12.04 Opioid Analgesics

Study Tools

Overview

  1. Opioids are given for moderate to severe pain
    1. They will not provide the same relief as an epidural
  2. They are typically given IV in labor and fast-acting
  3. Given PO in the postpartum period to treat pain

Nursing Points

General

  1. Ideal to be given when needed for breakthrough/acute pain during labor, not chronically throughout pregnancy
    1. Newborn can be born addicted→ refer to addicted newborn lesson
  2. History taking is essential before administration to make sure they haven’t been taking them during pregnancy
  3. Some meds are contraindicated if someone is already dependent on specific meds, as they may elicit withdrawal symptoms for both baby and mom

Assessment

  1. Patient history
  2. Pain level
  3. How close is the patient to delivery

Therapeutic Management

  1. Medicate properly
    1. Hydromorphone (Dilaudid)
    2. Morphine
    3. Butorphanol tartrate (Stadol)
    4. Nalbuphine (Nubain)
    5. Oxycodone
    6. Hydrocodone
  2. Naloxone available
  3. Anti nausea medications
    1. Nausea is a side effect of Opioids
  4. Monitor for overdose
    1. Respirations less than 12/min is a concern
    2. Hypotension

Nursing Concepts

  1. Pharmacology
  2. Comfort
  3. Safety

Patient Education

  1. Fast acting
  2. Treatment options

Reference Links

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Video Transcript

In this lesson I will help you understand the various opioids that are used as analgesics and when you will use them.

Alright opioids are used to treat pain that occurs. So they are given for moderate to severe pain. In labor they are usually given IV so that they act fast. They aren’t going to provide the same numbing effect as an epidural would. During the postpartum period period they are used to treat pain and usually given PO. So for cramping, incisional pain, or episiotomy pain.

The patient will need assessment for her history. We need to know if she has been taking opioids throughout the pregnancy or has a history of opioid use or abuse in her history. We want to know this so we don’t give opioids fi she has a history of use and abuse or if she currently takes them we need to know for the newborn care since they can be born addicted. You can refer to the lesson on the addicted newborn for more on that. The patient’s pain level should also be assessed so we can medicate her properly and we need to know how close she is to delivery if she is a laboring patient. If she is close to delivery and we give a narcotic it can cause respiratory depression in the newborn which we don’t want. Let’s review medications that are given.

We need to manage our patient with proper medications. So during labor medications like Hydromorphone, Morphine, Butorphanol tartrate or stadol, Nalbuphine or nubain are options to give. In the postpartum time frame the most widely used opioid medications are Oxycodone and Hydrocodone. And with these opioids we want to have naloxone or narcan available to reverse any overdose effects and have for delivery of the newborn if delivery happens too soon after opioids are given.

Additional management besides the opioid analgesia and Naloxone being available will be anti nausea medications because this is a side effect of Opioids and we want to monitor for overdose. So a patient that has respirations less than 12 a minute is a concern and hypotension are things we will watch for. We will educate the patient on the medication options and that they are fast acting.

Pharmacology and safety are our concepts because we are talking about medication and the safety of the patient is important when giving opioids.

Ok so what is important? Opioids are used as analgesics during labor and in the postpartum period. They are fast acting but will not take away pain during labor the same as an epidural. Naloxone should be available to reverse any overdosage and available at delivery for the newborn to reverse respiratory depression.

Make sure you check out the resources attached to this lesson and review the key points. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 10

A postpartum patient who had a vaginal delivery 24 hours ago is complaining of perineal pain. The nurse administers oxycodone with acetaminophen (Percocet) for pain control. An hour later, the patient still has pain rated at a “5” on a 0-10 scale. Which of the following medications could the nurse safely give to this client at this time that would not interact with the Percocet?

  • Question 2 of 10

A postpartum client that delivered by c-section is discharged with a prescription for a 4-day supply of oxycodone. What is the best education to give this client?

  • Question 3 of 10

A client has overdosed on an unknown amount of a medication. The nurse knows that if the client responds to naxolone they have likely overdosed on which of the following?

  • Question 4 of 10

A postpartum patient has been prescribed nalbuphine (Nubain) to take in the first 24 hours after delivery. Which best describes the purpose of this medication?

  • Question 5 of 10

A client is 41 weeks pregnant and in labor. The client is unable to lay down on the stretcher due to such immense pain. Which of the following medication does the nurse anticipate to be ordered for this client?

  • Question 6 of 10

A postpartum client receives a dose of ibuprofen for 8 out of 10 pain following her vaginal delivery and an hour later rates her pain a “7” out of 10? What next intervention would you expect for this client?

  • Question 7 of 10

A client has overdosed on heroin. Which of the following medications would the nurse anticipate to be ordered?

  • Question 8 of 10

A pregnant client regularly takes opioids for chronic pain control. The nurse knows that which of the following are true? Select all that apply.

  • Question 9 of 10

A pregnant client in labor receives a dose of IV push butorphanol tartrate and suddenly feels rectal pressure. What is your priority?

  • Question 10 of 10

A c-section client from 2 hours ago receives IV morphine for pain and is drowsy. The nurse assesses the client’s vitals and respirations are 8 per minute. What is the priority nursing intervention?

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