15.4 Evaluate Nutritional Strategies to Impact Renal Wellness
3 min read•june 18, 2024
Opioids are powerful pain-relieving drugs that work by binding to specific receptors in the nervous system. They come in two main types: agonists, which activate these receptors, and antagonists, which block them. Understanding how these drugs work is crucial for safe and effective pain management.
Nurses play a vital role in administering opioids and monitoring patients for side effects. Proper assessment, careful dosing, and patient education are key to maximizing pain relief while minimizing risks. Opioid safety is a critical concern, given the potential for addiction and overdose.
Opioid Agonists and Antagonists
Opioid agonists vs antagonists
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- Opioid agonists bind to and activate opioid receptors (mu, kappa, delta) producing analgesic effects by mimicking the actions of endogenous opioids (endorphins, enkephalins, dynorphins)
- Commonly used opioid agonists include morphine, oxycodone, fentanyl, hydromorphone, and codeine
- Opioid antagonists bind to opioid receptors without activating them, blocking the effects of opioid agonists and preventing or reversing their actions
- Opioid antagonists like naloxone and naltrexone are used to treat opioid overdose or opioid-induced side effects
Mechanisms of common opioid drugs
- Opioids bind to specific receptors in the central and peripheral nervous systems, and activation of these receptors leads to inhibition of pain transmission and modulation of pain perception
- Opioids also affect other systems such as respiratory, gastrointestinal, and immune systems
- Indications for opioid use include moderate to severe acute pain (post-operative, trauma), chronic pain (cancer-related pain, palliative care), cough suppression (codeine, hydrocodone), and diarrhea (loperamide, diphenoxylate)
- Major side effects of opioids include respiratory depression, sedation and drowsiness, nausea and vomiting, constipation, pruritus (itching), urinary retention, and tolerance and physical dependence with prolonged use
Nursing considerations for opioids
- Assessment involves evaluating pain intensity, character, and location using appropriate pain scales, monitoring vital signs especially respiratory rate and sedation level, and assessing for contraindications and risk factors (respiratory disorders, renal or hepatic impairment)
- Administration requires following the "5 rights" of medication administration (right patient, drug, dose, route, and time), starting with the lowest effective dose and titrating based on patient response and side effects, and using equianalgesic dosing when converting between different opioids or routes of administration
- Monitoring includes regularly reassessing pain control and side effects, watching for signs of respiratory depression, oversedation, or allergic reactions, and monitoring bowel function and implementing prophylactic measures to prevent constipation
- Safety measures involve securing and properly storing opioid medications to prevent diversion or misuse, disposing of unused or expired opioids according to institutional policies and local regulations, and educating patients and caregivers about safe storage, disposal, and potential risks
Patient education for opioid safety
- Proper use instructions include taking opioids exactly as prescribed by the healthcare provider, not changing the dose or frequency without consulting the prescriber, and not crushing, chewing, or breaking extended-release or long-acting formulations
- Patients should be informed about common side effects and how to manage them (stool softeners for constipation, antiemetics for nausea) and advised to report severe or persistent side effects to their healthcare provider
- Patients should be cautioned about potential drug interactions with other CNS depressants (alcohol, benzodiazepines, sedatives) and advised to inform all healthcare providers about their opioid use
- Risks of prolonged opioid use include tolerance, physical dependence, and addiction, and patients should be warned about the dangers of sharing opioids or taking them in ways not prescribed
- Patients should be educated on the signs and symptoms of opioid overdose and the use of naloxone if available
- Safe storage and disposal practices emphasize the importance of storing opioids securely and out of reach of children or pets and instructing patients on proper disposal methods for unused or expired opioids
Opioid Use Disorder and Treatment
- Opioid use disorder is a chronic condition characterized by problematic patterns of opioid use leading to significant impairment or distress
- The endogenous opioid system plays a crucial role in pain modulation, reward, and addiction, and is the target of both opiates (naturally derived from opium poppy) and synthetic opioids
- Treatment options for opioid use disorder include:
- Methadone: A long-acting opioid agonist used in medication-assisted treatment to reduce cravings and withdrawal symptoms
- Buprenorphine: A partial opioid agonist that helps manage withdrawal symptoms and cravings while having a lower risk of respiratory depression
Key Terms to Review (18)
Azotemia: Azotemia is a medical condition characterized by an abnormally high level of nitrogen-containing compounds, such as urea and creatinine, in the blood. This is often an indicator of impaired kidney function, as the kidneys are primarily responsible for filtering and removing these waste products from the body.
Chronic Kidney Disease: Chronic kidney disease (CKD) is a progressive condition characterized by the gradual loss of kidney function over time. It is a significant public health concern, as it can lead to end-stage renal disease and the need for dialysis or kidney transplantation if left untreated.
Creatinine: Creatinine is a waste product that is produced by the body's normal breakdown of muscle tissue. It is filtered out of the blood by the kidneys and excreted in urine. The level of creatinine in the blood is an important indicator of how well the kidneys are functioning.
Dialysate: Dialysate is the fluid used in the dialysis process to remove waste, excess water, and other unwanted substances from the body. It is a key component in the treatment of individuals with kidney failure or end-stage renal disease, as it facilitates the exchange of solutes and fluids between the blood and the dialysis solution.
Edema: Edema is the abnormal accumulation of fluid in the body's tissues, resulting in swelling. This condition can occur in various parts of the body and is often associated with underlying medical conditions or factors that affect fluid balance and circulation.
Glomerular Filtration Rate: Glomerular filtration rate (GFR) is a measure of the kidney's ability to filter waste and excess substances from the blood. It represents the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman's capsule per unit of time, and is a key indicator of overall kidney function.
Hemodialysis: Hemodialysis is a medical procedure that filters and purifies the blood using a dialysis machine, also known as an artificial kidney. It is a crucial treatment for individuals with end-stage renal disease or kidney failure, as it helps to remove waste, toxins, and excess fluid from the body when the kidneys can no longer perform these functions effectively.
Hyperkalemia: Hyperkalemia is a medical condition characterized by an abnormally high level of potassium in the bloodstream. This imbalance can have significant impacts on the body's overall health and wellness, particularly in the context of hydration, treatments, nutrition, and renal function.
Hyperphosphatemia: Hyperphosphatemia is a condition characterized by an abnormally high level of phosphate in the blood. This electrolyte imbalance can have significant implications for the renal system and overall health, making it an important consideration in the context of nutrition and renal wellness.
Low-Protein Diet: A low-protein diet is a dietary plan that restricts the intake of protein-rich foods, typically to less than 0.8 grams of protein per kilogram of body weight per day. This type of diet is often recommended for individuals with certain medical conditions, such as chronic kidney disease, to help manage the progression of the disease and reduce the strain on the kidneys.
Nephrons: Nephrons are the functional units of the kidneys, responsible for the filtration and reabsorption of blood to produce urine. They play a crucial role in maintaining the body's fluid balance, electrolyte levels, and overall renal wellness.
Parathyroid Hormone: Parathyroid hormone (PTH) is a polypeptide hormone produced by the parathyroid glands that plays a crucial role in regulating calcium and phosphate homeostasis in the body. It is a key player in maintaining the balance of these minerals, which is essential for the proper functioning of the renal, musculoskeletal, and integumentary systems.
Peritoneal Dialysis: Peritoneal dialysis is a type of dialysis treatment that uses the lining of the abdomen, called the peritoneum, to filter waste and excess water from the blood. It is an effective method for managing kidney failure and maintaining fluid and electrolyte balance in the body.
Phosphate Binders: Phosphate binders are medications that help control the levels of phosphorus in the blood for individuals with chronic kidney disease. They work by binding to phosphorus in the digestive system, preventing its absorption and reducing the overall phosphorus load on the body.
Renal Diet: A renal diet is a specialized dietary plan designed to support individuals with kidney-related health conditions, such as chronic kidney disease (CKD), end-stage renal disease (ESRD), or kidney failure. The primary goal of a renal diet is to help manage the progression of kidney disease and prevent or mitigate the associated complications by carefully regulating the intake of certain nutrients.
Renal Osteodystrophy: Renal osteodystrophy is a condition that occurs in individuals with chronic kidney disease, where the kidneys are unable to properly regulate the levels of minerals and hormones essential for maintaining healthy bones. This imbalance leads to abnormal bone formation, mineralization, and remodeling, resulting in weakened and deformed bones.
Uremia: Uremia is a condition that occurs when waste products, such as urea and creatinine, accumulate in the blood due to impaired kidney function. This buildup of waste products can have significant impacts on the body's overall health and wellness, particularly in relation to the renal system.
Vitamin D: Vitamin D is a fat-soluble vitamin that plays a crucial role in maintaining overall health and wellness. It is often referred to as the 'sunshine vitamin' because the body can synthesize it when the skin is exposed to sunlight. Vitamin D is essential for the regulation of calcium and phosphorus levels in the body, supporting strong bones and teeth, and it also has important functions in various other physiological processes.