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NURS 3046 Nursing Project

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NURS 3046 Nursing Project

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Course Code: NURS3046
University: University Of South Australia

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Country: Australia

Question:

Demonstrate extensive review of the literature and in-depth analysis of chosen topic:
Topic: Use of Opioid in dialysis patients

Answer:

Use of Opioid in dialysis patients
Kidney disease is quite common nowadays and the association of pain is very much concerning among the people who are suffering from chronic kidney disease. When a patient lose 85-90% of kidney function, dialysis is required at that stage (Kimmel et al. 2017). That time, dialysis keeps the body balanced by removing salt, waste as well as extra water to prevent them from building up inside the body. It also helps to maintain the level of certain chemicals in the blood to control the pressure of blood in the human being. In most of the cases kidney failure is permanent but in some exceptional cases kidney failure is cured after some acute treatment. However, in both the cases, until the kidney begins to function properly, dialysis is required to maintain the balance and even it can be continued for the rest of the life also (Olivo et al. 2015). Pain and dialysis are interrelated and one of the major after effect of dialysis is pain. Dialysis is painful and in order to manage the pain, several drugs and medicines are used among the patients and one of them is Opioid.
Investigators found from many studies that almost two-third of the dialysis patients received at least one opioid prescription per year during their treatment process and among them 20% received the repeated prescription of opioid (Kimmel et al. 2017). According to a news release journal, more than 25% of patients who were given opioid prescription received higher than recommended doses (Kimmel et al. 2017). However, many studies revealed that use of opioids leads to addiction and overdose of it is also a leading cause of increased deaths among the dialysis patients (Kimmel et al. 2017). The patients of chronic kidney disease mainly suffer from excessive pain due to various causes. Sometimes the pain occurs due to nerve damage. Since, mid 1990s the use of opioids has been increased in the United States (Kimmel et al. 2017). 50% long term dialysis patients reported that they suffer from excessive chronic pain and 75% of them stated their pain management is inadequate and among the sufferers 55% described that their pain sometimes last up to 24 hours which is extremely unbearable for them (Atkinson, Fudin and Bettinger 2014). Unfortunately, there is no any particular medication to prevent the pain but it can be managed by providing some pain killers with the action of sleeping pills. Opioids block the pain message signal to the brain so the patient cannot feel it for some time and when the patient gets some relief from pain it helps them to sleep for hours without having any pain. However, sometimes patients are more likely to consume it going beyond the prescribed solutions and overdose of opioids can cause serious health issues as it creates addiction among the patients and even in some cases it also leads to the death of the patient.  Excessive use of it can hamper the proper functioning of the nervous system which in turn produces adverse effects on health such as the patient might become drowsy, uncoordinated, and inattentive and these are the leading cause of fall risk and at the same time it is responsible for the dysfunction of brain among the patients (Silverman et al. 2017). 
In order to find the effects of opioids, various studies have been organized. In the year 2011, U.S. Renal Data System (USRDS) organized a study on the hemo-dialysis patient who received opioids and among them 17% stated that they experienced at least one episode of altered mental status fractures or falls and altered mental status was the highest incidence of 11% (Williams 2018). Sometimes opioids are not preferred to recommend in the renal failure as it cause seizures among the patients. Some opioids have been reported to cause profound toxicity among the patients. However, the most likely to die from opioid related causes are the addicted patients for whom it becomes an overdose because there is a strong correlation between overdose and adverse effects.
Opioids are basically morphins and some similar drugs are derived from opium. If in chronic problem like kidney disease and dialysis, it is used regularly then it will cause dependence and addiction for the drug and at the same time it will also develop the drug tolerance among the patients and after a period of regular use, it will become a failure in pain management too. Some dose of medicine will not be helpful to relieve the pain and patient will look forward to the overdose of it which in turn will lead to the death of the patient. When doctors prescribe the medicine in the pain management of dialysis, at the beginning they get relief but addiction occurs and patients will find difficulty in stopping the use of this drug. As a result they will also face depression, poor appetite, constipation and several other serious side effects of using excessive opioids in managing pain (Pham et al. 2017). However, many researchers said that pain management can be difficult in dialysis as people suffer from severe pain due to this but use of opioids should not be the first option as a pain management tool rather it should be applied as the last option when nothing is working properly to manage the pain (White 2018). On the basis of calculated GFR value among the dialysis patient, some authors recommended the dosage reduction of opioids. Before applying opioids the doctors must consider the factor of caution of using it. However, some studies related to this have also revealed that with careful monitoring of the doctors and limiting the dosage, the drug can be used safely among the patient of dialysis. The normal and moderate amount of opiods can be helpful in the pain management of dialysis and it adequately relieves pain without having any adverse effect upon the health of the patient. It is the prime responsibility of the doctors to specify the exact dose of opioids to be taken for pain management in order to avoid adverse effects on health which can be extremely dangerous (Cheatle 2015).
Sometimes pain management becomes very much difficult in some chronic diseases like renal failure or dialysis. Opioids have a good recognition in managing the pain of patient. However, controversy regarding the adverse effects of opioids is quite concerning before the application but limiting the amount of dose cannot be dangerous for the patients. It should be prescribed considering the health condition of the patient too. Patients should also be careful about not exceeding the dosage restricted in the prescription. Educating the patient about the side effects of this drug that can occur due to overdose is also necessary in this regard.    
References
Atkinson, T.J., Fudin, J. and Bettinger, J.J., 2014. Dialysis, opioids, and pain management: Where’s the evidence?. Letters To the Editor.
Cheatle, M.D., 2015. Prescription opioid misuse, abuse, morbidity, and mortality: balancing effective pain management and safety. Pain Medicine, 16(suppl_1),pp.S3-S8.
https://www.pharmacytoday.org/article/S1042-0991(18)30954-X/fulltext
Kimmel, P.L., Fwu, C.W., Abbott, K.C., Eggers, A.W., Kline, P.P. and Eggers, P.W., 2017. Opioid prescription, morbidity, and mortality in United States dialysis patients. Journal of the American Society of Nephrology, 28(12), pp.3658-3670.
Olivo, R.E., Hensley, R.L., Lewis, J.B. and Saha, S., 2015. Opioid use in hemodialysis patients. American Journal of Kidney Diseases, 66(6), pp.1103-1105.
Pham, P.C., Khaing, K., Sievers, T.M., Pham, P.M., Miller, J.M., Pham, S.V., Pham, P.A. and Pham, P.T., 2017. 2017 update on pain management in patients with chronic kidney disease. Clinical kidney journal, 10(5), pp.688-697.
Silverman, S., Raffa, R.B., Cataldo, M.J., Kwarcinski, M. and Ripa, S.R., 2017. Use of immediate-release opioids as supplemental analgesia during management of moderate-to-severe chronic pain with buprenorphine transdermal system. Journal of pain research, 10, p.1255.
White, D.M., 2018. Appropriate Use of Opioids in Patients with Kidney Diseases. Clinical Journal of the American Society of Nephrology, 13(5), pp.675-676.
Williams, R. A. (2018) Opioid treatment is risky in patients on hemodialysis. Pharmacy Today [online]. July. Available from :

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