Spinal narcotics require hourly monitoring for 24 hours after initiation of therapy, bolus dose or change in dosage. Onset of respiratory depression may occur up to 24 hours after an opiate is infused due to drug redistribution. Dosage changes will require restarting the monitoring process at q hour. Monitoring that reveals inadequate pain control or excessive toxicity will prompt nursing actions to alter the treatment plan. Opiate Administration Use equianalgesic charts to collaborate with physicians in identifying appropriate doses of analgesic for individual patients.
Infusions are most effective when preceded by a loading dose of medication.
Nurses will calculate appropriate concentration of drug to fluid and collaborate with physician and pharmacist to keep volume of infused fluid appropriate for selected route and patient status. The intravenous infusion will be administered ONLY through a controlled system. Narcotics added to I.V. fluid containers must, by law, be secured in a compartment with double locks until hung at the bedside. Thus, security and storage may influence the division of the full 24-hour dose to be given. Special delivery arrangements with the pharmacist may be needed to ensure sage storage of the narcotic fluids at all times.