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In this lesson, we'll go over the medication morphine sulfate and all of its effects, including indications, precautions and contraindications, and adult dosages. And at the end of the lesson, we take a look at respiratory distress.

Morphine sulfate is a mu-opioid receptor agonist used to relieve pain. It produces analgesic effects by binding to mu-opioid receptors in the central nervous system.

Morphine Sulfate Indications

Now let's take a look at morphine sulfate indications.

Morphine sulfate is indicated for chest pain that is refractory to the use of nitroglycerin.

Morphine Sulfate Precautions and Contraindications

Now let's go over the precautions and contraindications for morphine sulfate.

Opioids, like morphine sulfate, are known to depress the respiratory system and may also lower blood pressure. For this reason, consider using a reduced dosage in older patients or those patients with an altered level of consciousness.

Adult Dosage of Morphine Sulfate

Now let's look at the adult dosage of morphine sulfate.

Morphine sulfate may be given to patients in 2 to 4 mg increments via slow IV push. Additional morphine can be given in doses of 2 to 8 mg 5 to 15 minutes after the first dose.

Pro Tip: Be sure to titrate the dose of morphine to the patient's response and effects. If you notice signs of hypotension, hypoventilation, bradycardia, or any other serious central nervous system depression symptoms appear, naloxone may be given at 0.4 to 2 mg via IV to reverse the opioid side effects.

Also, be aware that gastrointestinal upset may occur in higher doses as well.

A Word About Respiratory Distress

As respiratory depression can occur with the use of morphine sulfate, we're going to dive a little deeper into the three types of respiratory issues – respiratory distress, respiratory failure, and respiratory arrest. In this Word, we'll first look at respiratory distress.

Normal and Abnormal Breathing

The average respiratory rate for an adult is about 12 to 16 respirations per minute. Normal tidal volume of 8 to 10 ml per kg will maintain normal oxygenation and the elimination of CO2.

Tachypnea occurs when the patient's respiratory rate is above 20 respirations per minute, while bradypnea occurs when their respiratory rate falls below 12 respirations per minute. A respiratory rate below 6 respirations per minute (known as hypoventilation) will require assisted ventilation with a bag-mask device or an advanced airway with 100 percent oxygen.

Respiratory Distress

Respiratory distress is a clinical state that is characterized by an abnormal respiratory rate (such as tachypnea) or effort. The respiratory effort may be increased (such as nasal flaring, retractions, and the use of accessory muscles) or it may be inadequate (like hypoventilation or bradypnea).

Respiratory distress can range from mild to severe. For instance, a patient with mild tachypnea and a mild increase in respiratory effort with changes in airway sounds would be considered in mild respiratory distress.

A patient with marked tachypnea, a significantly increased respiratory effort, a deterioration in skin color, and changes in their mental status would be considered in severe respiratory distress.

Severe respiratory distress can be an indication of respiratory failure. Clinical signs and symptoms of respiratory distress will typically include a few, or all, of the following signs:

  • Tachypnea
  • Increased respiratory effort, such as nasal flaring and retractions
  • Inadequate respiratory effort, such as hypoventilation or bradypnea
  • Abnormal airway sounds, such as stridor, wheezing, and grunting
  • Tachycardia
  • Pale, cool skin; however, it's important to note that some causes of respiratory distress, such as sepsis, may cause the skin to get warm, red, and diaphoretic
  • Changes in the patient's level of consciousness and/or agitation
  • The use of abdominal muscles to assist the patient with breathing

It's also important to note that these indicators may vary in severity.

Respiratory distress should be apparent when a patient tries to maintain adequate gas exchange despite airway obstruction, reduced lung compliance, or lung tissue disease. As the patient begins to tire or as respiratory function or effort (or both) deteriorate, adequate gas exchange cannot be maintained. When this happens, clinical signs of respiratory failure will develop.