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