Red flags — act immediately

Opioid-induced respiratory depression — unarousable or minimally responsive, respiratory rate below the ordered threshold, shallow or absent breathing, or pinpoint pupils with depressed consciousness → give naloxone per order and activate EMS; support the airway and breathing.

Increasing sedation — difficult to rouse — with a falling respiratory rate → hold the opioid and notify urgently; sedation precedes respiratory depression.

Naloxone unavailable or expired in a patient on opioids → obtain a replacement urgently; notify.

No bowel movement within the ordered interval, or distension, pain, and vomiting → possible obstruction or impaction; notify (cross-reference Gastrointestinal).

Pain persistently above the functional goal despite the ordered regimen → notify for a plan review; uncontrolled pain is also a skilled concern.

Concurrent alcohol or a sedating agent with opioids → notify for the compounded respiratory-depression risk.