Assessment and Interventions for Patients Receiving Narcotics 麻醉药品使用者的评估及措施
Assessment for patients receiving narcotic agonists-antagonists include:
麻醉激动药-拮抗药使用患者评估包括：
Assessing for contraindications or cautions: Any known allergies to these drugs or to sulfites if using nalbuphine to avoid hypersensitivity reactions; respiratory dysfunction, which may be exacerbated by the respiratory depression caused by these drugs; MI or CAD, which could be exacerbated by the effects of these drugs; renal or hepatic dysfunction, which might interfere with drug metabolism or excretion; current status of pregnancy and lactation, which require cautious use of the drugs; history of heart disease if administering pentazocine to reduce the risk of potential cardiac stimulation; diarrhea caused by toxic poisons because depression of GI activity could lead to increased absorption and toxicity; and after biliary surgery or surgical anastomoses because of the adverse effects associated with slowed GI activity due to narcotics.
Performing pain assessment with the patient to establish baseline and evaluate the effectiveness of drug therapy.
实施疼痛评估，确立基线数据，评价药物疗法效果。
Performing a physical assessment to establish baseline status before beginning therapy, determine drug effectiveness, and evaluate for any potential adverse effects.
实施体格评估，确定开始治疗前基线状态，确定药物效果，评价有无潜在不良效应
Assessing orientation, affect, reflexes, and pupil size to evaluate any central CNS effects; monitoring respiratory rate and auscultate lungs for adventitious sounds to evaluate respiratory effects.
评估定向力、情感、反射、瞳孔大小，以评价中枢CNS效应；监测呼吸率，听诊肺附加音，评价呼吸系统效应。
Monitoring pulse, blood pressure, and cardiac output to evaluate for cardiac effects.
监测脉搏、血压、心排血量，评价心脏效应。
Palpating abdomen for distention and auscultating bowel sounds to monitor for GI effects; assessing urine output and palpating for bladder distention to evaluate for GU effects.
触诊腹部膨胀，听诊肠鸣音，监测有无GI效应；评估尿排量，触诊膀胱是否膨胀，评价GU效应。
Monitoring the results of laboratory tests such as liver and renal function tests to determine the need for possible dose adjustment and identify toxic drug effects; obtaining an electrocardiogram to evaluate for possible cardiac stimulation and arrhythmias secondary to pentazocine administration.
Performing baseline and periodic pain assessments with the patient to monitor drug effectiveness and provide appropriate changes in pain management protocol as needed.
实施基线和定期疼痛评估，监测药物效果，必要适当调整疼痛管理方案
Having a narcotic antagonist and equipment for assisted ventilation readily available when administering the drug IV to provide patient support in case of severe reaction.
IV给药时备好麻醉药品拮抗剂和辅助通气装备，一旦出现严重反应即时患者支持
Monitoring injection sites for irritation and extravasation to provide appropriate supportive care if needed.
监测注射部位有无炎症外渗，必要时提供适当的支持性医疗
Monitoring timing of analgesic doses. Prompt administration may provide a more acceptable level of analgesia and lead to quicker resolution of the pain.
监测止痛剂量时间安排。及时用药可以提供更好的镇痛效果，加快止痛
Using extreme caution when injecting these drugs into any body area that is chilled or has poor perfusion or shock because absorption may be delayed, and after repeated doses an excessive amount is absorbed all at once.
Using additional measures to relieve pain (e.g., back rubs, stress reduction, hot packs, ice packs) to increase the effectiveness of the narcotic being given and reduce pain.
采取其他措施缓解疼痛（如，擦背、减压、热敷、冰敷），增加所用麻醉药品效果，减少疼痛
Monitoring respiratory status before beginning therapy and periodically during therapy to monitor for potential respiratory depression.
开始治疗前先监测呼吸状态，治疗期间定期监测，以监测有无潜在的呼吸抑制。
Instituting comfort and safety measures, such as side rails and assistance with ambulation, to ensure patient safety; bowel program as needed to treat constipation; environmental controls to decrease stimulation; and small, frequent meals to relieve GI distress if GI upset is severe.
Reassuring patients that the risk of addiction is minimal. Most patients who receive these drugs for medical reasons do not develop dependency syndromes.
安慰患者成瘾风险极小。应医疗问题接受这些药物的多数患者不会出现依赖综合症。
Offering support and encouragement to help the patient cope with the drug regimen.
提供支持与鼓励，帮助患者处理好药物治疗。
Providing thorough patient teaching, including drug name, prescribed dose, and schedule of administration; measures for avoidance of adverse effects; warning signs that may indicate possible problems; safety measures such as avoiding driving, getting assistance with ambulation, avoiding making important decisions or signing important papers; and the need for monitoring and evaluation to enhance patient knowledge about drug therapy and to promote compliance.
sulfite – n. 亚硫酸盐
nalbuphine – n. 纳布啡
pentazocine – n. 喷他佐辛
biliary – a. 胆（汁）的，胆道的
anastomosis – n. 吻合术
periodic – a. 定期的
extravasation – n. 溢出，外滩（物）
resolution – n. 缓解
hot packs – 热敷
ice packs – 冰敷
institute – v. 制订，创立
reassure – v. 安慰，使消除疑虑
enhance – v. 增强
★Video ★
Opioid Antagonists
★Test ★ 1. In preparing an inservice about opioids, the nurse includes which problem as the most serious adverse effect?
A. Suppressed cardiac automaticity
B. Respiratory depression
C. Profound sedation
D. Hyperthermia 2. The nurse correlates orthostatic hypotension resulting from opioid administration with which cause?
A. Decreased heart rate
B. Impaired contractility
C. Dilation of peripheral veins
D. Elevated circulating catecholamines
奥医教育“在线自测”正式上线，复习练习、效果检验，奥医NCLEX-RN/ISPN题库一站完成。
答案 Answer 1. B. Respiratory depression Rationale: Respiratory depression is the most serious adverse effect of the opioids. At equianalgesic doses, all of the pure opioid agonists depress respiration to the same extent. Death following overdose is almost always a result of respiratory arrest. 2. C. Dilation of peripheral veins Rationale: Morphine-like drugs lower blood pressure by blunting the baroreceptor reflex and by dilating peripheral arterioles and veins. Peripheral vasodilation results primarily from morphine-induced release of histamine. Hypotension is mild in the recumbent patient but can be substantial when the patient stands up
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