Opioid Analgesics
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Outline
Overview
- Opioids are given for moderate to severe pain
- They will not provide the same relief as an epidural
- They are typically given IV in labor and fast-acting
- Given PO in the postpartum period to treat pain
Nursing Points
General
- Ideal to be given when needed for breakthrough/acute pain during labor, not chronically throughout pregnancy
- Newborn can be born addicted→ refer to addicted newborn lesson
- History taking is essential before administration to make sure they haven’t been taking them during pregnancy
- Some meds are contraindicated if someone is already dependent on specific meds, as they may elicit withdrawal symptoms for both baby and mom
Assessment
- Patient history
- Pain level
- How close is the patient to delivery
Therapeutic Management
- Medicate properly
- Hydromorphone (Dilaudid)
- Morphine
- Butorphanol tartrate (Stadol)
- Nalbuphine (Nubain)
- Oxycodone
- Hydrocodone
- Naloxone available
- Anti nausea medications
- Nausea is a side effect of Opioids
- Monitor for overdose
- Respirations less than 12/min is a concern
- Hypotension
Nursing Concepts
- Pharmacology
- Comfort
- Safety
Patient Education
- Fast acting
- Treatment options
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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.
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Study Plan Lessons
Abdomen (Abdominal) Assessment
ABG (Arterial Blood Gas) Interpretation-The Basics
ABG (Arterial Blood Gas) Oxygenation
ABGs Nursing Normal Lab Values
ABGs Tic-Tac-Toe interpretation Method
Acetaminophen (Tylenol) Nursing Considerations
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Airborne Precaution Diseases Nursing Mnemonic (MTV)
Albuterol (Ventolin) Nursing Considerations
Alveoli & Atelectasis
Amoxicillin (Amoxil) Nursing Considerations
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Appendicitis
Appendicitis – Assessment Nursing Mnemonic (PAINS)
Appendicitis Case Study (Peds) (30 min)
Appendicitis for Certified Emergency Nursing (CEN)
Assessment of a Burn Nursing Mnemonic (SCALD)
Asthma
Asthma Concept Map
Asthma management Nursing Mnemonic (ASTHMA)
Attention Deficit Hyperactivity Disorder (ADHD)
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Blood Type O Nursing Mnemonic (Universally Odd)
Bronchiolitis and Respiratory Syncytial Virus (RSV)
Bronchodilators
Bupropion (Wellbutrin) Nursing Considerations
Burn Injuries
Burn Injury Case Study (60 min)
Burns for Certified Emergency Nursing (CEN)
Cardiac Glycosides
Care of the Pediatric Patient
Casting & Splinting
Cefaclor (Ceclor) Nursing Considerations
Celiac Disease
Cerebral Palsy (CP)
Cimetidine (Tagamet) Nursing Considerations
Ciprofloxacin (Cipro) Nursing Considerations
Cleft Lip and Palate
Cleft Lip Repair – Post Op Care Nursing Mnemonic (CLEFT LIP)
Clubfoot
Congenital Heart Defects (CHD)
Conjunctivitis
Constipation and Encopresis (Incontinence)
Corticosteroids
Coumarins
Cyanotic Defects Nursing Mnemonic (The 4 T’s)
Cystic Fibrosis (CF)
Day in the Life of a NICU Nurse
Day in the Life of a Peds (Pediatric) Nurse
Defects of Decreased Pulmonary Blood Flow
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Eczema
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Epiglottitis
Epiglottitis – Signs and Symptoms Nursing Mnemonic (AIR RAID)
Epispadias and Hypospadias
Famotidine (Pepcid) Nursing Considerations
Fever
Fever Case Study (Pediatric) (30 min)
Flu Symptoms Nursing Mnemonic (FACTS)
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Gas Exchange
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Heart Sounds Nursing Mnemonic (APE To Man – All People Enjoy Time Magazine)
Hematocrit (Hct) Lab Values
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Hemophilia
Hierarchy of O2 Delivery
Hydrocephalus
Hypoxia – Signs and Symptoms (in Pediatrics) Nursing Mnemonic (FINES)
Ibuprofen (Motrin) Nursing Considerations
Immunizations (Vaccinations)
Imperforate Anus
Impetigo
Indomethacin (Indocin) Nursing Considerations
Influenza – Flu
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Intussusception
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Iron Deficiency Anemia
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Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Meningitis for Certified Emergency Nursing (CEN)
Methylphenidate (Concerta) Nursing Considerations
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Nephrotic Syndrome Case Study (Peds) (45 min)
Neuro Assessment
NSAIDs
Nursing Care Plan (NCP) for Acute Bronchitis
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Nursing Care Plan (NCP) for Asthma
Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Nursing Care Plan (NCP) for Attention Deficit Hyperactivity Disorder (ADHD)
Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)
Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)
Nursing Care Plan (NCP) for Celiac Disease
Nursing Care Plan (NCP) for Cerebral Palsy (CP)
Nursing Care Plan (NCP) for Cleft Lip / Cleft Palate
Nursing Care Plan (NCP) for Clubfoot
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Constipation / Encopresis
Nursing Care Plan (NCP) for Cystic Fibrosis
Nursing Care Plan (NCP) for Decreased Cardiac Output
Nursing Care Plan (NCP) for Dehydration & Fever
Nursing Care Plan (NCP) for Eczema (Infantile or Childhood) / Atopic Dermatitis
Nursing Care Plan (NCP) for Enuresis / Bedwetting
Nursing Care Plan (NCP) for Epiglottitis
Nursing Care Plan (NCP) for Fluid Volume Deficit
Nursing Care Plan (NCP) for Hemophilia
Nursing Care Plan (NCP) for Hydrocephalus
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Nursing Care Plan (NCP) for Impetigo
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Nursing Care Plan for (NCP) Autism Spectrum Disorder
Nursing Case Study for Pediatric Asthma
Obstructive Heart (Cardiac) Defects
Ocular Infections (Conjunctivitis, Iritis) for Certified Emergency Nursing (CEN)
Omphalocele
Opioid Analgesics
Pancrelipase (Pancreaze) Nursing Considerations
Pediatric Bronchiolitis Labs
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pediatric Oncology Basics
Pediatrics Course Introduction
Pediculosis Capitis
Pertussis – Whooping Cough
Phenylketonuria
Phenytoin (Dilantin) Nursing Considerations
Platelets (PLT) Lab Values
Pneumonia
Promotion and Evaluation of Normal Elimination Nursing Mnemonic (POOPER SCOOP)
Pulmonary Function Test
Red Blood Cell (RBC) Lab Values
Respiratory Acidosis (interpretation and nursing interventions)
Reye’s Syndrome
Reyes Syndrome Case Study (Peds) (45 min)
Rheumatic Fever
ROME – ABG (Arterial Blood Gas) Interpretation
Rubeola – Measles
Salmeterol (Serevent) Nursing Considerations
Scoliosis
Selegiline (Eldepyrl) Nursing Considerations
Sickle Cell Anemia
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Steroids – Side Effects Nursing Mnemonic (6 S’s)
Stoma Care (Colostomy bag)
Strabismus
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Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
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Tonsillitis
Topical Medications
Tracheal Esophageal Fistula – Sign and Symptoms Nursing Mnemonic (The 3 C’s)
Transient Incontinence – Common Causes Nursing Mnemonic (P-DIAPERS)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Umbilical Hernia
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)
Varicella – Chickenpox
Varicella Case Study (Peds) (30 min)
Vitals (VS) and Assessment
Vomiting
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X-Ray (Xray)
05.03 Jaundice for CCRN Review
Abortion in Nursing: Spontaneous, Induced, and Missed
Abruptio Placenta for Certified Emergency Nursing (CEN)
Abruptio Placentae (Placental abruption)
Acyclovir (Zovirax) Nursing Considerations
Addicted Newborn
Adult Vital Signs (VS)
Alpha-fetoprotein (AFP) Lab Values
Ampicillin (Omnipen) Nursing Considerations
Anemia in Pregnancy
Antepartum Testing
Antepartum Testing Case Study (45 min)
Anti-Infective – Aminoglycosides
Anti-Infective – Lincosamide
Aspiration for Certified Emergency Nursing (CEN)
Babies by Term
Behind The Red Line – Live Tutoring Archive
Betamethasone and Dexamethasone
Betamethasone and Dexamethasone in Pregnancy
Bicarbonate (HCO3) Lab Values
Blood Cultures
Blood Glucose Monitoring
Blood Transfusions (Administration)
Body System Assessments
Breastfeeding
Butorphanol (Stadol) Nursing Considerations
Cardiac (Heart) Disease in Pregnancy
Causes of Chorioamnionitis Nursing Mnemonic (Pregnancies Are Very Interesting)
Causes of Labor Dystocia Nursing Mnemonic (Having Extremely Frustrating Labor)
Causes of Postpartum Hemorrhage Nursing Mnemonic (4 T’s)
Certified Nurse Midwife
Chorioamnionitis
Clindamycin (Cleocin) Nursing Considerations
Congestive Heart Failure (CHF) Labs
Day in the Life of a Labor Nurse
Day in the Life of a Postpartum Nurse
Dexamethasone (Decadron) Nursing Considerations
Direct Bilirubin (Conjugated) Lab Values
Discomforts of Pregnancy
Disseminated Intravascular Coagulation (DIC)
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Dystocia
Ectopic Pregnancy
Ectopic Pregnancy Case Study (30 min)
Ectopic Pregnancy for Certified Emergency Nursing (CEN)
Emergent Delivery (OB) (30 min)
Emergent Delivery for Certified Emergency Nursing (CEN)
Epidural
Episiotomy – Evaluation of Healing Nursing Mnemonic (REEDA)
Erythroblastosis Fetalis
Eye Prophylaxis for Newborn
Eye Prophylaxis for Newborn (Erythromycin)
Factors That Can Put a Pregnancy at Risk Nursing Mnemonic (RIBCAGE)
Family Planning & Contraception
Family Planning & Signs of Pregnancy – Live Tutoring Archive
Fertilization and Implantation
Fetal Alcohol Syndrome (FAS)
Fetal Circulation
Fetal Development
Fetal Distress Interventions Nursing Mnemonic (Stop MOAN)
Fetal Environment
Fetal Heart Monitoring (FHM)
Fetal Heart Monitoring Like A Pro – Live Tutoring Archive
Fetal Heart Monitoring Like A Pro 2 – Live Tutoring Archive
Fetal Wellbeing Assessment Tests Nursing Mnemonic (ALONE)
Fundal Height Assessment for Nurses
Furosemide (Lasix) Nursing Considerations
Gestation & Nägele’s Rule: Estimating Due Dates
Gestational Diabetes (GDM)
Gestational Diabetes and Why YOU Should Know About It – Live Tutoring Archive
Gestational HTN (Hypertension)
Glucagon Lab Values
Glucose Tolerance Test (GTT) Lab Values
Gravidity and Parity (G&Ps, GTPAL)
HELLP Syndrome
HELLP Syndrome – Signs and Symptoms Nursing Mnemonic (HELLP)
Hematomas in OB Nursing: Causes, Symptoms, and Nursing Care
Hemodynamics
Hemoglobin A1c (HbA1C)
Hemorrhage (Postpartum Bleeding) for Certified Emergency Nursing (CEN)
Hepatitis B Vaccine for Newborns
Homocysteine (HCY) Lab Values
Hydatidiform Mole (Molar pregnancy)
Hydralazine (Apresoline) Nursing Considerations
Hydrochlorothiazide (Hydrodiuril) Nursing Considerations
Hyperbilirubinemia (Jaundice)
Hyperemesis Gravidarum
Hyperemesis Gravidarum for Certified Emergency Nursing (CEN)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hypovolemic Shock Case Study (OB sim) (60 min)
Incompetent Cervix
Infections in Pregnancy
Initial Care of the Newborn (APGAR)
Inserting a Foley (Urinary Catheter) – Female
Intra Uterine Device – Potential Problems Nursing Mnemonic (PAINS)
Isotonic Solutions (IV solutions)
Labor Progression Case Study (45 min)
Leopold Maneuvers
Lung Surfactant
Lung Surfactant for Newborns
Magnesium Sulfate
Magnesium Sulfate
Magnesium Sulfate (MgSO4) Nursing Considerations
Magnesium Sulfate in Pregnancy
Mastitis
Maternal Risk Factors
Mechanisms of Labor
Meconium Aspiration
Meds for Postpartum Hemorrhage (PPH)
Meds for PPH (postpartum hemorrhage)
Menstrual Cycle
Methylergonovine (Methergine) Nursing Considerations
Newborn of HIV+ Mother
Newborn Physical Exam
Newborn Reflexes
Nifedipine (Procardia) Nursing Considerations
Nursing Care Plan (NCP) for Abortion, Spontaneous Abortion, Miscarriage
Nursing Care Plan (NCP) for Abruptio Placentae / Placental abruption
Nursing Care Plan (NCP) for Chorioamnionitis
Nursing Care Plan (NCP) for Diabetes Mellitus (DM)
Nursing Care Plan (NCP) for Dystocia
Nursing Care Plan (NCP) for Ectopic Pregnancy
Nursing Care Plan (NCP) for Gestational Diabetes (GDM)
Nursing Care Plan (NCP) for Gestational Hypertension, Preeclampsia, Eclampsia
Nursing Care Plan (NCP) for Hyperemesis Gravidarum
Nursing Care Plan (NCP) for Hypertension (HTN)
Nursing Care Plan (NCP) for Incompetent Cervix
Nursing Care Plan (NCP) for Mastitis
Nursing Care Plan (NCP) for Maternal-Fetal Dyad Using GTPAL
Nursing Care Plan (NCP) for Meconium Aspiration
Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
Nursing Care Plan (NCP) for Newborns
Nursing Care Plan (NCP) for Placenta Previa
Nursing Care Plan (NCP) for Postpartum Hemorrhage (PPH)
Nursing Care Plan (NCP) for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM)
Nursing Care Plan (NCP) for Preterm Labor / Premature Labor
Nursing Care Plan (NCP) for Process of Labor
Nursing Care Plan (NCP) for Transient Tachypnea of Newborn
Nursing Care Plan for (NCP) Fetal Alcohol Syndrome (FAS)
Nursing Care Plan for Newborn Reflexes
Nursing Case Study for Maternal Newborn
Nutrition Assessments
Nutrition in Pregnancy
Nutritional Requirements
OB (Labor) Nurse Report to OB (Postpartum) Nurses
OB Course Introduction
OB Non-Stress Test Results Nursing Mnemonic (NNN)
OB Pharm and What Drugs You HAVE to Know – Live Tutoring Archive
Obstetric Trauma for Certified Emergency Nursing (CEN)
Obstetrical Procedures
Opioid Analgesics in Pregnancy
Oral Birth Control Pills – Serious Complications Nursing Mnemonic (Aches)
Oxytocin (Pitocin) Nursing Considerations
Pediatric Vital Signs (VS)
Physiological Changes
Phytonadione (Vitamin K)
Phytonadione (Vitamin K) for Newborn
Placenta Previa
Placenta Previa for Certified Emergency Nursing (CEN)
Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
Post-Partum Assessment Nursing Mnemonic (BUBBLE)
Postpartum Discomforts
Postpartum Hematoma
Postpartum Hemorrhage (PPH)
Postpartum Interventions
Postpartum Physiological Maternal Changes
Postpartum Thrombophlebitis
Precipitous Labor
Preeclampsia (45 min)
Preeclampsia, Eclampsia, and HELLP Syndrome for Certified Emergency Nursing (CEN)
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Pregnancy Labs
Pregnancy Outcomes Nursing Mnemonic (GTPAL)
Preload and Afterload
Premature Rupture of the Membranes (PROM)
Preterm Labor
Preterm Labor for Certified Emergency Nursing (CEN)
Probable Signs of Pregnancy Nursing Mnemonic (CHOP BUGS)
Process of Labor
Process of Labor – Mom Nursing Mnemonic (4 P’s)
Process of Labor – Baby Nursing Mnemonic (ALPPPS)
Process of Labor – Live Tutoring Archive
Process of Labor 2 – Live Tutoring Archive
Prolapsed Umbilical Cord
Promethazine (Phenergan) Nursing Considerations
Prostaglandins
Prostaglandins in Pregnancy
Protein (PROT) Lab Values
Retinopathy of Prematurity (ROP)
Rh Immune Globulin (Rhogam)
Rh Immune Globulin in Pregnancy
Signs of Pregnancy – Live Tutoring Archive
Signs of Pregnancy (Presumptive, Probable, Positive)
Spironolactone (Aldactone) Nursing Considerations
Stages of Fetal Development Nursing Mnemonic (Proficiently Expanding Fetus)
Subinvolution
Terbutaline (Brethine) Nursing Considerations
Threatened/Spontaneous Abortion for Certified Emergency Nursing (CEN)
Tips & Advice for Newborns (Neonatal IV Insertion)
Tocolytics
Tocolytics
Top 5 Misunderstood OB Concepts – Live Tutoring Archive
Transient Tachypnea of Newborn
Umbilical Cord Vasculature Nursing Mnemonic (2A1V)
Uterine Stimulants (Oxytocin, Pitocin)
Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
VEAL CHOP Nursing Mnemonic (Fetal Accelerations and Decelerations) (VEAL CHOP)
What the Heck is Antepartum Testing? – Live Tutoring Archive