A nurse is caring for a client on the medical surgical unit. Click to highlight the findings at 1630 that require immediate follow-up. To deselect a finding, click on the finding again. Body System Findings Cardiovascular S1,S2, no murmur, bradycardia Respiratory decreased respiratory effort, equal chest expansion, bilateral crackles Neurologic somnolent Head, Ears, Eyes, Nose, and Throat(HEENT) oropharynx clear, mucous membranes moist, pinpoint pupils Vital Signs Temperature 37.4°C (99.4°F) Heart rate 58/min Respiratory rate 10min Blood pressure 98/58 mm Hg

Recognizing opioid-induced respiratory depression after administration of IV morphine in a postoperative client is important. Morphine is an opioid analgesic that can depress the central nervous system, leading to decreased respiratory drive, sedation, hypotension, and pinpoint pupils. The client’s worsening drowsiness, slow respirations, and decreased responsiveness shortly after receiving morphine strongly suggest opioid toxicity. Immediate identification is critical because untreated respiratory depression can rapidly progress to hypoxia, respiratory arrest, and cardiac arrest. Rationale for correct findings: • Respiratory; decreased respiratory effort, equal chest expansion, bilateral crackles: Decreased respiratory effort is the most urgent sign of opioid-induced respiratory depression. Opioids suppress the respiratory center in the brainstem, causing slow and shallow breathing that reduces oxygen exchange. Bilateral crackles may also suggest retained secretions or fluid accumulation due to poor ventilation. Respiratory compromise is the highest priority. • Neurologic; somnolent: Somnolence indicates excessive CNS depression and reduced responsiveness, which commonly occurs with opioid overdose or excessive opioid effect. A client who is slow to arouse may rapidly progress to unresponsiveness if respiratory depression worsens. Increasing sedation after morphine administration is a major warning sign. This requires urgent reassessment and likely reversal intervention. • HEENT; pinpoint pupils: Pinpoint pupils (miosis) are a classic sign of opioid toxicity and strongly support the suspicion of morphine overdose or excessive opioid response. When seen with respiratory depression and somnolence, this finding is especially concerning. It helps confirm that the symptoms are medication-related rather than another postoperative complication. Immediate intervention is needed. • Vital Signs; Respiratory rate 10/min: A respiratory rate of 10/min is below normal and indicates significant respiratory depression. Opioid administration can suppress respiratory drive, leading to hypoventilation and poor oxygenation. This is one of the earliest and most dangerous indicators of opioid toxicity. Prompt action such as naloxone administration may be required. • Vital Signs; Blood pressure 98/58 mm Hg: Morphine can cause vasodilation and hypotension, especially when combined with sedation and decreased respiratory effort. A drop in blood pressure from baseline suggests worsening hemodynamic status and possible poor tissue perfusion. In combination with bradycardia and CNS depression, this increases concern for opioid excess. Rationale for incorrect findings: • Cardiovascular; S1, S2, no murmur: The normal heart sounds without murmur indicate no acute structural cardiac issue. In this situation, respiratory compromise takes priority over mild bradycardia. Therefore, this finding is monitored but not the most immediate concern. • Vital Signs: Temperature 37.4°C (99.4°F): This temperature is within normal postoperative range and does not indicate fever or infection. There is no evidence of sepsis or acute inflammatory complications. Compared with respiratory depression and decreased consciousness, temperature is not an urgent concern.