Patient Data

Which actions should the nurse take to assure safety during morphine administration? Select all that apply.

A. Observe the client for the presence of pain behaviors before the next analgesic dose is due: In a nonverbal client, observing for pain behaviors such as grimacing, restlessness, moaning, or changes in vital signs is crucial. If these behaviors increase before the next scheduled dose, it may suggest that the current analgesic regimen is becoming less effective, indicating tolerance.

B. Review the client's laboratory values for a change in the peak and trough levels of the analgesic: Peak and trough levels are useful for monitoring therapeutic ranges for certain medications but are not reliable indicators of analgesic tolerance. Tolerance is a clinical observation based on pain behavior, not solely on drug concentration measurements.

C. Prolong the interval between analgesic medication doses and monitor the client's vital signs: Extending the interval between doses risks undertreating the client’s pain and causing unnecessary suffering. Tolerance assessment should focus on evaluating pain control, not withholding medication to observe physiological responses.

D. Ask family members to report behaviors suggesting that the client's pain has returned: While family members can provide valuable insight, their observations should supplement, not replace, the nurse's direct clinical assessment. Family members may miss subtle signs of pain or misinterpret behaviors unrelated to pain.

• Albuterol is classified as a beta-2 adrenergic agonist that specifically targets bronchial smooth muscle. It causes relaxation and bronchodilation, rapidly relieving bronchospasm in asthma exacerbations. This action improves airway flow and oxygenation almost immediately after administration. It is the primary rescue medication used in acute respiratory distress related to asthma.
• Beta-blockers inhibit beta-adrenergic receptors, leading to decreased heart rate and blood pressure. They can cause bronchoconstriction, especially in patients with reactive airway diseases like asthma. Using beta-blockers would worsen asthma symptoms rather than relieve them during an exacerbation. Therefore, they are contraindicated in many clients with a history of asthma or severe allergies.
• Corticosteroids are anti-inflammatory agents that decrease airway swelling over several hours or days. They do not provide the immediate bronchodilation needed during an acute asthma attack. Fluticasone and prednisone are examples used for long-term asthma control, not acute relief. Thus, corticosteroids differ significantly from bronchodilators like albuterol in onset and purpose.
• Albuterol reduces airway resistance by relaxing constricted bronchial smooth muscles. This effect allows greater airflow into and out of the lungs, improving oxygen exchange. Decreased airway resistance is the primary mechanism by which respiratory symptoms are relieved. Effective bronchodilation is critical to restoring normal breathing during asthma exacerbations.
• Albuterol may increase heart rate slightly due to beta-1 receptor cross-stimulation at high doses. It does not decrease heart rate and tachycardia is considered a known side effect. Heart rate monitoring is important during albuterol administration, especially in cardiac patients. Managing asthma symptoms requires balancing effective bronchodilation with minimal cardiac effects.
• Albuterol does not directly act on inflammation but instead targets smooth muscle relaxation. The inflammatory response in asthma is treated with corticosteroids and leukotriene modifiers. Immediate asthma symptom relief depends on bronchodilation, not anti-inflammatory action. Thus, albuterol is classified solely as a bronchodilator, not an anti-inflammatory medication.