During hourly rounding on an orthopedic unit, the nurse evaluates a client recovering from a total hip arthroplasty performed 6 hours ago. The client's pain is being managed with a continuous bupivacaine epidural infusion. The client states, 'My lips feel completely numb, and I have a strange metallic taste in my mouth.' The client also mentions a persistent ringing sound in their ears. Which action should the nurse take first?
- ALower the head of the bed to a flat position to prevent sympathetic blockade-induced hypotension.
- BEvaluate the client's sensory block level using a cold stimulus to determine the extent of cephalad spread.
- Stop the continuous epidural infusion pump and alert the anesthesia provider immediately.Answer
- DIncrease the primary intravenous fluid rate to treat early indicators of postoperative hypovolemic shock.
Answer
The nurse must immediately stop the epidural infusion and notify the anesthesia provider.
The client is exhibiting early, classic signs of Local Anesthetic Systemic Toxicity (LAST), which include a metallic taste, tinnitus (ringing in the ears), and perioral numbness. LAST is a life-threatening emergency caused by the systemic absorption of local anesthetics like bupivacaine. The absolute first priority is to stop the administration of the offending agent to prevent the progression to central nervous system excitation (seizures) and subsequent severe cardiovascular depression or arrest.
Step-by-Step Solution
Key Concept
Recognition and immediate management of Local Anesthetic Systemic Toxicity (LAST)