A client at 38 weeks gestation is in latent labor with ruptured membranes and is receiving an oxytocin infusion for labor augmentation. The client is requesting IV pain medication. When administering an IV narcotic during labor, which nursing action is appropriate?

Question

A client at 38 weeks gestation is in latent labor with ruptured membranes and is receiving an oxytocin infusion for labor augmentation.  The client is requesting IV pain medication.  When administering an IV narcotic during labor, which nursing action is appropriate?

Quizplus · Accepted Answer

Administration of IV narcotics (eg, nalbuphine, butorphanol, meperidine) during the peak of contractions can help decrease sedation of the fetus and subsequent newborn respiratory depression at birth (Option B). Uteroplacental blood flow is significantly reduced during contraction peaks, and administration of IV medication at this time results in less medication crossing the placental barrier. In addition, a higher concentration of medication remains in the maternal vasculature, which increases the effectiveness of pain relief. (Option A) There is no reason to discontinue oxytocin prior to IV administration of pain medication. However, IV push medications should not be given through IV lines already infusing medication. (Option C) Narcotics do not typically inhibit contraction patterns or labor progress when labor is well established (ie, contractions every 2-5 minutes). However, it is inappropriate to withhold pain medication simply because the frequency of contractions is inadequate. For some clients, IV narcotics are used to provide pain relief and promote rest when latent labor is prolonged. (Option D) Narcotics given by IV push may be diluted according to manufacturer directions so that they can be more easily pushed over the recommended administration interval. Diluent should never be obtained from the IV bag or tubing due to the risk of inadvertently adding medication to IV fluids. Educational objective: IV narcotics administered to laboring women can cause fetal sedation and subsequent respiratory depression at birth. Administering IV narcotics at the peak of contractions reduces the amount of narcotic that crosses the placental barrier and affects the fetus.

A Client at 38 Weeks Gestation Is in Latent Labor