Let’s Talk About the Nursing Considerations for Acetaminophen

• Acetaminophen is available over the counter and both analgesic and antipyretic effects.
• Acetaminophen nurisng considerations are based on the age and condition of the patient, as well as the concentration of the medicine.
• Acetaminophen can adversely affect the liver and can be toxic when taken with excessive alcohol.

Acetaminophen or paracetamol is a drug to produce analgesic and antipyretic effects. It is available over the counter without a doctor’s signed prescription. Acetaminophen is not an NSAID. It belongs to the para aminophenol derivatives.

Unlike salicylates, acetaminophen does not have anti-inflammatory properties, nor affect platelet function. However, it may potentiate the anticoagulant effects of Warfarin and increase INR (International normalized ratio).

The exact pain control effects of acetaminophen are unknown. In the central nervous system, it acts by inhibiting prostaglandin synthesis- chemicals that sensitize your nerves to pain.To reduce fever, it acts directly at the hypothalamus- the heat-regulating center in the brain.

Acetaminophen is used to relieve fever, headache, muscle aches, and general pain of all types. According to the American Arthritis Association, it is now useful in patients with some types of arthritis to relieve pain.

The benefit of Acetaminophen over NSAIDs and salicylates is that it does not cause adverse gastric effects. Therefore, the patient can take it for the long term, and those with gastric ulcers and acidity can tolerate it well.

Unlike salicylates, it is a drug of choice in children with fever or flu-like symptoms because it does not pose a risk for Reye’s syndrome. 

There are several acetaminophen nursing considerations to bear in mind while administering and observatiion this type of drug therapy.

Acetaminophen Drug Interactions

With acetaminophen, the following drug interactions can occur:  

• The effect of oral anticoagulants such as Warfarin and other thrombolytic drugs can be increased when combined with acetaminophen. Therefore, the chances of bleeding can be increased. If both are being given together, you might need to lower the dose of anticoagulants or thrombolytics and monitor the patient closely for any signs of bleeding. Tell them to inform you promptly if they notice blood in vomit, stool, or gums.

• When phenytoin, barbiturates, carbamazepine, rifampin, and isoniazid are given with acetaminophen, the risk of liver toxicity is increased. And it is increased even more with chronic alcohol abuse. Therefore, you need to alter the dose and keep an eye on liver function tests if the patient receives acetaminophen with any of the mentioned drugs.
  

• The effects of loop diuretics and zidovudine may be decreased when taken with acetaminophen. 

Side Effects of Acetaminophen

Acetaminophen is tolerated well. Unlike salicylates, it rarely causes gastric irritation and bleeding tendencies. However, it can disturb liver functions. Therefore, monitor the patient’s liver function tests and monitor the total dose. 

 The common adverse reactions of acetaminophen are:

• Skin rashes 
• Neutropenia 
• Hypoglycemia- with overdose

Acetaminophen Nursing Considerations

With this drug therapy, keep in mind the following acetaminophen nursing considerations:  

• Administer oral dosage forms to conscious adults. And for children and babies who cannot swallow, use the syrup dosage form. 

• When administering the oral dosage form, calculate the dose based on drug concentration because the drops and elixirs might have different concentrations of active pharmaceutical ingredients. 

• For children and unconscious adults, use a rectal route for administration. 

Acetaminophen Nursing Responsibilities

As a nurse, teach the following things to the patient and his caregivers about Acetaminophen therapy. 

• To administer the drug to a child below 2 years, consult with a healthcare provider. 
• Keep in mind that acetaminophen therapy is given for a short time. If a drug has to be administered to children for over 5 days or adults for over 10 days, consult the prescriber. 
• Don’t use the drug for marked fever (over 103.1° F [39.5° C]), fever persisting longer than 3 days, or recurrent fever unless directed by a prescriber. 
• Remember that ingesting more, and for the long term, than the prescribed doses of acetaminophen can cause liver damage. 
• Excessive consumption of alcoholic beverages with acetaminophen can cause liver damage and toxicity. 
• Various over-the-counter pain relievers and flu preparations contain acetaminophen. Therefore, count the total dose you consume of it per day. Make sure not to exceed the total daily dose. If you are confused between the two preparations and which to take, consult the pharmacist. 
• The drug is found in breast milk. However, it is safe when given for a short time and in the doses prescribed by the physician. Make sure not to exceed the total daily limit of Acetaminophen intake. 

The Bottom Line

Check all the pain-relieving preparations your patient takes because various over-the-counter drugs contain acetaminophen, which can cause its overdose, hence toxicity. 

This concludes the review on acetaminophen nursing considerations.

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