Dilaudid (hydromorphone) is a potent opioid analgesic used to manage moderate to severe pain. It is approximately 5-7 times more potent than morphine and requires careful nursing assessment and monitoring due to its strong effects and potential for adverse reactions.
Generic name: Hydromorphone hydrochloride
Brand names: Dilaudid, Dilaudid-HP, Exalgo, Hydromorph Contin (CAN), Palladone
Pharmacologic class: Opioid analgesic
Therapeutic class: Narcotic analgesic
Mechanism of action: Hydromorphone binds to mu-opioid receptors in the central nervous system (CNS), altering the perception of and emotional response to pain. It also produces sedation and respiratory depression through its effects on the brain stem.
Indications for use: Management of moderate to severe acute and chronic pain, including:
- Post-operative pain
- Cancer-related pain
- Severe trauma pain
- Burns
- Labor pain
- Severe back pain
- End-of-life pain management
Precautions and contraindications:
- Hypersensitivity to hydromorphone or other opioids
- Significant respiratory depression
- Acute or severe bronchial asthma
- Paralytic ileus
- Severe liver or kidney impairment
- Pregnancy (Category C)
- Breastfeeding mothers
- Elderly patients
- History of substance abuse
Drug Interactions
- CNS depressants (benzodiazepines, alcohol, barbiturates) increase the risk of respiratory depression
- MAO inhibitors can cause severe reactions, including serotonin syndrome
- Muscle relaxants increase the risk of respiratory depression
- CYP3A4 inhibitors or inducers may affect hydromorphone metabolism
- Anticholinergic medications may increase the risk of urinary retention and severe constipation
Adverse Effects
- Respiratory depression (most serious)
- Sedation and drowsiness
- Confusion and dizziness
- Nausea and vomiting
- Severe constipation
- Urinary retention
- Hypotension
- Pruritus
- Euphoria or dysphoria
- Physical dependence and tolerance
- Miosis (pupillary constriction)
Administration Considerations
Available preparations:
- Immediate-release tablets (2, 4, 8 mg)
- Extended-release tablets (8, 12, 16, 32 mg)
- Oral liquid (1 mg/mL)
- Injectable solution (1, 2, 4, 10 mg/mL)
- Suppositories (3 mg)
Typical adult dosages:
- Immediate-release oral: 2-4 mg every 4-6 hours as needed
- Extended-release oral: 8-64 mg once daily
- IV/IM: 0.2-1 mg every 2-3 hours as needed
- Initial doses should be reduced in elderly or debilitated patients
Nursing Considerations for Dilaudid
Related Nursing Diagnoses
- Acute pain
- Chronic pain
- Risk for respiratory depression
- Risk for falls
- Risk for constipation
- Risk for injury related to CNS depression
- Risk for opioid dependence
Nursing Assessment
Perform comprehensive pain assessment, including location, intensity, quality, and timing.
Complete thorough health history focusing on:
- Previous opioid use and tolerance
- Respiratory conditions
- Liver and kidney function
- History of substance abuse
- Current medications
Assess vital signs, including respiratory rate, depth, and pattern.
Monitor level of consciousness and mental status.
Assess for signs of opioid toxicity:
- Respiratory depression (rate < 12)
- Extreme drowsiness
- Pinpoint pupils
- Hypotension
- Cold, clammy skin
Nursing Interventions
Implement appropriate pain management protocols and documentation.
Use proper identification procedures before administration:
- Two patient identifiers
- Right medication
- Right dose
- Right route
- Right time
- Right documentation
Monitor respiratory status closely:
- Maintain the head of the bed at 30 degrees
- Assess respiratory rate before and after administration
- Monitor oxygen saturation
- Have naloxone readily available
Implement fall precautions due to CNS effects.
Monitor for and prevent constipation:
- Increase fluid intake
- Encourage mobility when appropriate
- Implement bowel protocol as ordered
- Monitor for signs of dependence or tolerance.
Patient Teaching Associated with Dilaudid
Explain the importance of taking medication exactly as prescribed:
- Never crush or break extended-release tablets
- Do not adjust doses without consulting healthcare provider
- Keep track of the timing between doses
Educate about signs of overdose requiring immediate medical attention:
- Difficulty breathing
- Extreme drowsiness
- Inability to wake up
- Cold, clammy skin
- Confusion
- Severe dizziness
Discuss lifestyle modifications:
- No alcohol consumption
- No driving or operating machinery
- Rise slowly from lying/sitting positions
- Use assistive devices as needed
Explain the prevention of constipation:
- Increase fiber intake
- Stay well hydrated
- Exercise as tolerated
- Use prescribed stool softeners
Stress proper storage and disposal:
- Keep medication secure and away from children
- Do not share medication
- Dispose of unused medication properly through approved take-back programs
Discuss the importance of:
- Regular follow-up appointments
- Reporting side effects
- Gradual discontinuation under medical supervision
- Having naloxone available at home
This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult with a pharmacist for complete information.
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Bc, J. B. D. A., Rosenthal, L., & Yeager, J. J. (2021). Study Guide for Lehne’s Pharmacology for Nursing Care. Saunders.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011 Mar-Apr;14(2):145-61. PMID: 21412369.
- Quigley C. Hydromorphone for acute and chronic pain. Cochrane Database Syst Rev. 2002;(1):CD003447. doi: 10.1002/14651858.CD003447. Update in: Cochrane Database Syst Rev. 2013 Oct 25;(10):CD003447. doi: 10.1002/14651858.CD003447.pub2. PMID: 11869661.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
