Physiological Effects and Opioid-induced Respiratory Depression (OIRD) (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:01 Not unlike alcohol, opioids are a central nervous system depressant.

    00:10 So, it affects their central nervous system. Initially, there's a sense of euphoria, and then there is mental dampening. There are mood changes.

    00:22 What we see as one of the cardinal signs are pinpoint pupils because it's affecting their ocular motor nerves.

    00:31 We see respiratory depression. It also affects their gastrointestinal tract.

    00:39 It slows the movement of food through the colon.

    00:43 That's why if you recall, it has antidiarrheal properties because in slowing down that colon, that also slows down the reabsorption of fluids, and that oftentimes takes care of diarrhea.

    00:59 It affects the heart muscles, the cardiovascular system.

    01:03 Morphine is actually used to reduce pain when a person is having a myocardial infarction or a heart attack.

    01:11 So, you can see how these drugs can be very beneficial when used properly.

    01:18 Opioids affect sexual function as well.

    01:23 It decreases the libido. It decreases sexual functioning.

    01:28 Oftentimes, males will experience erectile dysfunction and there is orgasm failure in both males and females.

    01:40 A person using opioids may have opioid intoxication, okay? And then, the intoxication is that euphoria that then is followed by this psychomotor retardation and a little agitation.

    01:56 What are we gonna see? We're gonna see those pin-pointed pupils.

    02:00 We're gonna start to see some drowsiness.

    02:03 We're going to see the body relax, so we may see some collapse in the body.

    02:09 We're going to start hearing a bit of slurred speech patterns.

    02:19 You may have to say, "I'm sorry, I didn't understand what you were saying.

    02:22 Can you repeat that?" And they may really be just so relaxed, it's hard for them to even respond to you or pay attention to what you're saying.

    02:36 Now, if a person's eyes are mostly closed and we start looking at their pupils, what do we expect? We expect to see larger pupils, right? When their eyes are closed and they open, and we can see them come to a pinpoint.

    02:49 But with a person who has been using heroin, we are gonna see those constricted pin-point pupils right away.

    02:57 Let's speak a minute about opioid induced respiratory depression or OIRD.

    03:04 Respiratory depression induced by the use of opioids is the most common cause of opioid related deaths.

    03:15 So, there is - with an increase in overdoses, we also see an increase in OIRD, especially with fentanyl.

    03:25 I had a patient, she was recovering, she went through detox, she went through in-patient detox, went home, she was going to out-patient detox, and she got to her 20th birthday, and some of her friends had invited her out, and she asked her mom, promised nothing was going to go wrong, mom said, "Fine, please be home by 10:30," the young lady went out, 10:30 and the car drove into the driveway, mom was so happy, the young lady didn't come in right away, mom figured she was on her phone saying goodbye to her friends and doing the rest.

    04:06 By 11:00, she still hadn't come in, so mom went out to the car, and her daughter was there with a needle in her arm and had passed from respiratory depression secondary to injection of the opioid heroin plus fentanyl. What can you do? What can you say to a family member? This young lady, because she had OUD, she had opioid use disorder.

    04:41 One of her friends who was still using gave her as a birthday present, a packet.

    04:48 Not knowing that there was all these fentanyl, and this young lady didn't take it right away.

    04:53 When she got home, she figured she was safe.

    04:56 And unfortunately, it costed her life.

    05:02 So, opioid induced respiratory depression is due to a stimulation of the opioid receptors in the brain in an area that's responsible that generates inspiration.

    05:17 And so, when the involuntary inspiration rate decreases, oxygen saturation in the blood also decreases.

    05:25 The combination of low respiratory rate and adding it to the low oxygen saturation can result in a respiratory arrest.

    05:35 And that is also when a patient dies.

    05:41 So, let's think a moment on a patient case.

    05:46 What are our responsibilities during an overdose of OUD overdose? The cause of the depressed respiration is a decrease in the voluntary breathing response, right? So, what should the nurse do? Carefully monitor the level of sedation experienced by the patient, monitor the respiratory status frequently and apply a pulse oximeter, remind the patient to deep breathe every one to two minutes, be certain that Naloxone is available, and that the nurse knows how to administer it.

    06:27 It's usually administered through the nose now.

    06:30 Naloxone is used to treat overdoses with narcotic analgesics, sedatives, like heroin, fentanyl, benzodiazepines, barbiturates, clonidine, and ketamine.

    About the Lecture

    The lecture Physiological Effects and Opioid-induced Respiratory Depression (OIRD) (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Opioid Use Disorder (Nursing).

    Included Quiz Questions

    1. They cause hypotension.
    2. They cause increased gastrointestinal motility.
    3. They cause pupils to dilate.
    4. They cause increased libido.
    1. “I was prescribed fentanyl because it has the least chance of causing opioid induced respiratory depression.”
    2. “I should change positions slowly, as fentanyl can cause hypotension.”
    3. “I will keep a naloxone kit in my home and show my family members how to use it.”
    4. "Opioid medications depress the central nervous system."
    1. A respiratory rate of 8 breaths per minute
    2. A blood pressure of 110/75 mmHg
    3. A heart rate of 87 bpm
    4. An oxygen saturation of 96%

    Author of lecture Physiological Effects and Opioid-induced Respiratory Depression (OIRD) (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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