Question

The nurse assesses a respiratory rate of 10 on a client with cancer who has just received a hydromorphone hydrochloride (Dilaudid) injection. Which drug should the nurse expect to be administered? A. Naloxone (Narcan) B. Flumazenil (Romazicon) C. Benztropine (Cogentin) D. Meperidine (Demerol)

Short answer

Answer: A. Naloxone (Narcan)

Step-by-step solution

Identify the issue

The main issue here is the client's respiratory rate of 10 after being administered hydromorphone hydrochloride (Dilaudid). This indicates that the client may be experiencing respiratory depression, which is a common side effect of opioid analgesics.

Review the drug options

We are given four drug options to choose from: A. Naloxone (Narcan) B. Flumazenil (Romazicon) C. Benztropine (Cogentin) D. Meperidine (Demerol)

Determine the function of each drug

Each drug has different properties and functions: A. Naloxone (Narcan) is an opioid antagonist used to reverse the effects of opioid drugs, particularly respiratory depression. B. Flumazenil (Romazicon) is a benzodiazepine antagonist commonly used to reverse the sedative effects of benzodiazepines. C. Benztropine (Cogentin) is an anticholinergic drug primarily used to treat Parkinson's disease symptoms. D. Meperidine (Demerol) is an opioid analgesic, similar to hydromorphone hydrochloride (Dilaudid), and would not be helpful in this situation.

Select the appropriate drug

Based on the functions of each drug and the situation presented, the most appropriate drug to administer would be Naloxone (Narcan) since it is used to reverse the respiratory depression caused by opioid drugs.

Answer

The correct answer is: A. Naloxone (Narcan).

Key concepts

Opioid Overdose Management

Managing an opioid overdose is critical to prevent life-threatening complications, such as respiratory depression. Opioids, such as hydromorphone hydrochloride (Dilaudid), are potent pain medications that have the potential to depress the central nervous system at high doses or when used incorrectly. Symptoms of an overdose include shallow breathing, drowsiness, inability to wake up, and a respiratory rate that may drop dangerously low.

When faced with a potential opioid overdose, as indicated by a low respiratory rate like in the given exercise, immediate intervention is necessary. Healthcare providers monitor vital signs, secure the airway, and prepare to administer the appropriate medication to reverse the effects of the opioid. Timing is crucial because prolonged hypoxia can lead to irreversible damage. Thus, quickly recognizing the signs and having a management plan ready could mean the difference between life and death.

Respiratory Depression

Respiratory depression is a severe side effect of opioid use, often characterized by a decrease in the ability to breathe deeply or rapidly enough to maintain normal oxygen and carbon dioxide levels in the blood. In the context of opioid analgesics, this condition occurs because these drugs act on the brainstem's respiratory centers, altering the body's response to carbon dioxide.

It's vital for healthcare practitioners to assess the breathing pattern and frequency of patients under opioid treatment. Early signs of opioid-induced respiratory depression include slow and shallow breathing, reduced urge to breathe, or a significant drop in respiratory rate—as showcased in the exercise scenario with a rate of 10 breaths per minute. Standard practice is to observe the patient's respiratory function regularly, especially after administration of a known respiratory depressant drug like hydromorphone hydrochloride.

Naloxone Administration

Naloxone (Narcan) is the medication of choice to counteract life-threatening respiratory depression due to an opioid overdose. It is an opioid antagonist, which means it binds to the same receptors in the brain that opioids do but does not activate these receptors. Instead, naloxone effectively blocks or displaces opioids from these receptors, swiftly reversing their effects.

When it comes to administration, naloxone can be given intravenously, intramuscularly, subcutaneously, or via nasal spray. The route of administration is chosen based on the clinical situation and the available formulation. Since naloxone has a shorter half-life than most opioids, repeated doses may be necessary to prevent recurrence of respiratory depression.

The onset of action is rapid, often restoring adequate spontaneous breathing within minutes. Nurses and first responders must monitor patients after administration for signs of withdrawal and recurrence of overdose symptoms, as additional treatment or supportive care may be required.