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 be prepared to administer? A. Naloxone (Narcan) B. Flumazenil (Romazicon) C. Benztropine (Cogentin) D. Meperidine (Demerol)

Short answer

Answer: A. Naloxone (Narcan)

Step-by-step solution

Identify the problem

The client has a respiratory rate of 10, which is lower than the normal respiratory rate. This could be due to the administration of hydromorphone hydrochloride, a powerful opioid analgesic. The problem here is to determine which drug the nurse should be prepared to administer in response to the client's situation.

Examine each of the options and their functions

A. Naloxone (Narcan) is an opioid antagonist, which can reverse the effects of opioid analgesics, such as respiratory depression in case of an overdose. B. Flumazenil (Romazicon) is a benzodiazepine antagonist, used to reverse the effects of benzodiazepine overdose. C. Benztropine (Cogentin) is an anticholinergic drug used to treat Parkinson's disease symptoms and extrapyramidal side effects caused by antipsychotic medications. D. Meperidine (Demerol) is another opioid analgesic, similar to hydromorphone, and would not be appropriate in this situation as it would not help in reversing the effects of hydromorphone.

Choose the appropriate drug

After examining all the options, it becomes clear that the appropriate drug to administer in this situation is Naloxone (Narcan), as it is an opioid antagonist that can reverse the effects of the hydromorphone hydrochloride. Therefore, the correct answer is: A. Naloxone (Narcan)

Key concepts

Opioid Overdose

An opioid overdose occurs when a person takes a toxic dose of an opioid, which can lead to life-threatening issues such as respiratory depression. Opioids like hydromorphone hydrochloride (Dilaudid), as mentioned in the exercise, are powerful pain relievers but can cause serious harm if misused.

Opioids bind to receptors in the brain and nervous system responsible for pain relief, but they also can depress breathing by altering the brain’s responsiveness to carbon dioxide. When too much opioid medication is consumed, the body's natural drive to breathe can be severely diminished, leading to slow and ineffective breathing, or in severe cases, cessation of breathing altogether.

Signs of opioid overdose include:

• Extremely slow or shallow breathing
• Unconsciousness or inability to wake up
• Small, pinpoint pupils
• Limp body
• Pale, blue, or cold skin

It's crucial for healthcare providers to recognize these signs promptly and be prepared to take immediate action, which often involves the administration of an opioid antagonist such as naloxone.

Naloxone Administration

Naloxone, also known as Narcan, is a life-saving medication that can rapidly reverse the effects of an opioid overdose. As indicated in the solution, naloxone is an opioid antagonist, meaning it displaces opioids from their receptors and reverses their effects, especially the respiratory depression.

When administering naloxone, timing is critical. The medication can be given via injection or as a nasal spray, and often, healthcare providers need to act swiftly as the risk of permanent injury or death increases the longer the brain is deprived of oxygen. Moreover, multiple doses of naloxone may be required as the drug has a shorter half-life than many opioids, and respiratory depression can recur.

Naloxone can cause withdrawal symptoms in patients dependent on opioids, including:

• Agitation
• Nausea
• Sweating
• Tachycardia

Despite these potential withdrawal symptoms, the benefits of administering naloxone in the event of an overdose are evident, with the primary goal being to restore normal respiration and prevent death or brain damage.

Respiratory Depression

Respiratory depression involves the inadequate ventilation of the lungs, leading to reduced oxygen intake and increased carbon dioxide in the blood. A major cause of fatal opioid overdose is respiratory depression. It happens when the drug impacts the brainstem's respiratory centers, diminishing the body's automatic response to breathe.

During assessment, medical professionals like nurses need to observe for telltale signs which include a reduced respiratory rate (as in the exercise scenario), shallow breathing, and difficulty in arousal. Normal adult respiratory rates typically range from 12 to 20 breaths per minute, and rates below this threshold, especially as low as 10 breaths per minute, warrant urgent attention.

Effective treatment for opioid-induced respiratory depression begins with support of the airway and breathing, which may include oxygen supplementation and airway clearance. However, the definitive treatment involves the administration of naloxone to counteract the effects of the opioid, thereby restoring the body's respiratory drive and preventing further complications such as hypoxia and brain injury.