Page 2078 - Saunders Comprehensive Review For NCLEX-RN

respiratory disorders; head injuries;
increased ICP; severe renal, hepatic, or
pulmonary disease; or seizure activity
e. Morphine is used with caution in clients
with blood loss or shock.

Respiratory depression is the priority

concern with morphine.
5. Nalbuphine is preferable for treating the pain of a
myocardial infarction because it reduces the oxygen
needs of the heart without reducing blood pressure.
6. Methadone
a. Dilute doses of oral concentrate with at
least 90 mL of water.
b. Dilute dispersible tablets in at least
120 mL of water, orange juice, or acidic
fruit beverage.
c. Methadone is used as a replacement
medication for opiate dependence and
to facilitate withdrawal.
7. Hydrocodone/homatropine frequently is used for
cough suppression.

C. Interventions for opioid analgesics

1. Monitor vital signs.
2. Assess the client thoroughly before administering pain
medication.
3. Initiate nursing measures such as massage, distraction,
deep breathing and relaxation exercises, the
application of heat or cold as prescribed, and
providing care and comfort along with administering
the opioid analgesic.
4. Administer medications 30 to 60 minutes before
painful activities.

5. Monitor respiratory rate and, if the rate is less

than 12 breaths per minute in an adult, withhold the
medication unless ventilatory support is being
provided or the client has terminal disease (as
prescribed).
6. Monitor pulse and, if bradycardia develops, withhold
the dose and notify the PHCP.
7. Monitor blood pressure for hypotension.
8. Auscultate breath sounds, because opioid analgesics
suppress the cough reflex.
9. Encourage activities such as turning, deep breathing,

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