Opioid-induced respiratory depression (OIRD) is the life-threatening suppression of the respiratory drive caused by mu-opioid receptor (MOR) agonism in the brainstem's pre-Botzinger complex — the central respiratory rhythm generator. OIRD is defined clinically as a respiratory rate of 8 breaths/min or fewer, SpO2 <90%, or a sedation level that prevents the patient from maintaining airway patency. It is the leading mechanism of opioid overdose death and a critical nursing safety priority in any setting where opioids are administered. Consequence if missed: Untreated OIRD progresses within minutes to hypoxic respiratory failure, cardiac arrest, and anoxic brain injury. Death from opioid overdose occurs within 1–5 minutes of apnea. Top 3 nursing priorities: 1. Continuous monitoring of respiratory rate, sedation level (Pasero Opioid-Induced Sedation Scale — POSS), and SpO2 for ALL patients receiving opioids 2. Immediate naloxone administration and airway support when POSS is 3 or higher, or RR is 8 or fewer 3. Identify and address modifiable risk factors before initiating opioid therapy (concurrent CNS depressants, sleep apnea, hepatic/renal impairment) Common NCLEX trap: Candidates focus on respiratory rate alone and miss the...