Physiological Integrity Q 44
An elderly client with an abdominal surgery is admitted to the unit following surgery. In anticipation of complications of anesthesia and narcotic administration, the nurse should:
A. Administer oxygen via nasal cannula
B. Have narcan (naloxone) available
C. Prepare to administer blood products
D. Prepare to do cardio resuscitation
Correct Answer: B. Have narcan (naloxone) available
Narcan is the antidote for narcotic overdose. Naloxone is indicated for the treatment of opioid toxicity, specifically to reverse respiratory depression from opioid use. It is useful in accidental or intentional overdose and acute or chronic toxicity. Common opioid overdoses treated with naloxone include heroin, fentanyl, carfentanil, hydrocodone, oxycodone, methadone, and others.
Option A: If hypoxia occurs, the client should have oxygen administered by mask, not cannula. The incidence of naloxone-induced noncardiogenic pulmonary edema is estimated to be between 0.2% and 3.6% of patients who have received naloxone and are transported to the emergency department. Symptoms include persistent hypoxia, despite the resolution of respiratory depression secondary to acute overdose. Patients may also have a cough productive of the classic “pink, frothy sputum” indicative of pulmonary edema.
Option C: In chronic opioid users, naloxone requires slow administration to individuals who are dependent on opioids. All patients who have responded to naloxone should be continuously monitored for at least six to 12 hours since some opioids (methadone, fentanyl, buprenorphine) have a much longer half-life than naloxone.
Option D: There is no data to support cardiac resuscitation in this case. The patient should have vital signs, including pulse oximetry, monitored until obtaining a full recovery. Even after reversing respiratory depression, the patient must be monitored for at least six to 12 hours because the patient may have ingested the longer-acting opioids, which will continue to exert their effects after excretion of the naloxone. Any patient that requires IV naloxone of doses more than 5 mg should be admitted.