

slower buildup

Question 49

What can be used to reverse respritory depression

Answer 49

Narcan available to reverse resp depression

Question 50

Monitor for orthostatic hypotension, what are some nursing processes

Answer 50

1. Dizziness when rising or ambulating 2. Assist patient to ambulate 3. Have patient seek assistance when getting out of bed 4. Check for constipation = (stool softener, ambulation) 5. Watch for loss of appetite

Question 51

PCA machine Patient Education

Answer 51

Location of buttons Regulation of dose and time interval Assure machine will not deliver dose until correct time Pain relief should occur shortly after pushing button Inform nurse if pain not relieved after two doses

Question 52

Patient Teaching = home use

Answer 52

Drug may cause drowsiness, dizziness Caution with driving Avoid alcohol Take med as directed Explain how to put on patch

Question 53

Patient with Respiratory Depression Assess

Answer 53

Resp, Pulse, BP q 5-15 min

Question 54

Nursing Dx Patient with Respiratory Depression

Answer 54

Ineffective Airway Clearance r/t Overdose | Risk for Impaired gas exchange r/t decreased resp rate

Question 55

Plan Patient with Respiratory Depression

Answer 55

Respiratory rate, rhythm & depth | return to baseline (normal)

Question 56

Patient with Respiratory Depression Implementation

Answer 56

Cardiac monitor Suction equipment handy Keep patent airway Monitor VS Have Narcan available (antagonist) Monitor fluid intake and output

Question 57

Patient with Respiratory Depression Evaluation

Answer 57

Therapeutic effect is achieved Respiratory rate, rhythm & depth return to baseline (normal) Clear Airway is maintained