Page 75 - Critical Care Nursing Demystified

60 CRITICAL CARE NURSING DeMYSTIFIED

Morphine Sulfate

Morphine sulfate is a strong opioid that has been the gold standard for pain
medication control. In the critical care environment, it is used for its rapid
action of depressing the patient’s respirations and allowing the patient to
breathe comfortably. This medication can be given IV or as a continuous drip.
Because morphine can cause histamine release and resultant vasodilatation and
hypotension, assessment of the patient’s hemodynamic response to this medi-
cation, pain, and SaO should be measured when using this therapy.
2

Fentanyl (Sublimaze)

Fentanyl is another opioid that has the advantages of being more potent, work-
ing faster, and having a shorter duration than morphine. It also does not have
the hypotensive effects that morphine has and is safe to use in patients with
renal dysfunction and allergies to morphine. Assessment of the patient’s hemo-
dynamic status as well as respiratory effort and pain response are needed when
using this drug.

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This short-acting general anesthetic agent is used when sedation is needed
quickly and rapid metabolism is needed to assess neurologic status or readiness
to wean. This should be administered through a large IV as it can result in
uncomfortable burning or stinging at the administration site. The dose should
be reduced daily to assess the patient’s neurological and respiratory status.
Analgesic agents must be added to this therapy as it does not affect pain per-
ception. Because it is an excellent medium for infection, IV bottles and tubing
must be changed every 12 hours after opening. Monitor the patient for hypoten-
sion and triglyceride levels when administering this infusion.

Benzodiazepines

Benzodiazepines have many uses, but in the critical care environment you will
see them used to decrease ventilator and procedural anxieties. Commonly used
benzodiazepines include alprazolam (Xanax), lorazepam (Ativan), midazolam
(Versed), and diazepam (Valium). These drugs can be given IV in the case of
patient intubation. The side effects to look for include sedation, dizziness, head-
ache, dry mucous membranes, and blurred vision. Overdose with benzodiaz-
epines can be managed with IV flumazenil (Romazicon).