Fundamentals of Nursing Q 460
Which client is at greater risk for respiratory depression while receiving opioids for analgesia?
A. An elderly chronic pain client with a hip fracture.
B. A client with heroin addiction and back pain.
C. A young female client with advanced multiple myeloma.
D. A child with an arm fracture and cystic fibrosis.
Correct Answer: D. A child with an arm fracture and cystic fibrosis.
At greatest risk are elderly clients, opiate naïve clients, and those with underlying pulmonary disease. The child has two of the three risk factors. Many complications can occur with multiple different opioids, such as non-cardiogenic pulmonary edema, while many of the complications are unique to the opioid used as well as the route of administration.
Option A: Pain in the elderly population is especially difficult given the myriad of physiological, pharmacological, and psychological aspects of caring for geriatric patient. Opiates are the mainstay of pain treatment throughout all age groups but special attention must be paid to the efficacy and side effects of these powerful drugs when prescribing to a population with impaired metabolism, excretion, and physical reserve.
Option B: Prescription opioids and heroin are chemically similar and can produce a similar high. In some places, heroin is cheaper and easier to get than prescription opioids, so some people switch to using heroin instead. More recent data suggest that heroin is frequently the first opioid people use. In a study of those entering treatment for opioid use disorder, approximately one-third reported heroin as the first opioid they used regularly to get high.
Option C: Bone pain is one of the most common presentations of multiple myeloma and nearly all patients have skeletal involvement in the course of the disease. Consequently, many patients require narcotics for symptom management at the time of diagnosis but the long-term impact of MM treatment on pain control remains uncertain.