Respiratory depression

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On the area I work we use a lot of iv meds and especially opiates and sometimes bentos for palliative patients. I am aware that given these can both cause respiratory depression, how fast will this occur after iv admin? What would happen if its not noticed? Once the meds half life has been reached and patient is talking does that mean they are not at risk anymore? What else should I be aware, I'm scared I might miss something? If they aren't given O2 or naloxone fast will they deteriorate quickly?

Yeah I understand that not all palliative patients are end of life, therefore wouldn't be treated the same. As we get such a variety of patients copd ling cancer and chest infection's was more wondering if acidosis chnaged vital signs or caused any changes in actions of patients that may trigger me to aak for an abg. I think it is so important to be aqare of goal of care. Being new its so much to take in just trying to get all the tasks done with such little staff.

Metabolic acidosis would likely manifest as tachypnea and a decreased CO2 level (as seen on CMP). Respiratory acidosis could manifest as hypoventilation, mental status changes, dyspnea, and/or confusion.

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Thankyou. Would the outcome be resp arrest and cardiac arrest if undiagnosed? How fast would that occur?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Thankyou. Would the outcome be resp arrest and cardiac arrest if undiagnosed? How fast would that occur?

Eventually....yes. How fast would depend on the individual patient. You look for the patient that is exhibiting changes. They are suddenly confused or increasingly restless. Or...they can become difficult to arouse.

Respiratory patients are tough as many of them have such abnormal abg's and compensatory mechanisms you look for changes from their baseline.

LOC, orientation, B/P heart rate, O2 sat.

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Specializes in ICU, ED.

IMO, you shouldn't be giving these drugs if you don't know the onset, peak, and duration of action. Especially since it sounds like you give them pretty frequently.

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IMO, you shouldn't be giving these drugs if you don't know the onset, peak, and duration of action. Especially since it sounds like you give them pretty frequently.

This is a great point. It's essential that nurses know what and why they are giving meds. Beyond that, I feel that knowing pharmacokinetics/pharmacodynamics, at least the fundamentals, is also important.

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I was just really looking for advice and experience, is aware the onset is fast and they peak fast and aware of half life's it was more that I am quite new to nursing and wanted ore experienced nurses to give me their opinions and knowledge. I completely agree we should not be expected to work outside our sphere of knowledge and I will always try and ask when I don't know something but when you don't work with nurses who will support and hate to be bothered it can be hard.

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Specializes in Mental Health, Gerontology, Palliative.

No, or at least I wouldn't

Imagine a graph if you will with a straight horizontal line in the middle. This line represents the ideal amount of narcotic/medication needed to manage a palliative patients condition including pain, anxiety, nausea etc.

For example with pain meds, each does has a time when it reaches peak therapeutic level in the patients system, after that depending on the half life of the medication it then exits the system either by the liver or the kidneys.

If you skip a dose, what happens is that the previous dose continues to be excreted form the body but nothing more is being put into the body so the levels of the pain med drop and patient experiences an increase in pain.

I had a case recently where a patient was dying, and it seemed the only two choices were to have this person awake and in intense pain, anxiety and agitation or sleeping as a result of the meds that we were giving them. Ideally I would have liked to be able to achieve more of a middle ground. The family were very clear that if they would much prefer to see their family member sleeping peacefully than awake and in agony.

Also what would you do in the case of palliative patients who's resps decrease as it does seem naloxone or the reverse of benzoa isn't used? Would we skip next doses
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I was just really looking for advice and experience, is aware the onset is fast and they peak fast and aware of half life's it was more that I am quite new to nursing and wanted ore experienced nurses to give me their opinions and knowledge. I completely agree we should not be expected to work outside our sphere of knowledge and I will always try and ask when I don't know something but when you don't work with nurses who will support and hate to be bothered it can be hard.

I understand what you're saying and I'm sorry that you don't work with supportive colleagues; I can imagine that it would be challenging to work in that type of environment. However, your nursing colleagues are not your only resources. You should be familiar with, and able to enlist the help of, any number of online medication resources, your pharmacist, and/or your charge nurse. Being that you are new you SHOULD BE asking alot of questions. If your colleagues are unsupportive, speak with your nurse manager and express how you are feeling. It scares me when I hear someone say that they will "try and ask" when they don't know something because that implies that they sometimes do things when they're not 100% sure of it. I'm not saying that this is what you are doing, but you can imagine that it happens. Just remember that at the end of the day, you worked hard to become a nurse and earn your license; don't do anything to jeopardize that.

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