Pain - acetaminophen & NSAIDS

Question 1

what type of pain is PO & PR acetaminophen used for?

Answer 1

mild pain & fever

Question 2

what type of pain is IV acetaminophen (ofirmev) used for?

Answer 2

moderate to severe pain in conjunction with opioid analgesics

Question 3

what are the characteristics of acetaminophen?

Answer 3

• no anti-inflammatory properties
• additive pain relief in combination with opioids
• good to use with anticoagulants
• max daily doses is 4000mg/day
• hepatotoxicity or renal failure with chronic use (#1 cause of acute hepatic failure)
- NTE 3g or 2g/24 hours if liver failure `

Question 4

what is aspirin used for?

Answer 4

mild to moderate pain
anti-pyretic (fever)
↓ platelet aggregation
inflammatory disorders (rheumatoid arthritis)

Question 5

how does aspirin work?

Answer 5

it inhibits COX - 1 and COX - 2 (cyclooxygenase)

Question 6

what does COX - 1 do?

Answer 6

protects stomach mucosa lining

we all need this: ↓ acid production & ↑ mucous production

Question 7

what does COX - 2 do?

Answer 7

promotes prostaglandins

Question 8

what is at risk d/t the inhibition of COX - 1?

Answer 8

risk of ulcer formation and bleeding

***contraindicated in hx of GI bleeds or ulcer disease

Question 9

what will occur with the inhibition of COX - 2?

Answer 9

↓ pain and inflammation

Question 10

T/F: there is an increased risk of bleeding with anticoagulants/

Answer 10

TRUE.. aspirin causes ↓ in platelet aggregation

Question 11

what is ibuprofen used for?

Answer 11

mild to moderate pain, anti-pyretic (fever), inflammatory disorders (rheumatoid arthritis), dysmenorrhea (painful menstruation)

Question 12

how does ibuprofen work?

Answer 12

inhibits COX - 1 and COX - 2, like aspirin

Question 13

what are characteristics associated with ibuprofen?

Answer 13

• extreme caution with hx of GI bleeds or GI ulcer disease
• anti-inflammatory relief may take up to 7 days
• ↑ risk of GI bleeds with concurrent use of NSAIDS, warfarin, and clopidogrel

Question 14

what is the new research about ibuprofen?

Answer 14

may ↑ risk of serious and potentially fatal thrombotic events (MI and stroke) - inhibits COX 2, ↑ clots and blood pressure - effects enzymes that effect clotting

Question 15

what is celecoxib used for?

Answer 15

management of OA, RA, acute pain, and dysmenorrhea

Question 16

how does celecoxib work?

Answer 16

it’s a selective COX - 2 inhibitor, DOESNT inhibit COX - 1.

Question 17

characteristics of celecoxib

Answer 17

• lower risk of GI bleeds & ulcer formation
• increased risk of GI bleeds with concurrent use of anticoagulants and chronic NSAID therapy
• ↑ risk of thrombotic events like MI and stroke (use cautiously with CV disease)

Question 18

what are the neurological adverse effects of NSAIDS

Answer 18

assess for stroke symptoms

aspirin and NSAIDS may cause tinnitus (ringing in the ears)

Question 19

what are ♥ system adverse effects of NSAIDs

Answer 19

assess for MI symptoms (chest pain, difficulty breathing, numb jaw/arm

Question 20

what are the GI system adverse effects of NSAIDs

Answer 20

assess for GI bleeding symptoms (black tarring, bloody emesis)
assess for symptoms related to blood loss (low H&H, tachycardia, hypotension, light headed)

Question 21

what are the 9 nursing roles for managing pain?

Answer 21

• assess PAIN (pattern, area, intensity, and nature)
• discuss pain medication orders (what ordered, when can take, side effects, pros/cons)
• assess previous experiences (what’s worked before)
• anticipate & admin before activities (PT)
• assess effectiveness
• teach importance of pain management (willing to participate in activity, can lessen pain)
• assess and manage adverse effects (level of sedation, bowel movements??)
• implement safety precautions (slowly getting up, start low & go slow)
• lower doses for opioid naive and geri pts (start low & go slow)

Question 22

NANDAs for pain

Answer 22

acute/chronic pain
ineffective health maintenance
ineffective coping
deficient knowledge 
risk for injury 
risk for falls