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What risk factors does John have for risk of opioid withdrawal during this hospitalization?

John, a 46-year-old African American male presents for admission to your hospital for hemi colectomy for colon polyps. He is complaining of chronic back pain. Patient is on disability from work-related injury. History of two previous back surgeries with relief of numbness in RLE, but pain has not been relieved. His current medications include Methadone, Neurontin, and Norco. John states he takes Tylenol PM every night in addition to his prescribed medications. John is a smoker and smokes 1 PPD. John confides in you that he is considering a spinal cord stimulator for the chronic pain.

  • What risk factors does John have for risk of opioid withdrawal during this hospitalization?
  • Is there a stigma connected to being disabled and/or methadone?
  • Does the nurse need to be concerned about acetaminophen use?
  • What are the differences in acute and chronic pain?
  • REFERENCE:
  • Jarvis, C. (2016). Physical examination & health assessment (7th ed.). Philadelphia, PA: Saunders.
  • Chapter 10: Pain Assessment: The Fifth Vital Sign

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Opiate drugs, including prescription painkillers and heroin, can produce withdrawal symptoms just hours after the last dose, and the symptoms can last for a week or more.
 Unassisted withdrawal may not be life-threatening, but it can lead to relapse. Medications and therapy, accessed in medical detox, may make relapse less likely. Opiate withdrawal symptoms may range from mild to severe, depending on how dependent the individual is on an opioid drug. Dependency can be directly tied to the length of time taking a particular drug, dosage amount, which drug was taken, how the drug was taken, underlying medical conditions, the co-occurring presence of a mental health issue, and certain biological and environmental factors, such as family history of addiction, previous trauma, or highly stressful and unsupportive surroundings. Withdrawal from an opioid drug may roughly adhere to the following timeline, although it can vary from person to person…

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