Naloxone Training: Treating an Opioid Overdose

General Instructions:

In this learning activity, you will discuss the following: opioids, signs of opioid overdose, and Naloxone. Regarding Naloxone, you will learn the following: proper dosage, route of administration, adverse effects, and differences in the administration between adults and children. You will also be presented with a basic treatment algorithm on how to medically address an opiate overdose in the outpatient setting. 

Step 1: Review and Reflect 

Review the necessary learning resources for this module and read the case study below. Reflect on all the student learning objectives.

Tackling Opioid Abuse in Postoperative Patients

VG, a 38-year old male, underwent hemorrhoidectomy using a spinal anesthesia about 48 hours ago in a specialist hospital in Northern Ireland. There were no reported complications. Immediately following the hemorrhoidectomy, the surgeon prescribed, among other medications, pain relievers such as Pentazocine 30 mg orally every six hours, Diclofenac Sodium injection 100 mg intramuscularly every twelve hours, and Paracetamol 500 mg intramuscular injection every eight hours. Although the surgeon proclaimed the operation to be successful, VG still complained of moderate to severe abdominal pains. During the 48-hour observation period in the hospital, VG requested nursing staff to administer the next dose of Pentazocine injection due to severe pains.

VG’s pains worsened when passing stool. Since there were no complications, he  was discharged and placed on Tramadol 100 mg orally every twelve hours. VG resumed his previously sedentary lifestyle with poor diet choices consisting of low fiber intake. His pain gradually increased and he independently increased the dosage of his tramadol to 200 mg orally every eight hours. 

About 48 hours following this dosing increase, VG experienced decreased bowel sounds, body weakness, malaise, and decreased respiratory rate. Suspecting that his condition was related to a possible Tramadol overdose, VG found a Narcan nasal spray (containing four mg per spray). He self administered nasal sprays, alternating nostrils every 2-3 minutes whenever symptoms reemerged, as this appeared to decrease symptoms periodically. Twenty four hours following the tramadol increase, the nasal spray became ineffective and VG attempted to use a Narcan nasal injection (1 mg every 3-5 minutes by alternating nostrils) to no effect. The symptoms worsened to include further constipation, headache, drowsiness, vomiting, heartburn, and dry mouth.

Anxious for help, VG called a friend who drove him to the hospital for further medical attention.

Step 2: Respond. 

Pretend you are a provider at the hospital and VG is now your patient. Prepare a 450-500 word written piece discussing the treatment choices and failures in VG’s case. Ensure that your response includes the following:

• Other signs and symptoms which VG might be experiencing to his opioid overdose
• A brief list of differential diagnoses that you think may be appropriate to consider and why these would be applicable based on the above prompt. You should have a minimum of one differential diagnosis.
• Assuming opiate overdose, the best treatment option for VG’s symptoms once he arrives at the hospital.
• The appropriateness of VG choosing to independently increase his tramadol and whether this new dose was appropriate
• Possible reasons VG’s home-based medications failed; whether VG followed the treatment algorithm appropriately and how he might have improved things (if at all) 
• How would you explain to VG about his medical situation? (Remember to include patient education)

Step 3: Share 

To share your work, click the “Add a new discussion topic” button under this post and paste your work into the “Message” box. Make sure to reference others’ intellectual property when necessary. All references should follow 7th Edition APA formatting. For further instructions, see the resource on the Himmelfarb Health Sciences Library: APA citation resource (N.B.: references are excluded from word counts).

Step 4: Interact 

To complete the activity, you will need to reply to at least two posts made by your peers in a respectful and professional manner. Be sure your post engages your peers' ideas by including a reflection on their comments, sharing ideas on other potential difficulties and parties involved, or asking thought-provoking questions. If a peer comments on your posting, please reply. To post a reply, click “Reply” on a particular discussion, write your feedback and then click “Post to forum.”