Pharmacology Analgesic Question #4

Question

A nurse is caring for a postoperative patient who has received hydromorphone every six hours for the past two days. The patient’s appetite and post-operative mobility efforts have decreased. Which nursing intervention will the nurse perform first?

Answers

  1. Assess bowel sounds and contact health care provider
    • Rationale:

      This answer is correct because hydromorphone is a potent opioid that causes central nervous system depression, including nausea and decreased gastrointestinal (GI) motility (constipation), which then can cause the patient’s appetite to become decreased. An assessment of the bowel sounds will determine the status of the GI system that needs to be reported to the health care provider. If bowel sounds are present, but hypoactive, then the health care provider may prescribe various things, including a change or discontinuation of medications treating pain, medications to promote motility, increased activity, fluids, and dietary changes. On the other hand, if the patient has no bowel sounds, the patient may need to be immediately treated for a postoperative paralytic ileus. Assessment of bowel status is priority due to the symptoms of the patient. 

  2. Assess respiratory status and contact health care provider
    • Rationale:

      This answer is not correct because since there is no indication of respiratory concerns, this would not be the priority action. Hydromorphone is a potent opioid that causes central nervous system depression, including nausea and decreased gastrointestinal (GI) motility (constipation), which then can cause the patient’s appetite to become decreased. An assessment of the bowel sounds will determine the status of the GI system that needs to be reported to the health care provider.

  3. Encourage patients to ambulate every four hours to facilitate bowel movement
    • Rationale:

      This answer is not correct because although ambulatin every four hours to facilitate bowel movement may be prescribed later by the health care provider, it is not the priority. There is a possibility the patient might have little to no bowel sounds. The priority is assessing to be able to report that information to the health care provider for orders and prescriptions needed to help what is going on with the patient. Assessment is first in the nursing process!

  4. Document findings and monitor for further changes
    • Rationale:

      This answer is not correct because “document and monitor” indicates there is no action needed. The nurse should assess first, notify the health care provider, obtain prescriptions/orders, carry those out accordingly, document, and continue to monitor.

Overview

Treatment of postoperative pain with hydromorphone, a potent opioid, slows the gastrointestinal systems, which can cause constipation, which can decrease appetite for the patient.

Explanation

Learning Outcomes

Hydromorphone is a potent opioid that causes central nervous system depression, including nausea and decreased gastrointestinal (GI) motility (constipation), which then can cause the patient’s appetite to become decreased. An assessment of the bowel sounds will determine the status of the GI system that needs to be reported to the health care provider. If bowel sounds are present, but hypoactive, then the health care provider may prescribe various things, including a change or discontinuation of medications treating pain, medications to promote motility, increased activity, fluids, and dietary changes. On the other hand, if the patient has no bowel sounds, the patient may need to be immediately treated for a postoperative paralytic ileus.

Test Taking Tip

Remember to prioritize assessment first. It is first in the nursing process!

Video Rationale