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Difficulty: MediumPharmacological and Parenteral Therapies

Following an open laparotomy, a client is receiving pain management via a continuous epidural infusion containing bupivacaine and fentanyl. Upon entering the room, the nurse observes that the client is deeply sedated and unarousable. The client's respiratory rate is 7 breaths per minute. Which action represents the nurse's immediate priority?

  1. Stop the epidural infusion and prepare to administer intravenous naloxone.Answer
  2. B
    Lower the head of the bed to a Trendelenburg position and notify the anesthesia provider.
  3. C
    Administer a prescribed intravenous fluid bolus to support hemodynamic stability.
  4. D
    Apply supplemental oxygen via a non-rebreather mask and maintain the current infusion rate.

Answer

The immediate priority is to stop the epidural infusion and prepare to administer intravenous naloxone.
The client is exhibiting severe respiratory depression (7 breaths per minute) and profound sedation, which are signs of opioid toxicity from the epidural fentanyl. The nurse's absolute priority is to address the breathing compromise (ABCs) by immediately stopping the source of the medication and preparing the specific pharmacological antidote, naloxone, to reverse the respiratory depression.

Step-by-Step Solution

1
Recognize the clinical signs presented in the scenario.
The client is unarousable with a respiratory rate of 7 breaths per minute.
These are hallmark indicators of severe opioid toxicity induced by the fentanyl in the epidural infusion.
2
Prioritize nursing interventions using the ABC (Airway, Breathing, Circulation) framework.
Breathing is severely compromised and takes absolute priority over other assessments.
Respiratory failure is the most immediate threat to the client's life.
3
Determine the appropriate pharmacological and parenteral intervention.
Halt the continuous epidural infusion and prepare the opioid antagonist.
Stopping the epidural prevents further medication delivery, and naloxone reverses the existing central nervous system and respiratory depression.

Key Concept

Management of opioid toxicity and safe administration of continuous epidural therapies.
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Topics

Pharmacological and Parenteral Therapies

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