Assignment of Tramadol is the choice of intervention for Martha

Answer 4a
Tramadol is the choice of intervention for Martha for pain relief postoperatively.
Tramadol
Therapeutic class Tramadol is an agent for controlling moderate to moderately severe
pain. Tramadol is a synthetic opioid analgesic which acts centrally and
also is a SNRI (serotonin/norepinephrine reuptake-inhibitor) (Barakat,
2019).
Pharmaceutical
action
Tramadol is a centrally acting opiate receptor agonist. It acts by
inhibiting the uptake of norepinephrine and serotonin. It indicates that
tramadol works through opioid as well as non-opioid mechanisms of
pain management. Tramadol can generate opioid-like characteristics,
but leads to less respiratory depression as compared to opioid.
Tramadol induces analgesic effects through a variety of different
targets on the noradrenergic system, serotoninergic system and opioid
receptors system (Hitchings, Lonsdale, Burrage, & Baker, 2015).
Tramadol acts as a racemic mixture, the positive enantiomer inhibits
serotonin reuptake while the negative enantiomer inhibits
noradrenaline re-uptake, by binding to and blocking the transporters
(Vazzana, et al., 2015). Tramadol also has an action of releasing
serotonin. Both enantiomers of tramadol are agonists of the μ-opoid

receptor and its M1 metabolite, O-demethylate, is also a μ-opoid
receptor agonist but is 6 times more potent than tramadol itself. These
actions work in synergy to cause analgesia.
Induction of tramadol in human occurs after 60 minutes of oral
administration and it peaks in next one to two hours(WHO, 2014). The
effect of tramadol is dose-dependent (Radbruch, et al., 2013).
Nursing
responsibilities
Nurse must check if Martha has an allergy of Tramadol prior to
administering it. If Martha is hypersensitive to tramadol, it may lead to
serious complications.
Nurse will also assess Marta’ history in terms of current pregnancy,
alcohol consumption, intake of opioids or other centrally acting
analgesics, seizures; intake of any CNS depressants; renal or hepatic
illness.
Nurse will take any history of opioid addiction as tramadol is
contraindicated in people who are opioid dependent or who have a
history of taking opioids for over 7 days as it may lead to withdrawal
symptoms of opioids.
Nurse will regulate Martha’s environment such as temperature,
lighting, if sweating or any CNS effects occur.
Nurse will educate Martha about the side-effects of tramadol. Teaching
Martha about tramadol in a way that she does not panic yet has enough
information to identify the side effects of tramadol.
Nurse will report any episode of extreme nausea, dizziness or