Four clients in labor are requesting pain relief. The nurse understands that which client can safely receive a dose of IV butorphanol tartrate, an opioid agonist-antagonist, at this time?

Question

Four clients in labor are requesting pain relief.  The nurse understands that which client can safely receive a dose of IV butorphanol tartrate, an opioid agonist-antagonist, at this time?

Quizplus · Accepted Answer

11ecbb05_cc01_e766_b433_5dc872d1d086_MD0009_00 Opioid agonist-antagonist medications used in labor include butorphanol tartrate (Stadol) and nalbuphine hydrochloride (Nubain). Maternal adverse effects include sedation, dizziness, and nausea. Butorphanol tartrate crosses the placental barrier, peaking in 30-60 minutes; its duration of action is approximately 2-4 hours. If given near the time of birth, there is a risk for newborn respiratory depression, which may require naloxone (Narcan) to reverse the effects. IV opioids are safest for clients who will give birth 2-4 hours after administration so that the opioid effect has time to wear off before the birth. IV opioids are also best for clients in active labor or those with a well-established contraction pattern because opioid administration may slow labor progression in the latent phase (Option D). (Option A) Although this client is in active labor, recent heroin use is a contraindication to opioid agonist-antagonists because of the risk for maternal and/or fetal withdrawal symptoms. (Option B) An urge to push may indicate imminent birth, especially in a multiparous client. To ensure newborn safety, imminent birth is a relative contraindication for the administration of narcotics. (Option C) Opioid administration in latent labor may slow labor progression. In addition, medication adverse effects (eg, sedation, dizziness) are a safety concern for a client desiring to ambulate. Educational objective: Opioid agonist-antagonist medications (eg, butorphanol tartrate [Stadol]) are most appropriate for clients in active labor with no contraindications (eg, imminent birth, opioid dependence). Opioids have maternal adverse effects (eg, sedation, dizziness, slow labor progression) and may cause newborn respiratory depression.

Four Clients in Labor Are Requesting Pain Relief