The burned client newly arrived from an accident scene is prescribed to receive 4 mg of morphine sulfate by IV push. What is the most important reason to administer the opioid analgesic to this client by the intravenous route?
A. The medication will be effective more quickly than if given intramuscularly.
B. It is less likely to interfere with the client’s breathing and oxygenation.
C. The danger of an overdose during fluid remobilization is reduced
D. The client delayed gastric emptying.
Correct Answer: C. The danger of an overdose during fluid remobilization is reduced.
The most important reason is to prevent an overdose from accumulation of drug in the interstitial space during the fluid shift of the emergent phase. When edema is present, cumulative doses are rapidly absorbed when the fluid shift is resolving. This delayed absorption can result in lethal blood levels of analgesics.
Option A: Providing some pain relief has a high priority and giving the drug by the IV route instead of IM, SC, or orally does increase the rate of effect. Pain that is more severe and not well controlled may be manageable with single or continuous doses of IV, epidural, and intrathecal formulations. Infusion dosing can vary significantly between patients and largely depends on how naive or tolerant they are to opiates.
Option B: Respiratory depression is among the more serious adverse reactions with opiate use that is especially important to monitor in the postoperative patient population. Extreme caution is necessary with severe respiratory depression and asthma exacerbation cases since morphine can further decrease the respiratory drive.
Option D: Delayed gastric emptying is not a side effect of morphine. Among the more common unwanted effects of morphine use is constipation. This effect occurs via stimulation of mu-opioid receptors on the myenteric plexus, which in turn inhibits gastric emptying and reduces peristalsis.
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