A patient in labor who is dilated 7 cm reports that narcotic pain medication given 3 hours ago has worn off and is asking for another dose. How should the nurse respond to this request?
A) "I will get permission from your doctor.".
B) "Your stage of labor makes giving another dose unsafe.".
C) "It is too early as the medication should be given only every 4 hours.".
D) "Since it has been over 3 hours, you should be able to have more of the medication.".
B
Feedback:
The timing of administration of narcotics in labor is especially important. If given close to birth, because the fetal liver takes 2 to 3 hours to activate a drug, the effect will not be registered in the fetus for 2 to 3 hours after maternal administration. For this reason, narcotics are preferably given when the mother is more than 3 hours away from birth. This allows the peak action of the drug in the fetus to have passed by the time of birth. The nurse does not need to get permission from the physician. Pain medication can be provided when needed and not on a set schedule of every 4 hours. The patient is nearing delivery so 3 hours from the last dose will not influence the decision to provide more medication.
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