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Medication/ Dose Route/Frequency dilaudid 2mg po q6 hour (pt had it on shift)

Generic/Trade hydromorphone
Classification Opioid agonist
Why is Client Receiving? Back pain

Therapeutic Effect- What does it do? Pain relief

Mechanism of Action- How does it do it? Binds to opiate receptors in the CNS.
 Alters the perception of and response to painful stimuli while producing generalized
CNS depression.
 Suppresses the cough reflex via a direct central action.

Adverse Effects CNS: confusion, sedation, dizziness, dysphoria, euphoria, floating feeling,

hallucinations, headache, unusual dreams
CV: hypotension, bradycardia
Derm: flushing, sweating
EENT: blurred vision, diplopia, miosis
Endo: adrenal insufficiency
GI: constipation, dry mouth, nausea, vomiting
GU: urinary retention
Resp: RESPIRATORY DEPRESSION (INCLUDING CENTRAL SLEEP APNEA AND
SLEEP-RELATED HYPOXEMIA)
Misc: physical dependence, psychological dependence, tolerance

NSG Implications Pain:

Assess type, location, and intensity of pain prior to and 1 hr following IM or PO and 5
min (peak) following IV administration. When titrating opioid doses, increases of 25–
50% should be administered until there is either a 50% reduction in the patient's pain
rating on a numerical or visual analogue scale or the patient reports satisfactory pain
relief. When titrating doses of short-acting hydromorphone, a repeat dose can be
safely administered at the time of the peak if previous dose is ineffective and side
effects are minimal.
o Patients on a continuous infusion should have additional bolus doses
provided every 15–30 min, as needed, for breakthrough pain. The bolus
dose is usually set to the amount of drug infused each hr by continuous
infusion.
o Patients taking extended-release hydromorphone may require additional
short-acting or rapid-onset opioid doses for breakthrough pain. Doses of
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short-acting opioids should be equivalent to 10–20% of 24 hr total and

given every 2 hr as needed.
o An equianalgesic chart (see equianalgesic dosing guidelines) should be used
when changing routes or when changing from one opioid to another.
o Prolonged use may lead to physical and psychological dependence and
tolerance. This should not prevent patient from receiving adequate
analgesia. Patients who receive hydromorphone for pain rarely develop
psychological dependence. Progressively higher doses may be required to
relieve pain with long-term therapy.
o Assess risk for opioid addiction, abuse, or misuse prior to administration.
Abuse or misuse of extended-release preparations by crushing, chewing,
snorting, or injecting dissolved product will result in uncontrolled delivery
of hydromorphone and can result in overdose and death.
 Cough: Assess cough and lung sounds during antitussive use.

Patient Education Instruct patient on how and when to ask for pain medication. Do not stop
taking without discussing with health care professional; may cause withdrawal symptoms if
discontinued abruptly after prolonged use. Discuss safe use, risks, and proper storage and
disposal of opioid analgesics with patients and caregivers with each Rx. The Patient Counseling
Guide (PCG) is available at www.fda.gov/OpioidAnalgesicREMSPCG.
 Advise patient that hydromorphone is a drug with known abuse potential. Protect it
from theft, and never give to anyone other than the individual for whom it was
prescribed. Store out of sight and reach of children, and in a location not accessible by
others.
 May cause drowsiness or dizziness. Advise patient to call for assistance when
ambulating or smoking. Caution patient to avoid driving or other activities requiring
alertness until response to medication is known.
 Advise patient to notify health care professional if pain control is not adequate or if
side effects occur.
 Advise patient to change positions slowly to minimize orthostatic hypotension.
 Instruct patient to avoid concurrent use of alcohol or other CNS depressants.
 Instruct patient to notify health care professional of all Rx or OTC medications,
vitamins, or herbal products being taken and consult health care professional before
taking any new medications.
 Encourage patient to turn, cough, and breathe deeply every 2 hr to prevent atelectasis.

Labs to check May ↑ plasma amylase and lipase concentrations.

I would CHECK THESE LABS