C7 · Side effects of pain medicine
Actual ⚠ URGENT Comfort and rest
Definition
Drowsiness, nausea, constipation, or slowed breathing caused by pain medicines.- Opioid medicines
- dose too high
- older age
- kidney problems
- Drowsiness
- nausea
- constipation
- slow breathing
- confusion
- itching
📋 Scenario
A patient after surgery is very sleepy and breathes six times a minute after morphine.
Subjective (S): "I feel very sleepy and sick since the morphine."
Objective (O): Drowsy but rousable; respiratory rate 6/min; oxygen saturation 90%; nausea; no bowel movement for 3 days.
Assessment tools for this scenario: CP-PAIN Pain & Comfort Score CP-ELIM Elimination Check CP-BREATH Breathing & Circulation Check
Validated scales to consider: NRS 0–10, FLACC, PAINAD, Bristol Stool Chart, bladder scan, NEWS2, SpO₂, ECG
**CarePath diagnosis:** Side effects of pain medicine related to opioid medicines, as evidenced by drowsiness, respiratory rate 6/min, oxygen saturation 90% and nausea (urgent: respiratory depression).
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Check sedation level and breathing rate before and after each dose; if drowsy or breathing slowly (under 10/min), hold the dose and call for help at once. | Opioids can slow breathing and cause sedation, so checking before and after doses spots danger early, and holding the dose and calling for help prevents further slowing of breathing. |
| Give oxygen and prepare an opioid antagonist (for example naloxone) as ordered. | Oxygen supports low saturation while breathing is slow, and an opioid antagonist such as naloxone can quickly reverse the drug's effect on breathing when ordered. |
| Give laxatives and anti-sickness medicine as ordered. | Opioids slow the bowel and trigger nausea, so laxatives and anti-sickness medicine relieve these effects and make the pain medicine easier to tolerate. |
| Review the dose and timing with the prescriber. | The prescriber may lower the dose, change the drug or space out the timing to keep pain controlled with fewer side effects. |
| Teach the patient and family warning signs. | A patient and family who know warning signs, such as unusual sleepiness or slow breathing, can alert staff early so harm is prevented. |
**Expected outcomes**
- Within 1 hour: alert and rousable, respiratory rate 12-20/min, oxygen saturation at target.
- Pain controlled at 3/10 or lower.
- Nausea settled and bowels open within 48 hours.
**Linking the data to the diagnosis**
After morphine the patient says they feel very sleepy and sick. The nurse found drowsiness but rousable, respiratory rate 6/min, oxygen saturation 90%, nausea and no bowel movement for 3 days. These are known opioid side effects, and the slow breathing is respiratory depression, so help is called first, before anything else. The problem has already occurred, so this is an actual diagnosis. The plan aims within 1 hour for an alert, rousable patient breathing 12 to 20/min with oxygen saturation at target, pain at 3/10 or lower, nausea settled, and bowels open within 48 hours.
CarePath diagnosis
Side effects of pain medicine related to opioid medicines, as evidenced by drowsiness, respiratory rate 6/min, oxygen saturation 90% and nausea (urgent: respiratory depression).
Interventions and rationale
Listed in priority order — for urgent statements the first action is to get help.
| Intervention | Rationale |
|---|---|
| 1. Check sedation level and breathing rate before and after each dose; if drowsy or breathing slowly (under 10/min), hold the dose and call for help at once. | Opioids can slow breathing and cause sedation, so checking before and after doses spots danger early, and holding the dose and calling for help prevents further slowing of breathing. |
| 2. Give oxygen and prepare an opioid antagonist (for example naloxone) as ordered. | Oxygen supports low saturation while breathing is slow, and an opioid antagonist such as naloxone can quickly reverse the drug's effect on breathing when ordered. |
| 3. Give laxatives and anti-sickness medicine as ordered. | Opioids slow the bowel and trigger nausea, so laxatives and anti-sickness medicine relieve these effects and make the pain medicine easier to tolerate. |
| 4. Review the dose and timing with the prescriber. | The prescriber may lower the dose, change the drug or space out the timing to keep pain controlled with fewer side effects. |
| 5. Teach the patient and family warning signs. | A patient and family who know warning signs, such as unusual sleepiness or slow breathing, can alert staff early so harm is prevented. |
Expected outcomes
- Within 1 hour: alert and rousable, respiratory rate 12-20/min, oxygen saturation at target.
- Pain controlled at 3/10 or lower.
- Nausea settled and bowels open within 48 hours.
Linking the data to the diagnosis
After morphine the patient says they feel very sleepy and sick. The nurse found drowsiness but rousable, respiratory rate 6/min, oxygen saturation 90%, nausea and no bowel movement for 3 days. These are known opioid side effects, and the slow breathing is respiratory depression, so help is called first, before anything else. The problem has already occurred, so this is an actual diagnosis. The plan aims within 1 hour for an alert, rousable patient breathing 12 to 20/min with oxygen saturation at target, pain at 3/10 or lower, nausea settled, and bowels open within 48 hours.