- 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
- 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
- Patient history
- Pain level
- How close is the patient to delivery
- Medicate properly
- Hydromorphone (Dilaudid)
- Butorphanol tartrate (Stadol)
- Nalbuphine (Nubain)
- Naloxone available
- Anti nausea medications
- Nausea is a side effect of Opioids
- Monitor for overdose
- Respirations less than 12/min is a concern
- Fast acting
- Treatment options
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
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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.