A patient has just received 30 mg of codeine by mouth for pain. Five minutes later he vomits. What should the nurse do first?
A. Call the physician
B. Remedicate the patient
C. Observe the emesis
D. Explain to the patient that she can do nothing to help him.
Correct Answer: C. Observe the emesis.
After a patient has vomited, the nurse must inspect the emesis to document color, consistency, and amount. Nausea or vomiting is another commonly seen adverse effect that is expected to diminish the following days to weeks of continued codeine exposure. Antiemetic therapies, in oral and rectal formulations, are available for the treatment of nausea or vomiting.
Option A: The nurse must then notify the physician, who will decide whether to repeat the dose or prescribe an antiemetic. Monitoring should include subjective as well as objective assessment via laboratory testing. There must be documentation of pain intensity, level of functioning, progress toward therapeutic goals, the presence of adverse effects, and adherence to the therapy.
Option B: In this situation, the patient recently ingested medication, so the nurse needs to check for remnants of the medication to help determine whether the patient retained enough of it to be effective.
Option D: Codeine has a half-life of 3 hours. Initial dosing and titration can be individualized depending on the patient’s health status, previous opioid exposure, attainment of therapeutic outcomes, and predicted or observed adverse events.