Respiratory depression is the most serious adverse effect and is the priority assessment before and after dosing.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client is prescribed buprenorphine-naloxone (a combination film) for opioid use disorder. Why is naloxone included in this combination product?
Answer: A. In the sublingual buprenorphine-naloxone product, naloxone is poorly absorbed sublingually and has little effect when taken as directed. It is included to deter misuse: if the product is dissolved and injected, the naloxone becomes active and precipitates withdrawal, discouraging diversion. It is not added to reverse buprenorphine when taken correctly, to boost the high, or to prevent constipation.
Question 2 of 5
A hospice client with metastatic cancer has severe, constant pain. Based on the principles of pain management at end of life, which approach should the nurse anticipate?
Answer: B. For severe, constant cancer pain, opioids are given around the clock on a scheduled basis to maintain steady analgesia, with additional short-acting doses available for breakthrough pain. Waiting until pain is severe or giving analgesics only as needed leads to poorly controlled pain. There is no arbitrary ceiling on opioid dose when titrated to relieve suffering at end of life.
Question 3 of 5
A client recovering from alcohol use disorder is prescribed naltrexone. Which statement by the client indicates a need for further teaching?
Answer: A. Naltrexone is an opioid antagonist that reduces alcohol cravings and the rewarding effects of drinking. Because it blocks opioid receptors, it can precipitate withdrawal in someone using opioids and will block the analgesic effect of opioid pain medication. The statement that the client can take opioid pain pills as usual indicates a misunderstanding and a need for further teaching. The other statements are accurate.
Question 4 of 5
A client on scheduled opioids for cancer pain reports no bowel movement in 3 days. Which nursing action is most appropriate?
Answer: B. Constipation is an expected and persistent side effect of opioids because tolerance to it does not develop. A stimulant laxative and stool softener bowel regimen should be started prophylactically and continued for the duration of opioid therapy. Stopping the opioid would leave the client in pain, and constipation will not simply resolve on its own.
Question 5 of 5
A nurse is teaching a client taking codeine for cough and mild pain. Which common side effect should the nurse include in the teaching?
Answer: B. Codeine, like other opioids, commonly causes constipation, and clients should increase fluids and fiber and use a stool softener as needed. Diarrhea, hypertension, and increased urination are not typical opioid effects; opioids tend to cause urinary retention rather than increased output.
Keep the streak going with more questions like these, each with a full rationale.
What is opioid analgesics and naloxone?
Their most dangerous adverse effect is respiratory depression. Naloxone (Narcan) is the opioid reversal agent. Memory aid: opioids cause the triad of pinpoint pupils, decreased respirations, and sedation.
Key points to remember
- Respiratory depression is the most serious adverse effect and is the priority assessment before and after dosing.
- Classic opioid signs are pinpoint (constricted) pupils, decreased respiratory rate, sedation, and decreased level of consciousness.
- Constipation is a near-universal side effect that does not improve with tolerance, so a bowel regimen is standard.
- Other effects include nausea, urinary retention, hypotension, and itching.
- Naloxone reverses opioid effects but has a shorter duration than many opioids, so repeat dosing and continued monitoring are required.
- Naloxone can precipitate acute withdrawal and the abrupt return of severe pain in dependent patients.
Signs & symptoms
- Resp depression, sedation
- Pinpoint pupils, ↓ BP, constipation
Nursing priorities
- Assess respiratory rate, depth, and oxygen saturation before and after administration; hold the dose for a respiratory rate below 12.
- Have naloxone and resuscitation equipment readily available.
- Use a sedation scale and a pain scale to titrate safely.
- Initiate a bowel regimen with stool softeners and stimulants to prevent constipation.
- Implement fall precautions and monitor blood pressure and level of consciousness.
Patient teaching
- Take stool softeners and increase fluids and fiber to prevent constipation.
- Do not drink alcohol or take other sedatives with opioids.
- Avoid driving or operating machinery until you know how the medication affects you.
Red flags: report now
- Respiratory rate below 12, oxygen desaturation, or increasing sedation requires holding the opioid and considering naloxone.
- Unarousable patient with pinpoint pupils and shallow breathing.
- After naloxone, watch for re-sedation because the opioid may outlast the antidote.
- Severe hypotension or loss of airway protection.
References
Clinical references for this topic
