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Roopa Dhaliwal, 27 y. o. female who gave birth this morning, told to self…
Roopa Dhaliwal, 27 y. o. female who gave birth this morning, told to self-administer ibuprofen for perineal tear. Client has an allergy to acetaminophen and thus only has ibuprofen for pain relief. Client thus far has refused to take ibuprofen as she is worried about the risk posed to her new baby while breastfeeding.
Pain
management
pharmacological options:
Non-pharmacological options: mindful breathing, application of a cold compress, relaxation techniques
Client Education
Client is to notify her healthcare provider if taking other drugs concurrently with ibuprofen including: alcohol, aspirin, and any over the counter or herbal products
Client is not to take any over the counter ibuprofen for more than 10 days for pain and should notify her healthcare provider if her symptoms persist or worsen past that time
Client is to avoid activities requiring she be alert as ibuprofen may cause drowsiness or dizziness
Ibuprofen has some side effects which should be reported to her healthcare provider if occurring. These include: rash, itching, visual disturbances, tinnitus, weight gain, edema, epigastric pain, dyspepsia, black stool, hematemasis, persistent headache, or any flu-like symptoms
Client is to take ibuprofen as directed on the packaging, if a dose is missed take it as soon as remembered but not if too close to timing of next dose
As noted in pharmacokinetics, ibuprofen does not enter breastmilk and large quantities and thus is ruled safe for use in breastfeeding women with healthcare provider awareness. In Roopa's case, ibuprofen is a relatively safe and effective way to deal with her post-operative pain without harming her newborn.
Client is to take ibuprofen with water and remain upright for 15-30 minutes after administration
Ibuprofen
-
Indications
PO: treatment of inflammatory diseases such as rheumatoid and osteoarthritis, dysmenorrhea.
IV: moderate to severe pain with opioid analgesics
Mechanism of Action
Inhibits prostaglandin synthesis
Pharmacokinetics
Absorption: oral formula well absorbed from GI tract, IV administration results in complete bioavailability
Distribution: Does not enter breast milk in large amounts
Metabolized by the liver, small amounts excreted from kidneys unchanged
Contraindications/Precautions
Cross-sensitivity may exist with other NSAIDs
Active GI bleeds, ulcer disease
Coronary artery bypass graft surgery
Recent history of MI
Avoid after 30 weeks gestation
use caution in clients with cardiovascular disease or risk factors for cardiovascular disease, recent MI or HF, renal or hepatic disease, Aspirin triad patients, or chronic alcohol use/abuse
Adverse Reactions and Side Effects
Most common include headache, constipation, dyspepsia, nausea, and vomiting
More serious reactions may include HF, MI, stroke, exfoliative dermatitis, toxic epidermal necrolysis, GI bleeding, hepatitis, and hypersensitivity reactions
Route and Dosage
PO (adults): Anti-inflammatory - 400-800 mg 3-4x/day, max 24h dose 3200 mg/day. Antipyretic - 200-400 mg q4-6h, max 24h dose 1200mg/day
IV (adults): Analgesic: 400-800mg q6h PRN, max 3200 mg/day
Assessments
Vitals
BP
HR
Respirations
Temperature
Monitor for infection
Pain OPQRSTUV's
Monitor for pain management
O2 saturation
Lab values
BUN, serum creatinine, CBC, liver function tests
serum potassium, serum cretinine, alkaline phosphatase, LDH, AST, ALT
Blood glucose, hemoglobin, hematocrit concentrations, leukocyte and platelet counts
Allergies
Client is allergic to acetaminophen
Condition of perineal tear
GI Assessment
acute overdose symptoms:
GI bleeding
Nausea
Vomiting
Neurological assessment
acute overdose symptoms:
drowsiness, lethargy, mental confusion, parasthesias, numbness, aggressive behaviour, headache, dizziness, cerebral edema
By: Lauren Van Rassel, Justin Gillespie, and Robyn Harris
References:
Vallerand, A. H., & Sanoski, C. A. (2021).
Davis's drug guide for Nurses
. F.A. Davis Company.
Sealock, K., Seneviratne, C., Lilley, L. L., Collins, S. R., Snyder, J. S., Lilley, L. L., & Lilley, L. L. (2021).
Lilley's pharmacology for Canadian Health Care Practice
. Elsevier.