Opioid-induced respiratory depression is the most feared adverse effect of morphine and other mu-agonists. Risk factors include older age, opioid naivete, sleep apnea, obesity, concurrent sedatives or benzodiazepines, hepatic or renal impairment, and the first 24 hours of opioid initiation or dose escalation. Standard surveillance: RR, SpO2, level of consciousness, and a sedation scale such as POSS (Pasero Opioid-induced Sedation Scale: 1=awake/alert, 2=slightly drowsy, 3=frequently drowsy/arousable/drifts off mid-conversation, 4=somnolent/minimal response). Treatment of clinically significant respiratory depression: (1) hold further opioid, (2) stimulate the patient and apply oxygen by face mask 8 to 10 L/min while preparing equipment, (3) administer naloxone 0.04 to 0.4 mg IV slowly, titrated to restore respirations and arousability without precipitating severe withdrawal or pain — repeat every 2 to 3 minutes as needed, (4) call rapid response, monitor q5 to q15 minutes given naloxone half-life is shorter than morphine; rebound respiratory depression is common, naloxone infusion may be needed, (5) document and notify prescriber. Documenting alone, giving more morphine, or restraining are unsafe.
In-depth explanation
Stop opioid, stimulate and oxygenate, give naloxone in small titrated doses, and watch for renarcotization. POSS 4 plus RR 8 is the classic NCLEX picture for naloxone.
For study reference only. Always follow current clinical guidelines and your institution’s protocols.