Narcotic AnalgesicMedications
Narcotic Analgesics
Opioids
Actions–Analgesia
– Euphoria
– Sedation
Opioids
Primary Use–Moderate Pain
– Severe Pain
–Acute Pain
–Chronic Pain
– Breakthrough Pain
Opioids
Other Uses
– Pre-Op Sedation
–Adjunct Anesthesia
–Anti Anxiety
–Diarrhea
–Opiate Dependence
Opioids
Common Opioids
– Morphine sulfate– Codeine– meperidine HCl (Demerol)– hydromorphone (Dilaudid)– fentanyl (Duragesic)– oxycodone (OxyContin)
Opioids
Common Routes
– IV– IM– Subcutaneous– Oral– Transdermal– Epidural
Opioids
Adverse Reactions
Euphoria, dysphoria, confusion, sedation
Nausea, vomiting, constipation
Hypotension, bradycardia or tachycardia
Urinary hesitancy, dysuria
Respiratory depression, cough depression
Allergic reactions, pruritis Pain, irritation at injection site
Opioids
Contraindications
Opiate allergies
Head injuries, increased intracranial pressure
Convulsions
Ulcerative colitis
Pulmonary diseases (asthma, COPD)
Renal or hepatic dysfunction
Opioids
Not recommended during labor
Use caution with elderly
Not recommended for biliary surgery
Not recommended during lactation
Precautions
Opioids
Opioid Naive
Tolerance Addiction
Precautions
Opioids
Precautions
Opioids and Acetaminophen
Daily acetaminophen intake should NOT EXCEED 4 grams
Opioids
Interactions
CNS Depressants
Use caution whenever two or more CNS depressants given
Opioids
Special Circumstances
Opiates of Choice
CodeinePersistent Cough
MorphineMyocardial Infarct
MeperidineBiliary Surgery
Opioids
Opiate Poisoning
miosis
Respirations < 10 / min
hypoxia
Opioids
Opiate Antagonist
Opioids
Patient Controlled Analgesia (PCA)
Opioids
Epidural
Opioids
Transdermal
Narcotic AnalgesicsNursing Process
• Assessment
– Pain assessment– Precipitating factors– Nonpharmacological medications– Time last medicated– Response to last pain medication– Allergies– Bowel history
Narcotic AnalgesicsNursing Process
• Planning
– Adverse reactions– Expected pain relief– Route of administration
Narcotic AnalgesicsNursing Process
• Suggested Nursing Diagnoses
– Pain, acute– Pain, chronic– Constipation r/t adverse drug effects
Narcotic AnalgesicsNursing Process
• Implementation
– Identify patient– Observe 6 Rights
Narcotic AnalgesicsNursing Process
• Evaluation
– Response to medication– Evidence of adverse reactions– Evidence of tolerance, addiction
Narcotic AnalgesicsKey Points
• Side Effects– Lethargy, Confusion– Constipation
• Adverse Reactions– Respiratory Depression (Opiate Naïve)– Opiate Poisoning
• Combination Drugs– Be mindful of acetaminophen toxicity
Narcotic AnalgesicsKey Points
• Addiction– Not likely to happen when purpose of drug is to
relieve pain
• Tolerance– Likely to occur, especially with morphine
• PCA’s– PCA’s are PATIENT controlled, not nurse
controlled
Narcotic AnalgesicsKey Points
• Opioids are drugs of choice for SOME pains
• Not ALL pain should be managed with Opioids
• Review: Thumbs Up? Thumbs Down?
Narcotic AnalgesicsKey Points
• Pain associated with Myocardial Infarction– Morphine is the drug of choice
Narcotic AnalgesicsKey Points
• Pain associated with Ulcerative Colitis– Opioids should be avoided
Narcotic AnalgesicsKey Points
• Pain associated with Gall Bladder surgery– Avoid morphine– Meperidine is drug of choice
Narcotic AnalgesicsKey Points
• Pain associated with Labor– May prolong labor– May cause respiratory depression in the
newborn
Narcotic AnalgesicsKey Points
• Pain associated head injury– Opioids may increase intracranial pressure
(ICP)
Narcotic AnalgesicsKey Points
• Pain in patients with COPD– Opioids cause respiratory depression
Narcotic AnalgesicsKey Points
• Pain in patients with seizure disorders– Opioids may precipitate seizures
Anesthestic Medications
Anesthetic Medications
• Topical
– Application to body surface– Cream, lotion, spray, gel, etc.– May be given prior to an
injection
Anesthetic Medications
• Local Infiltration
– Injection of anesthetic into tissue– Example: Novacaine
Anesthetic Medications
• Regional Anesthesia
– Spinal
Subarachnoid space
– Conduction
Near a nerve
Anesthetic Medications
• Regional Anesthesia - Spinal
– Injected into subarachnoid space of spinal cord– Most commonly 2nd lumbar vertebra– Loss of feeling and movement• Lower abdomen
• Perineum
• Lower extremities
Anesthetic Medications
• Regional Anesthesia – Conduction Blocks
– Epidural block– Caudal block
– Brachial plexus block
Anesthetic Medications
• Preparing the patient for local or regional anesthetics– Positioning– Teaching– Emotional Support
Anesthetic Medications
• Providing care after local or regional anesthesia– Safety r/t lack of sensation– Loss of body functions– Hemorrhage– Infection
Anesthetic Medications
• Preanesthesia Medications
– Opioids to decrease anxiety / apprehension• Fentanyl (Sublimaze)
• Meperidine (Demerol)
• Morphine
Anesthetic Medications
• Preanesthesia Medications
– Barbiturates to decrease anxiety / apprehension• Pentobarbital (Nembutal)
• Secobarbital (Seconal)
Anesthetic Medications
• Preanesthesia Medications
– Benzodiazepines to decrease anxiety / apprehension• Chlordiazepoxide (Librium)
• Diazepam (Valium)
• Midazolam (Versed)
• Lorazepam (Ativan)
Anesthetic Medications
• Antiemetic Medications
– Decrease nausea / vomiting and side effect of drowsiness / antianxiety• Hydroxizine (Vistaril)
• Promethazine (Phenergan)
Anesthetic Medications
• Antiemetic Medications
– Cholinergic blocking agents to decrease respiratory secretions and mucous production• Atropine sulfate
• Robinul
• Scopolamine
Anesthetic Medications
• General Anesthesia
– Cause loss of consciousness– Except for very short procedures, patient must
be intubated– Profound analgesia
Anesthetic Medications
• Types of General Anesthesia
– Barbiturates• Methotrexital (Brevital)
• Propofol (Diprivan)
Anesthetic Medications
• Types of General Anesthesia
– Benzodiazepines• Midazolam (Versed)
Anesthetic Medications
• Types of General Anesthesia
– Ketamine (Ketalar)
• Street Drug
Special K
Anesthetic Medications
• Types of General Anesthesia
– Gases and Volatile Liquids• Nitrous oxide
Anesthetic Medications
• Types of General Anesthesia
– Opioids• Fentanyl (Sublimaze)
• Given as adjunct to other medications to produce reduced motor activity and profound analgesia
Anesthetic Medications
• Types of General Anesthesia
– Skeletal Muscle Relaxants• Deep abdominal or chest surgery
• Facilitate endotracheal insertion
• Succinylcholine (Anectine)
Anesthetic Medications
• 4 Stages of Anesthesia
– Stage 1 – Analgesia– Medication given to induce anesthesia– Lasts 5 – 10 seconds
Anesthetic Medications
• 4 Stages of Anesthesia
– Stage 2 – Delerium– Delerium– Keep room quiet
Anesthetic Medications
• 4 Stages of Anesthesia
– Stage 3 – Surgical Analgesia– Deep coma– Surgery takes place
Anesthetic Medications
• 4 Stages of Anesthesia
– Stage 4 – Respiratory Paralysis– ABNORMAL – Severe Complication– Respiratory and Cardiac Arrest
Anesthetic Medications
• Nursing Responsibilities
– Preanesthesia• Check Allergies
• Administer Pre-op medications observing 5 rights
• Provide safety after medications given
Anesthetic Medications
• Nursing Responsibilities
– Post Anesthesia: PACU• Check airway for patency
• Observe for hypoxia, especially if nitrous oxide administered
• Position patient to prevent aspiration
• Check patient every 5 – 10 minutes, suctioning as needed
Anesthetic Medications
• Nursing Responsibilities
– Post Anesthesia: PACU (cont.)• Exercise caution in administering opioids
• Record all medications given
Anesthetic Medications
• Nursing Responsibilities
– Post Anesthesia: Post-op• Continue to exercise caution with opioid medications
• Refrain from barbiturates and benzodiazepines during first 24 hours
• Administer supplemental oxygen as needed
Anesthesia MedicationsKey Points
• Anesthesia can be– Local– Regional– General
Anesthesia MedicationsKey Points
• Many different kinds of medications can induce anesthesia– Barbiturates (Nembutal, Seconal)– Benzodiazepines (Versed)– Ketamine– Nitrous oxide– Opioids (Inapsine)– Skeletal muscle relaxants (Anectine)
Anesthesia MedicationsKey Points
• Many different kinds of medications can induce anesthesia– Barbiturates (Nembutal, Seconal)– Benzodiazepines (Versed)– Ketamine– Nitrous oxide– Opioids (Inapsine)– Skeletal muscle relaxants (Anectine)
Anesthesia MedicationsKey Points
• Nursing Responsibilities are dependent upon type of anesthesia given, but always focus on– Airway (respiratory depression, aspiration)– Safety (confusion, lethargy)– Comfort (without reentering anesthesia state)
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