increased risk for GI bleeding with NSAID use. 2007;115(12):1634-1642. We should use every opportunity to explain to our patients why we recommend a certain OTC analgesic. As a nurse, we have the opportunity to heal the heart, mind ,soul and body of our patients, their families and ourselves. NSAIDs may irritate the stomach lining. Take extra precautions to keep this drug out of the reach of children; this drug can be very dangerous for children. Determine pain and analgesic usage patterns. Maternal and Child Health Nursing (NCLEX Exams), Medical and Surgical Nursing (NCLEX Exams), Pharmacology and Drug Calculation (NCLEX Exams), buspirone hydrochloride Nursing Considerations & Management, methadone hydrochloride Nursing Considerations & Management, lorazepam Nursing Considerations & Management, Available in oral and suppository forms. The syndrome was first described in 1963 in Australia by RDK Reye and described a few months later in the United States by GM Johnson. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. One treatment does not fit all, and individualizing our considerations for the management of pain is paramount to patient safety. Monitor diabetics using sulfonylureas for hypoglycemia. Pregnancy complication (e.g., premature rupture of membranes, placenta previ… Inactive ingredients: colloidal silicon dioxide, microcrystalline cellulose, pregelatinized starch, sodium starch glycolate, talc, magnesium stearate, Opadry II contains hypromellose, polyethylene glycol, sodium citrate, lactose monohydrate and … Pregnancy Category D, aspirin Nursing Considerations & Management. Content provided with support from McNeil Consumer Healthcare. Even though it is an NSAID, aspirin is an exception to this warning and is still proven to reduce the risk of heart attack and stroke (US FDA 2015). As such, we realize recommending an OTC analgesic to treat pain is not that simple. Comparative effects of non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure in patients with hypertension. Inflammatory conditions—rheumatic fever, rheumatoid arthritis, osteoarthritis, Reduction of risk of recurrent TIAs or stroke in males with history of TIA due to fibrin platelet emboli, Reduction of risk of death or nonfatal MI in patients with history of infarction or unstable angina pectoris, Unlabeled use: Prophylaxis against cataract formation with long-term use, Contraindicated with allergy to salicylates or NSAIDs (more common with nasal polyps, asthma, chronic urticaria); allergy to tartrazine (cross-sensitivity to aspirin is common); hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency (increased risk of bleeding). 3. Abnormal liver function 2. - For patients who have had oral or dental surgery or tonsillectomy in the last seven days avoid chewable or dispersible aspirin tablets, or aspirin in crushed tablets or gargles. Although aspirin is an NSAID, the recommendation to avoid or limit the use of NSAIDs does NOT apply to people who have been advised to take low-dose aspirin to treat or prevent heart attacks or strokes. The first six NSAID groups on the list are known as first-generation NSAIDs, and the COX-2 inhibitors are called second-generation NSAIDs.. Table 25-2 provides dosage information and considerations for use for the most commonly used NSAIDs. Both nurses wondered about the best way to help treat their patients’ pain safely. NSAIDs have been linked to increased risk of cardiovascular complications, such as hypertension, myocardial infarction, and stroke (Bavry 2011; Antman 2007). 4. Monitoring and Managing Complications increases risk for bleeding with warfarin, heparin, and clopidogrel. 6. Pain is just a piece of the mosaic — a big piece, surely — but one that cannot complete the image on its own. Physiologically, ibuprofen takes the place of aspirin at the COX-1 binding site on the platelet, making it impossible for the aspirin to bind and exert its action. Reye’s syndrome is characterized by acute noninflammatory encephalopathy and fatty degenerative liver failure. Monitor carefully patients with a history of CHF, HTN, or edema for fluid retention. The full pain management picture includes age, pre-existing conditions, concomitant medications, adherence, lifestyle, etc. Relieving Pain. Administer opioid analgesics (IV or intramuscular) with IV NSAID as prescribed. Pain, Acute, related to injury or surgical procedure Circulation. Learn nsaids nursing with free interactive flashcards. Do not crush, and ensure that patient does not chew SR preparations. Also, get the conversation going with your colleagues by sharing the helpful infographic above. One nurse said she thought her patient, who was taking an opioid for mild lower back pain, might be able to achieve the same relief with acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). Lab test… Final rule. Click image to download infographic on NSAIDs. Report ringing in the ears; dizziness, confusion; abdominal pain; rapid or difficult breathing; nausea, vomiting, bloody stools. 3. Pain management can be thought of as a mosaic — a grand visual composed of smaller pieces. Withhold drug and notify physician if hepatotoxicity or GI bleeding is suspected. While prescription NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease, patients treated with prescription NSAIDs after a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with prescription NSAIDs after their first heart attack. Nursing Considerations of Naproxen (anaprox, naprosyn) Administer with food, optimal therapeutic response is seen after 2 weeks of treatment, in patient with history of aspirin allergy Side Effects of Celecoxib (celebrex) fatigue, anxiety, depression, nervousness, nausea, vomiting, anorexia, dry … Venous tone determines the capacity of the venous circulation an controls the amount of blood … No matter where you practice, you have opportunities to help ensure your patients fully understand the risks of NSAID use. Choose from 150 different sets of nsaids nursing flashcards on Quizlet. NSAIDs are good at treating pain caused by slow tissue damage, such as arthritis pain. - In long-term therapy monitor renal and liver function and ototoxicity. Antman EM, Bennett JS, Daugherty A, Furberg C, Roberts H, Taubert KA. 2. It is also important to educate patients about the importance of telling us about coexisting medical conditions and other medications that they may be taking so that we can make informed decisions on their behalf. - Assess other medication for possible interactions - especially warfarin which is a special hazard. She has held positions as pain and palliative care nurse practitioner for Johns Hopkins-Suburban Hospital and Mayo Clinic Jacksonville. Many of these drugs contain aspirin, and serious overdose can occur. What are the Indications of Famotidine (Pepcid) Nursing Pharmacology Considerations? The risk of heart attack or stroke can occur as early as the first weeks of using a prescription NSAID and may increase with longer use. You may experience these side effects: Nausea, GI upset, heartburn (take drug with food); easy bruising, gum bleeding (related to aspirin’s effects on blood clotting). Drug label warnings for ibuprofen highlight the fact that the drug may decrease the benefit of aspirin heart therapy when taken together. The risk is also greater at higher doses. Avoid the use of other over-the-counter drugs while taking this drug. Talk to your patients about NSAIDs. The concern about these effects was enough to draw the attention of the U.S. Food and Drug Administration. Depending on a patient’s cardiovascular, renal, or gastrointestinal condition, an alternative pain relief option might be more appropriate. Give drug with full glass of water to reduce risk of tablet or capsule lodging in the esophagus. Monitor for loss of tolerance to aspirin. Comfort NSAIDs are often given to treat pain that is associated with inflammation, Pharmacology NSAIDs are a commonly presecribed medication. Children on high doses of aspirin are particularly prone to hypoglycemia (see Appen… Here are important nursing considerations when administering this drug: Nursing Assessment. Here is a table of commonly encountered NSAIDs and related agents, their generic names, and brand names: Give drug with food or after meals if GI upset occurs. Not only are nurses tasked with evaluating what they see and determining the best fit for treatment for their patients, but they also frequently need to confirm they have all of the right pieces! Geriatric populations should not exceed 3000 mg in 24 hours, and chronic alcoholics should not exceed 2000 mg in 24 hours due to the risk for hepatoxicity. short term treatment of active ulcer, GERD, treatment of heartburn, indigestion, management of Zollinger Ellison syndrome, prevention of GI bleeding in critically ill patients, management of symptoms List four nursing considerations around NSAIDS and homeopathic preparations. Reye’s syndrome typically occurs after a viral illness, particularly an upper respiratory tract infection, influenza, varicella, or gastroenteritis, and is associated with the use of aspirin during the illness. 2012;12:93. Inhibition of platelet aggregation is attributable to the inhibition of platelet synthesis of thromboxane A2, a potent vasoconstrictor and inducer of platelet aggregation. md associate professor pharmacology sknmc Aljadhey H, Tu W, Hansen RA, Blalock SJ, Brater DC, Murray MD. Mozaffarian D, Benjamin EJ, Go AS, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Harmful effects of NSAIDs among patients with hypertension and coronary artery disease. NSAIDS can have some bad side effects such as, stomach ache, heartburn, diarrhea, and nausea. Nursing Considerations Across the Lifespan Acetaminophen is safe for all ages and can be administered using various routes. Steroids are man-made drugs that are similar to cortisone, a … Disseminated intravascular coagulopathy 4. Over-the-counter aspirins are equivalent. 2. These are the important things the nurse should include in conducting assessment, history taking, and examination: Brand Name:Apo-ASA (CAN), Aspergum, Bayer, Easprin, Ecotrin, Empirin, Entrophen (CAN), Genprin, Halfprin 81, 1/2 Halfprin, Heartline, Norwich, Novasen (CAN), PMS-ASA (CAN), ZORprin, Alka-Seltzer, Ascriptin, Asprimox, Bufferin, Buffex, Magnaprin, Classification: Antipyretic, Analgesic (nonopioid), Anti-inflammatory, Antirheumatic, Antiplatelet, Salicylate, NSAID Editor’s note: OnCourse learning does not endorse any views expressed or products or services recommended or offered in the content of this blog. What are the Nursing Considerations of Bismuth Subsalicylate (Kaopectate, Pepto-Bismol) Nursing Pharmacology Considerations? Lab tests: frequent PT and IRN with concurrent anticoagulant therapy; more frequent fasting blood glucose levels with diabetes. The most common side effects from NSAIDs are stomach aches, heartburn, and nausea. NSAID use has also been linked to an increase in systolic blood pressure (Aljadhey 2012). Nursing Concepts. NSAIDs also work well fighting back pain, menstrual cramps and headaches. May cause GI bleeding, neutropenia, hypercholesterolemia May increase risk for bleeding in warfarin, aspirin, heparin Use cautiously with impaired renal function; chickenpox, influenza (risk of Reye’s syndrome in children and teenagers); children with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy (maternal anemia, antepartal and postpartal hemorrhage, prolonged gestation, and prolonged labor have been reported; readily crosses the placenta; possibly teratogenic; maternal ingestion of aspirin during late pregnancy has been associated with the following adverse fetal effects: low birth weight, increased intracranial hemorrhage, stillbirths, neonatal death); lactation. A dramatic decrease in the use of aspirin among children, in comb… Higher doses inhibit the synthesis of prostacyclin, a potent vasodilator and inhibitor of platelet aggregation. BMC Cardiovasc Disord. Price does not reflect effectiveness. Encourage and assist patient to assume a position of comfort. 2. The Powerful Impact of Specialty Certification, Nurses, Here’s What You Need to Know About Medical Waste, 10 Questions to Ask Recruiters Before Choosing a Travel Nursing Job, Technology Can Drive Patient-Centered Care, Fall Prevention in Hospitals: What Every Nurse Needs to Know, Nurses Demonstrate Resilience During a Challenging Year. Identify infectious agents or other factors responsible for inflammation or pain. FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes [safety announcement]. Patient Education . Vasodilators are the drugs that tend to dilates the (relax) smooth muscles of blood vessels. The other nurse’s patient was achieving her treatment goals for her moderate neck pain with ibuprofen, but the RN was concerned about her CVD risks. Monitor pain closely and report promptly increases in severity. Take the drug with food or after meals if GI upset occurs. Nursing considerations Assessment History : Allergy to naproxen, salicylates, other NSAIDs; asthma, chronic urticaria, CV dysfunction; hypertension; GI bleeding; peptic ulcer; impaired hepatic or renal function; pregnancy; lactation Use the drug only as suggested; avoid overdose. Antipyretic effects are not fully understood, but aspirin probably acts in the thermoregulatory center of the hypothalamus to block effects of endogenous pyrogen by inhibiting synthesis of the prostaglandin intermediary. Analgesic and antirheumatic effects are attributable to aspirin’s ability to inhibit the synthesis of prostaglandins, important mediators of inflammation. Nurses should … NSAIDs block the production of certain body chemicals that cause inflammation. Save my name, email, and website in this browser for the next time I comment. aspirin with viral infections can cause Reye’s syndrome. We recognize the prevalence of coexisting conditions which need to be taken into consideration when recommending (OTC) NSAIDs—with specific emphasis in this blog post around CVD. We also recognize the prevalence of use for nonprescription NSAIDs. 236 Unit 3 The Nervous System Assessment Potential Nursing Diagnoses Prior to administration: Obtain a complete health history including allergies, drug history, and possi- ble drug interactions. CVD affects approximately 85.6 million Americans, more than 1 in 3 (Mozaffarian 2015). https://www.nurse.com/blog/2016/09/22/nsaids-what-nurses-need-to-know If the medicine upsets your stomach, you can try taking it with food. Am J Med. Nursing Interventions. Monitor the diabetic child carefully for need to adjust insulin dose. The half-lives of NSAIDs differ greatly—some have a short half-life, and others have a moderate to long half-life with a general range of 8 to 24 hours. 5. contraindicated in aspirin hypersensitivity increase risk for impaction with geriatric and pediatric patients •. Assist patient to ambulate to obtain some pain relief. Do not cut, crush, or chew sustained-release products. We have become intimately aware of the gastrointestinal and renal risks that NSAIDs pose, especially in patients who are predisposed to these risks (US FDA 2009). Also available as chewable tablets, gum; enteric coated, SR, and buffered preparations (SR aspirin is not recommended for antipyresis, short-term analgesia, or children < 12 yr.). 2009;74(81):19385-19409. concurrent use with alcohol may increase risk for GI bleeding. Arteriolar tone directly controls the peripheral vascular resistance and thus arterial pressure. 3. History of falls: Age greater than 70 years. Editor’s note: Content sponsored by McNeil Consumer Healthcare. US Food and Drug Administration. Nursing considerations Assessment History : Allergy to ibuprofen, salicylates or other NSAIDs; CV dysfunction, hypertension; peptic ulceration, GI bleeding; impaired hepatic or renal function; pregnancy; lactation Yvonne D'Arcy, MS, CRNP, CNS, is a pain management and palliative care nurse practitioner with more than 20 years of pain management experience. 2015;131(4):e29-e322. Fed Regist. Monitor for and immediately report S&S of GI ulceration or bleeding, including black, tarry stool, abdominal or stomach pain; hepatotoxicity, including fatigue, lethargy, pruritus, jaundice, flu-like symptoms; skin rash; weight gain and edema. However, the use of any dose of aspirin plus an NSAID is associated with an increased risk of bleeding. Patients should be educated to monitor for signs of bleeding. Recently, I overheard two RNs talking about patients they were treating for pain. Use of nonsteroidal antiinflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association. In reducing inflammation, NSAIDs are not as effective as glucocorticoids are. At request of the sponsor, McNeil Consumer Healthcare, comments relating to this post will not appear. It is critical that patients are aware of medication risks before taking NSAIDs. We should also understand that NSAIDs may interact with medications commonly used in patients with CVD risks. 2011;124(7):614-620. Inherent coagulopathies 7. We nurses are in an ideal position to help patients understand the big picture in pain management, including the risks and benefits of their medications. The smooth muscles of blood vessels is responsible for arteriolar and venous tone which in turn play important role role in myocardial wall stress. Circulation. Assessment & Drug Effects 1. - Be aware that aspirin is a common constituent of a variety of over-the-counter medications. The FDA has warned that all prescription non-aspirin NSAIDs, except aspirin, put patients at increased risk for heart attack, stroke, and heart failure, any of which can lead to death. When the commonality of these conditions overlap with the widespread use of nonprescription NSAIDs, there becomes a serious need for healthcare professionals to educate patients about the safe use of NSAIDs. These and other considerations form the basis for pain treatment individualization. However, coming to the forefront more recently are the risks associated with NSAIDs and CVD. We accomplish this by spending quality time with the patients and acquiring a full medical history. Postpartum complications (e.g., retained placenta, uterine atony) 8. Nurses are part of the front lines in managing patients with mild-to-moderate pain. 100 mg, 200 mg, 400 mg, 600 mg, 800 mg tablets; 50 mg, 100 mg chewable tablets;; 100 mg/5 mL, 100 mg/2.5 mL suspension; 40 mg/mL drops Bavry AA, Khaliq A, Gong Y, Handberg EM, Cooper-DeHoff RM, Pepine CJ. Here is a table of commonly encountered anti-inflammatory agents, their generic names, and brand names: What are the Nursing Considerations of Clopidogrel (Plavix )? 1. Assessment & Drug Effects 1. Nursing considerations Assessment History: Allergy to salicylates or NSAIDs; allergy to tartrazine; hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency; impaired hepatic function; impaired renal function; chickenpox, influenza; children with fever accompanied by dehydration; surgery scheduled within 1 wk; … - Assess pain and/or pyrexia one hour before or after medication. Here are some factors that may be related to Risk for Bleeding: 1. Aneurysm 3. Organ-specific warnings; internal analgesic, antipyretic, and antirheumatic drug products for over-the-counter human use; final monograph. Ibuprofen tablets, a nonsteroidal anti-inflammatory drug (NSAID), is available in 400 mg, 600 mg, and 800 mg tablets for oral administration. After all, millions of Americans use nonprescription NSAIDs each day, and there is potential for this number to grow as the US population ages. Patients taking NSAIDs may be at risk of exacerbating existing CVD. monitor liver function tests. We as healthcare professionals should help our patients understand their risk of heart attack or stroke when using NSAIDs. dr.uma kadam m.b.b.s. Accessed April 18, 2016. Do not use aspirin that has a strong vinegar-like odor. Gastrointestinal disorders (e.g., varices, polyps ,ulcer) 5. The more our patients understand why we make certain recommendations, the more likely they are to remember those recommendations and follow the directions we provide. Generic Name: aspirin OnCourse Learning assumes no responsibility or liability for any consequence resulting, directly or indirectly, from any action or inaction taken based on or made in reliance on the information within this article. This represents a limitation for cardiac patients and an important consideration for their healthcare professionals. http://www.fda.gov/Drugs/DrugSafety/ucm451800.htm. The reaction is nonimmunologic; symptoms usually occur 15 min to 3 h after ingestion: profuse rhinorrhea, erythema, nausea, vomiting, intestinal cramps, diarrhea. Nonetheless, they are preferred as they possess an added advantage of analgesia and have fewer side effects. July 9, 2015. Diclofenac, naproxen ibuprofen, and aspirin are the examples of traditional NSAIDs while examples of COX-2 inhibitor include celecoxib and etoricoxib (NHS, 2014). Current FDA recommendations indicate that prescription NSAIDs should be used for the shortest period of time and at the lowest effective dose (US FDA 2015). NSAIDs work like corticosteroids (also called steroids), without many of the side effects of steroids. Considerations in NSAIDs for renal impairment answer can cause acute renal insufficiency Monitor for renal impairment: I/O, weight, rapid elevated Serum creatinine/BUN Avoid Prolonged NSAID use if possible (can cause renal papillary necrosis) In July 2015 the FDA strengthened the existing label warning on non-aspirin prescription NSAIDs regarding cardiovascular risks and will be requesting similar updates to the label warning of OTC non-aspirin NSAIDs (US FDA 2015). This effect occurs at low doses and lasts for the life of the platelet (8 days). NSAIDs: increased risk for decreased antihypertensive effects; Nursing Considerations. So what now? Parents should be informed not to give Aspirin to children because of the risk of Reye’s Syndrome. US Food and Drug Administration. She is the author of 10 books on pain management and presents frequently on a variety of pain topics.