A patient is admitted to the emergency department in respiratory depression following self-injection with hydromorphone. The admitting nurse knows that which drug will reverse respiratory depression caused by opioid overdose?

Morphine is a potent opioid analgesic commonly used for postoperative pain. While effective for pain relief, it has several predictable adverse effects due to its action on the central nervous system and gastrointestinal tract. Nurses must educate patients about these effects and implement strategies to manage or prevent them.

Rationale for correct answers:

B. Constipation:
Opioids decrease gastrointestinal motility, leading to constipation. Patients should be encouraged to increase fluid intake, dietary fiber, and activity, and stool softeners or mild laxatives may be prescribed prophylactically.

C. Pruritus:
Morphine can cause itching due to histamine release. This is usually mild but may require antihistamines if bothersome.

E. Nausea:
Opioids often stimulate the chemoreceptor trigger zone, leading to nausea and sometimes vomiting. Anti-emetic medications may be needed.

Rationale for incorrect answers:

A. Diarrhea:
Morphine decreases gut motility rather than increases it, making diarrhea uncommon unless the patient has other contributing factors.

D. Urinary frequency:
Opioids may cause urinary retention rather than increased frequency, due to relaxation of bladder detrusor muscles and increased sphincter tone.

Take-home points:

• Constipation, pruritus, and nausea are common opioid adverse effects.
• Preventive measures, such as stool softeners and antiemetics, should be part of patient teaching.
• Monitor for these effects to ensure patient comfort and adherence to pain management therapy.

Opioid therapy via PCA (patient-controlled analgesia) is effective for postoperative pain, but overdose or accumulation can cause life-threatening respiratory depression. When a patient is found unresponsive with shallow respirations, the immediate priority is to reverse the opioid’s effects with an antagonist such as naloxone. Rapid intervention can prevent respiratory arrest and stabilize the patient before additional assessments or notifications are made.

Rationale for correct answer:

C. Administer an opiate antagonist per standing orders:
Naloxone is the antidote for opioid-induced respiratory depression. Given this patient’s unresponsiveness and low respiratory rate, reversal must occur immediately to restore adequate ventilation and prevent further complications.

Rationale for incorrect answers:

A. Notify the charge nurse:
While communication is important, notifying others delays lifesaving intervention. The nurse must act first to stabilize the patient.

B. Draw arterial blood gases:
ABG testing can help determine the extent of respiratory compromise, but it is a diagnostic step, not a priority in an emergency. Immediate reversal with naloxone takes precedence.

D. Perform a thorough assessment, including mental status examination:
A full assessment is important, but not before addressing the acute emergency of respiratory depression. Stabilization comes first, then further assessment.

Take-home points:

• Naloxone is the antidote for opioid-induced respiratory depression and must be administered immediately when a patient is unresponsive and hypoventilating.
• In emergencies, airway and breathing stabilization come before notification and diagnostics.
• Nurses must recognize signs of opioid toxicity early and act rapidly to prevent respiratory arrest.