Assessing for Respiratory Depression

Always assess respiratory rate and sedation level before administering an opioid, and hold the dose if respirations are below 10-12/min or the patient is difficult to arouse — sedation precedes respiratory depression, so a rising sedation score is the earliest warning sign, not just the respiratory rate itself. Use a sedation scale (e.g., POSS) alongside pulse oximetry and capnography in high-risk patients. NCLEX often presents a patient reporting pain of 8/10 but who is also lethargic with respirations of 8/min — the correct action is to withhold the dose and reassess, not automatically medicate for pain.

Naloxone Administration

Naloxone reverses opioid-induced respiratory depression by competitively displacing opioids from receptors, but its duration (30-90 minutes) is often shorter than the opioid itself, so repeat dosing and close monitoring for re-sedation are essential. Reversing too aggressively in a chronic opioid user can precipitate acute withdrawal and severe pain, so titrate to adequate respiratory rate, not full alertness. Have resuscitation equipment available. After naloxone, continue monitoring respiratory status for at least 2 hours because the opioid may outlast the antidote.

Managing Common Adverse Effects

Constipation is the one opioid side effect patients do not develop tolerance to, so a stimulant laxative and stool softener should be started prophylactically with any scheduled opioid, not just PRN. Monitor for urinary retention, pruritus (often histamine release, not a true allergy, especially with morphine), and orthostatic hypotension — instruct patients to change positions slowly. For PCA pumps, only the patient should press the button, never family or staff, to prevent oversedation from someone dosing on the patient's behalf.