Pain is an experience characterized by unpleasant
feelings, usually associated with trauma or disease.
Pain may be classified as either
Acute or Chronic
-Acute pain is an intense pain occurring over a brief period of
time usually from injury to recovery.
-Chronic pain persists over a longer time
Pain can also be classified
according to its source.
Nociceptive pain is produced by tissue injury
Neuropathic pain results from injury to the nerves
Nonpharmacologic techniques
Acupuncture -Meditation or payer
Massage -Hypnosis
Heat or cold packs
Relaxation therapy
Radiation therapy
-Radiation therapy may provide pain relief by shrinking solid
tumors that may be pressing on nerves.
-Surgery may be used to remove pain
-Injection of alcohol or other neuronal tissue is occasionally
performed to produce nerve blocks.
Analgesics are medications used
to relieve pain.
-Opioids is a natural or
synthetic morphine-like
substance responsible for
reducing moderate to
severe pain.
-Opiods are narcotic
substances, meaning that
they produce numbness or
stupor-like symptoms
Physical Dependence
All of the narcotic
analgesics have the
potential to cause
physical dependence
(addiction).
Morphine Sulfate-MS Contin
Morphine is an opiate
which binds to the opiate
receptors in the brain and
brings on feelings of
euphoria and relaxation. It
basically distracts both the
mind and the body from any
pain that may be felt, both
real and imaginary
MS Contin
Controlled-Release Tablets 15 mg 30 mg 60 mg 100
mg* 200 mg*
*100 mg and 200 mg are for use in opioid-tolerant
patients only
Its given
PO
Rect
IM, subcut
IV
Side effects
Confusion Constipation
Dizziness Nausea
Floating feeling Vomiting
Hallucinations
Unusual dreams
Blurred vision
Respiratory depressions
Nursing assessment
Assess type, location and intensity of pain
Asses the level of consciousness, blood
pressure, pulse, and respiration before and
periodically during administration.
Asses bowel functions routinely
Geriatrics, Pediatrics, Pregnancy
Asses both frequently they are sensitive to the effects
of opioid analgesics and may experience respiratory
complications, excitability and restlessness
The drug is classified as a pregnancy Category C
medication. This means that the drug may not be safe
for use during pregnancy, but may still be prescribed
in some situations.
Codeine (koe-deen)
INDICATIONS:
• management of mild to moderate pain.
• suppress hyperactive or nonproductive cough
ACTION:
• binds to opiate receptors in the CNS.
• alters perception of and response to painful stimuli while
producing generalized CNS depression.
• antitussive effects are mediated through direct action on
receptors in the cough center of the medulla.
• Decreases cough reflex. Decreases GI motility
Codein (cont.)
Therapeutic Effects:
• decreased severity of pain
• suppression of the cough reflex
• relief of diarrhea
Safe Doses:
Analgesic
• Adults: PO/IM/SC 15-60 mg QID
• Child: PO/IM/SC 0.5-1 mg/kg q4-
6hr prn
(max 60mg/dose)
Codein (cont.)
Side Effects:
• confusion • constipation
• dizziness • nausea
• drowsiness • vomiting
• hypotension • pruritus
Assessment:
• assess blood pressure, pulse, and respirations before and
periodically during administration
• assess type, location, and intensity of pain before and duration
of analgesia
• evaluate effectives as cough suppresant (cough and lung sounds)
Codein (cont.)
Drug Dependence
considered to have a strong potential for abuse
or addiction but that have legitimate medical use
Interaction with other CNS Depressants
Patients receiving other narcotic analgesics,
or other CNS depressants (including alcohol)
concomitantly with codeine may exhibit an additive CNS depression..
Usage in Pregnancy
codeine should not be used in pregnant women, the potential benefits outweigh the possible
hazards.
Pediatric Use
safe dosage of this drug has not been established in children below the age of three.
Caution is advised when using this drug in the elderly because they may be more sensitive
to its effects, especially slow/shallow breathing, drowsiness, and difficulty urinating.
Hydromorphone hydrochloride (Dilaudid)
Pharmacologic class: Opioid
Therapeutic class: Analgesic
Pregnancy risk category: C
Schedule substance: 2
Opioid agonist with high effectiveness.
Hydromorphone hydrochloride (Dilaudid) (cont.)
It is used to control moderate to severe pain and
suppress cough.
Binds with opiate receptors in CNS, subdues cough
reflex and decreases GI motility.
Pain: Adults; 2 to 4 mg PO every 4 to 6 hours PRN
or 1 to 2 mg IM, subcut, or IV (over at least 2 to 3
minutes) every 4 to 6 hours PRN.
Cough: Adults; 1 mg PO every 3 to 4 hours PRN.
Children ages six to twelve; 0.5 mg PO every 3 to 4
hours PRN.
Hydromorphone hydrochloride (Dilaudid) (cont.)
Side effects
CNS: confusion, sedation.
CV: hypotension.
GI: constipation.
Nursing Assessment: With I.V. use, monitor for
respiratory depression. Keep resuscitation equipment
nearby.
• Assess for signs and symptoms of physical or
psychological drug dependence.
• Monitor for constipation.
Naloxone – Narcan
(opoid-antagonist)
Indications
reversal of CNS depression and respiratory
depression because of suspected opoid overdose
Action
• blocks the effects of opoids, including CNS and
respiratory depression, without producing any agonist
effects.
Therapeutic Effects
• Reversal of signs of opoid excess
Naloxone (cont.)
Safe Dose (opiate Side Effects
overdose) • Hypertension
• Adult: IV 0.4-2mg, may • Hypotension
repeat q2-3mins up to • Nausea
10mg if necessary
• Vomiting
• Child: (5yr or older and
at least 20 kg) IV 2mg,
may repeat q2-3min if
needed
Naloxone (cont.)
Nursing Assessment
• monitor respiratory rate
and other vital signs
• assess patient for signs
and symptoms of opoid
withdrawal (vomiting,
restlessness, abdonimal
cramps, increased blood
pressure, and
temperature)
Naloxone (cont.)
Usage in Pregnancy
• codeine should not be used in pregnant women
• Naloxone crosses the placenta, and may precipitate withdrawal
in the fetus as well as in the mother. Patients with mild to
moderate hypertension who receive naloxone during labor
should be carefully monitored as severe hypertension may
occur.
Usage in Elderly
• dose selection for an elderly patient should be cautious,
usually starting at the low end of the dosing range, reflecting
the greater frequency of decreased hepatic, renal, or cardiac
function, and of concomitant disease or other drug therapy.
Nursing Diagnosis
NANDA
Opoid agonists:
(Morphine, Codiene, Hydromorphone)
• Acute Pain
• Disturbed Sensory perception
• Risk for injury
Opoid antagonist: Naloxone
• Ineffective breathing pattern
• Ineffective coping
• Acute Pain
Client teaching
Encourage patient to ask for medication before pain
becomes severe.
Advise patient to report difficulty breathing, nausea,
vomiting, or dizziness.
Caution patient to avoid driving or other activities
requiring alertness.
Tell patient to take oral form with food to avoid GI
upset.
AVOID alcohol and other CNS depressants while
during therapy.
References
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