Patient Monitoring A 70 year old client is receiving a continuous infusion of IV morphine sulfate to help manage severe chronic pain during their hospital stay. Upon examination, the client is more lethargic than usual and the nurse observes a significantly lower respiration rate (breaths per minute) According to the client data, choose 2 Actions to Take, a Potential Complication, and 2 Parameters to Monitor from the options below.

• Stop the morphine infusion: The client exhibits lethargy and significantly reduced respiratory rate, which are classic signs of opioid-induced respiratory depression. Stopping the infusion immediately prevents further drug accumulation and reduces the risk of life-threatening hypoventilation. This action is the first critical step in managing suspected opioid overdose. • Prepare to administer naloxone: Naloxone is an opioid antagonist that rapidly reverses the effects of opioid overdose, including respiratory depression and sedation. Preparing for administration ensures timely intervention if the client’s respiration continues to decline or oxygen saturation drops. Early readiness supports safety and can prevent hypoxic injury. • Review the patient's allergy list: While reviewing allergies is always good practice, it is not immediately relevant to acute opioid-induced respiratory depression. The current priority is stabilizing breathing and reversing overdose. • Prepare to administer flumazenil: Flumazenil is a benzodiazepine antagonist and is not effective for opioid toxicity. Administering it would not reverse morphine-induced respiratory depression. Using flumazenil in this context could delay appropriate treatment and worsen hypoxia. • Gastrointestinal (GI) bleeding: GI bleeding is unrelated to the acute lethargy and respiratory depression seen in opioid overdose. The client shows no signs of melena, hematemesis, or hypotension from bleeding. • Opioid overdose: The client’s lethargy and bradypnea are hallmark signs of opioid overdose, particularly in the context of continuous IV morphine infusion. Overdose can lead to hypoxia, brain injury, or death if not addressed promptly. The risk is heightened in older adults due to altered pharmacokinetics and decreased respiratory reserve. • Malignant hyperthermia: Malignant hyperthermia is a rare reaction to certain anesthetic agents, characterized by hyperthermia, muscle rigidity, and metabolic acidosis. It is not associated with IV opioid infusion. • Local anesthetic systemic toxicity (LAST): LAST occurs with excessive absorption of local anesthetics, causing CNS and cardiovascular symptoms such as seizures or arrhythmias. The client is receiving IV morphine, not local anesthetics, so this is not applicable. • Decreased respiration rate (breaths per minute): Monitoring respiratory rate is essential to assess the severity of opioid-induced respiratory depression. Continuous assessment allows the nurse to determine the effectiveness of interventions and identify deterioration. Declining respiratory rate signals worsening overdose, guiding escalation of care. • Signs of withdrawal: If naloxone is administered or the morphine infusion is abruptly stopped, the client may develop opioid withdrawal symptoms such as agitation, nausea, or tremors. Monitoring for withdrawal ensures appropriate supportive care and symptom management. Early recognition allows gradual titration or adjunct therapy to minimize distress. • Reduced blood in stools: This parameter monitors for GI bleeding, which is unrelated to opioid overdose or respiratory depression. Observing stool for blood does not guide immediate management of lethargy or bradypnea. • Cooling of body temperature: Hypothermia is not a common feature of opioid overdose. Temperature changes may occur in other conditions but are not relevant for monitoring acute morphine toxicity. Focus should remain on respiratory and neurological parameters.