Nursing Considerations for Morphine Administration, Non-Pharmacological Pain Management, and Post-Operative Care for Sigmoid Colostomy Patients

This article discusses nursing considerations for morphine administration, non-pharmacological pain management, and post-operative care for sigmoid colostomy patients. It covers the risks of respiratory depression, benefits of cold compress therapy, and importance of infection prevention. The article cites various studies and journals to support the information provided.

Colorectal
Cancer

Table of Contents
Question 1....................................................................................................................................1
Question 2....................................................................................................................................1
Question 3....................................................................................................................................2
REFERENCES................................................................................................................................4

Question 1
In the given case, morphine was administered to Mr. Hemsley. The most important
nursing consideration that needs to be taken into account while administering this medication is
respiratory depression. According to Kiyatkin (2019) Morphine has been known to cause
respiratory depression if administered rapidly. This is because, morphine when administered
rapidly causes rigidity of the chest wall resulting in respiratory depression (Gumus and et.al.,
2020). Therefor the nurses should consider to assess the level of respiration before administering
morphine. If the respiratory rate is less than 10/ min, then the level of sedation should be
assessed. For this, it is important that the nurses consider proper dosing and titration of morphine
injection.
Kliewer (2020) states that for the patients who are opioid naive, it is important to initiate
with 15 mg PO q8- 12hr. this is because for patients who are not opioid tolerant, use of higher
starting doses may result in fatal respiratory depression. Baby (2018) found that Opioids have
been known to induce respiratory depression due to the activation of μ-opioid receptors which
occurs at specific sits in the central nervous systems. This takes place in the pre-Bötzinger
complex which is an area that is known to generate respiratory rhythm. Morphine has impact on
the onset and offset of breathing. Politis and Smallwood (2017) found that Compilations take
place when the opioids affect and causes desensitization of the brain stem to cause an increase in
the CO2. This results in the full blown respiratory failure. Opioids are also known to cause
respiratory depression as these result a decrease in the sensitivity of the peripheral
chemoreceptors to carbon dioxide. This causes a decrease in the activity of the central respiratory
centers.
Dahan (2020) asserted that Respiratory depression is always preceded by sedation.
Therefore, as a clinical indicator, it is considered to be the most important observation. Due to
this nursing consideration, it is important for the nurse to monitor Mr. Hemsley for signs and
symptoms of respiratory depression. Sedation score and respiratory should be monitored. Also,
Mr. Hemsley was also administered Ondansetron which also has sedation as a side effect.
Therefore, it becomes of extreme importance to take into account the nursing consideration of
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respiratory depression. This is because, with another concurrent medication which is a sedative,
the risk of respiratory depression increases.
Question 2
In order to provide non pharmacological nursing comfort to manage pain of Mr. Hemsley, cold
compress can be used. Yaban (2019) states The cold therapy is also known as the cryotherapy.
Cold compress is a method in which a frozen or chilled material is used for reliving pain and
swelling (Telford, 2020). This technique is known to reduce the flow of blood to a particular
area. In the cold therapy, ice is used for reducing pain, inflammation and swelling in the post-
operative area. This can be in the form of bag of ice, cold compress or ice pack.
Gatewood, Tran and Dragoo (2017) found that cold compression is effective in reducing
inflammation as well as swelling which are responsible for pain. In this way, it reduces the pain
and discomfort. Cold comfort therapy is known to reduce swelling as well bruising. In this way,
these would help in managing the discomfort of Mr. Hemsley. Use of cold therapy allows the
tissues and blood vessels to swell so that the immune cells could reach the damaged site thus
aiding in reduction of pain.
Winge and et.al. (2017) suggested that use of cold compress helps in reducing the tissue
temperature thus resulting in the vasoconstriction. It also decreases conduction in the motor and
sensory nerve. According to Chughtai (2017), due to hypothermia, post- operative pain is known
to decrease due to reduction in the concentration of tumor necrosis factor as well as nitric oxide.
These are considered to be the two most important inflammatory mediators. In addition to it cold
compress helps in downregulation of muscle excitability which results in the decrease in pain
and muscle spasms cold compress helps in increasing the content between the cold source and
the patient thus causing an improvement in the beneficial effects and decrease in the local edema.
Question 3
A sigmoid colostomy was performed in Mr. Hemsley. There are various nursing
considerations which need to be taken care during the post- operative period. Infection is one of
the most important considerations that nurses should take care in the given case. The skin around
stoma may become inflamed because of leakage or infection. After colonostomy, the area around
stoma is warm, humid and soiled (Dylen and et.al., 2022). Du to this, it provides the favorable
conditions for the skin microbiota to easily multiply and cause infection. Minor skin infection
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may be seen in the form of red and inflamed skin surrounding stoma. Infection may also cause
swelling around stoma. These infections may be bacterial, such as impetigo and cellulitis
(Jackson, Hamed and Shabbir, 2020). These may also be fungal infections such as thrush. Stoma
may also be infected by viral infections and peristomal abscess.
This requires the nurses to take proper skin care regime after colostomy. It is a prior
responsibility of the nurses to care for the skin around stoma. The sin around stoma should be
cleansed with water regularly to prevent the development of infection (Zelga and et.al., 2021).
The nurses need to look for signs and symptoms of stoma infection in Mr. Hemsley. Regular
inspection of the skin around the stoma should be done for early identification pf any signs and
symptoms of infection. The stoma and peristomal skin area needs to be inspected with each
pouch change. The nurses should look for any irritation, bruises and rashes around this area
which caring for Mr. Hemsley. Warm water should be used for cleaning the area regularly and
pat dry it. Maintenance of a clean and dry area would help in preventing skin breakdown in Mr.
Hemsley.
It also needs to be ensured that Mr Hemsley is educated regarding the post -operative
care. Patient education goes a long way in ensuring that no further complications arise. It also
helps in better management post- surgery. Counselling and patient education would assist Mr.
Hemsley in identifying early signs of infection and reporting them to the nurses and healthcare
profession. This will help in preventing development of any complication. Hence it is important
to inform Mr. Hemsley and provide him adequate support during the entire treatment period.
Reports of bruising, itching should be properly investigated to confirm if there is ne for any
intervention. Appropriate pharmacological treatment needs to be provided after the infection has
been diagnosed.
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REFERENCES
Journals
Dylen, M.Y.C., Lee, J.W.K., Ting, L.Y., Ragupathi, T., Yu, N.J., Lim, F., Farouk, R. and Seng,
C.C., (2022). Transverse Colostomy Differs in Outcomes Compared to Sigmoid
Colostomy: A Cohort Analysis. Journal of Investigative Surgery, 35(4), pp.783-787.
Jackson, S., Hamed, M.O. and Shabbir, J., (2020). Management of sigmoid volvulus using
percutaneous endoscopic colostomy. The Annals of The Royal College of Surgeons of
England, 102(9), pp.654-662.
Gumus,K., Musuroglu, S., Ozlu, Z.K., & Tasci, O. (2020). Determining the Use of
Nonpharmacologic Methods by Surgical Nurses for Postoperative Pain
Management and the Influencing Professional Factors: A Multicenter Study. Journal of
PeriAnesthesia Nursing, 35, 75-
79. https://doi.org/10.1016/j.jopan.2019.04.011
Telford, A. (2020). Role of the nurse in supporting the safe use of opioids. Nursing Standard,
35(9), 77-82.
Zelga, P., Kluska, P., Zelga, M., Piasecka-Zelga, J., & Dziki, A. (2021). Patient-Related Factors
Associated With Stoma and Peristomal Complications Following Fecal Ostomy
Surgery. J Wound Ostomy Continence Nursing, 48(5):415-430.
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Kiyatkin, E.A., (2019). Respiratory depression and brain hypoxia induced by opioid drugs:
Morphine, oxycodone, heroin, and fentanyl. Neuropharmacology, 151, pp.219-226.
Kliewer, A., Gillis, A., Hill, R., Schmiedel, F., Bailey, C., Kelly, E., Henderson, G., Christie,
M.J. and Schulz, S., (2020). Morphine‐induced respiratory depression is independent of
β‐arrestin2 signalling. British Journal of Pharmacology, 177(13), pp.2923-2931.
Baby, S.M., Gruber, R.B., Young, A.P., MacFarlane, P.M., Teppema, L.J. and Lewis, S.J.,
(2018). Bilateral carotid sinus nerve transection exacerbates morphine-induced
respiratory depression. European journal of pharmacology, 834, pp.17-29.
Dahan, A., van Dam, C.J., Niesters, M., van Velzen, M., Fossler, M.J., Demitrack, M.A. and
Olofsen, E., (2020). Benefit and risk evaluation of biased μ-receptor agonist oliceridine
versus morphine. Anesthesiology, 133(3), pp.559-568.
Politis, J., Le, B. and Smallwood, N., (2017). Respiratory depression secondary to morphine use
in a patient with COPD and refractory breathlessness. European Respiratory
Journal, 49(5).
Yaban, Z.S., (2019). Usage of non-pharmacologic methods on postoperative pain management
by nurses: Sample of turkey. International Journal of Caring Sciences, 12(1), pp.529-
541.
Gatewood, C.T., Tran, A.A. and Dragoo, J.L., (2017). The efficacy of post-operative devices
following knee arthroscopic surgery: a systematic review. Knee Surgery, Sports
Traumatology, Arthroscopy, 25(2), pp.501-516.
Winge, R., Bayer, L., Gottlieb, H. and Ryge, C., (2017). Compression therapy after ankle
fracture surgery: a systematic review. European Journal of Trauma and Emergency
Surgery, 43(4), pp.451-459.
Chughtai, M., Sodhi, N., Jawad, M., Newman, J.M., Khlopas, A., Bhave, A. and Mont, M.A.,
(2017). Cryotherapy treatment after unicompartmental and total knee arthroplasty: a
review. The Journal of arthroplasty, 32(12), pp.3822-3832.
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