e. Postural Hypotension. When the client sits up or stands up, he may
experience the effects of low blood pressure. That is, he may become dizzy and even
faint. This is called postural hypotension or orthostatic hypotension.
f. Constipation. Since morphine has a constipating effect, paregoric, which
contains opium, is used to treat diarrhea.
g. Miosis. Morphine causes the pupils to contract.
3-20. TOLERANCE, ADDICTION, AND HABITUATION
a. Tolerance is the condition which develops after the continued use of a drug
and which requires the use of progressively larger doses of the drug to achieve the
same effect. Tolerance does not occur with all drugs, but it does occur with narcotic
analgesics. Tolerance is not the same as addiction.
b. Addiction (physical dependence) occurs when a drug must be present in the
body to maintain physiological balance. If administration of the drug stops, the
individual experiences a withdrawal state. A withdrawal state is characterized by
excitement, anxiety, nasal discharge, sweating, and goose-flesh, and -- in the case of
severe withdrawal state -- pain in the muscles, joints, abdomen, fever, and even
convulsions. Normally, this severe degree of withdrawal is seen only in addicts who
have been unable to make a "connection" or who have been put in prison. In a
controlled situation, when the client has been receiving narcotics for valid medical
reasons, withdrawal is usually mild, and the client usually does not even realize the
source of his discomfort. (Once an addict has endured the withdrawal state, however,
he is still not free from his compulsion to use narcotics. In fact, the typical addict lives a
life in which he repeatedly withdraws and returns to the use of narcotics.)
c. Habituation is a psychological dependence on drugs. We have seen how
individuals may become habituated to the use of sedatives because they mentally
associate relief from anxiety with the administration of the sedative. When the addict
injects heroin, he experiences a pleasurable "rush." The addict, even after withdrawal,
may be convinced that the use of heroin is essential to a feeling of well being, that
without it he is unable to cope with his life and environment. (The addict typically has
serious anxieties related to pain, sexuality, and feelings of aggression.) These factors
may cause the addict to remain psychologically dependent on, that is, habituated to,
narcotics even when he is no longer physically dependent on them.
3-21. CAUTIONS FOR THE USE OF NARCOTIC ANALGESICS
a. One of the main contraindications for the use of narcotic analgesics is a
client's lack of sufficient respiratory reserve to withstand the respiratory depressions
caused by narcotic analgesics. This is especially true of clients with emphysema,
kyphoscoliosis (in which the spine is curved backwards or to the side), corpulmonale
(heart disease secondary to lung disease), and sometimes extreme obesity.