Aspirin Nursing Implications
Aspirin Nursing Pharmacology
Acetylsalicylic acid (ASA), more commonly known as aspirin, is classified as a non-selective cyclooxygenase (COX) inhibitor. In the USA it was a regularly used medicine for the treatment of pain and fever caused by a variety of conditions.
Acetylsalicylic acid is anti-inflammatory as well as antipyretic, it also prevents blood clots, strokes, and myocardial infarction by inhibiting platelet aggregation. Interestingly, long-term usage of acetylsalicylic acid has been shown in trials to reduce the incidence of numerous malignancies, including colorectal, esophageal, breast, lung, prostate, liver, and skin cancer.
It comes in a variety of doses and forms, including chewable tablets, suppositories, extended-release formulations, and more.
Indications of Aspirin
Acetylsalicylic acid (ASA) or aspirin is commonly used to treat the following:
- Treatment of inflammation that is associated with a variety of conditions, including flu, common cold, neck and back pain, dysmenorrhea, headache, tooth pain, sprains, fractures, myositis, neuralgia, synovitis, arthritis, bursitis, burns, and a variety of injuries.
- Relief of symptomatic discomfort following surgical and dental procedures.
- Photophobia or sensitivity to light and phonophobia or sensitivity to sound are also treated with the additional strength formulation of acetylsalicylic acid.
Because of its capacity to inhibit platelet aggregation, aspirin is used for a variety of additional purposes. These include:
- To lower the risk of cardiovascular death in suspected myocardial infarction cases.
- To lower the risk of a first non-fatal myocardial infarction in patients, as well as morbidity and mortality in patients with unstable angina and those who have experienced a previous myocardial infarction.
- To reduce the risk of transient ischemic attacks (TIA) and to avoid atherothrombotic cerebral infarction, In conjunction with other treatments.
- To prevent thromboembolism, after hip replacement surgery.
- To reduce platelet to platelet adhesion and prevent transient ischemic attacks (TIA), after carotid endarterectomy.
- To avoid thrombosis at the insertion site of a silicone rubber arteriovenous cannula in patients receiving hemodialysis.
Pharmacokinetics of Aspirin
- Effects on pain and fever. Acetylsalicylic acid or aspirin inhibits the production of prostaglandins in the body by targeting cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). Prostaglandins are powerful irritants that have been demonstrated to produce headaches and pain in people when injected. Prostaglandins make pain receptors and chemicals like histamine and bradykinin more sensitive. This medicine may prohibit prostaglandins from acting on pain receptors by disrupting their manufacture and preventing their release in inflammation. Because of its potential to inhibit the formation of brain prostaglandin E1, acetylsalicylic acid is considered an antipyretic. Prostaglandin E1 is well-known for being a potent fever-inducing substance.
- Effects on Platelet Aggregation. Platelet aggregation is inhibited by ASA due to its interference with thromboxane A2 in platelets, which is induced by COX-1 suppression. Thromboxane A2 is a lipid that causes platelet aggregation, which can lead to clot formation and an increased risk of heart attack or stroke in the future.
Mechanism of Action
Acetylsalicylic acid (ASA) inhibits the production of prostaglandins. It is non selective for COX-1 and COX-2 enzymes. Platelet aggregation is inhibited for roughly 7-10 days when COX-1 is inhibited (average platelet lifespan). Acetylsalicylic acid’s acetyl group binds to a serine residue in the cyclooxygenase-1 (COX-1) enzyme, causing irreversible inhibition.
This stops pain-inducing prostaglandins from being produced. This method also prevents arachidonic acid from being converted to thromboxane A2 (TXA2), a potent inducer of platelet aggregation. Platelet aggregation can cause clots and dangerous venous and arterial thromboembolism, which can lead to pulmonary embolism and stroke.
It’s worth noting that the protein architectures of COX-1 and COX-2 share 60% of their similarities. ASA binds to the serine 516 residue on COX-2’s active site in the same way that it attaches to the serine 530 residue on COX-1’s active site.
However, because COX-2’s active site is somewhat larger than COX-1’s, arachidonic acid (which eventually produces prostaglandins) is able to skip the aspirin molecule, which inactivates COX-2. As a result, ASA has a stronger effect on the COX-1 receptor than the COX-2 receptor. COX-2 suppression necessitates a greater dose of acetylsalicylic acid.
Absorption of Aspirin
Following oral administration, absorption is usually rapid and complete, but it might vary depending on the route, dosage form, and other parameters such as the rate of tablet dissolution, gastrointestinal contents, gastric emptying time, and gastric ph.
Acetylsalicylic acid is readily absorbed in the stomach and proximal small intestine when consumed orally. Passive diffusion allows non-ionized acetylsalicylic acid to permeate through the stomach lining. The pH range of 2.15 – 4.10 is ideal for salicylate absorption in the stomach.
Acetylsalicylic acid is absorbed much more quickly in the intestine. In the first hour after administration, esterases in the gastrointestinal tract hydrolyze at least half of the ingested amount to salicylic acid. Between 1-2 hours after injection, plasma salicylate concentrations reach their peak.
In the circulation, ASA has a half-life of 13 to 19 minutes. After complete absorption, blood concentrations decline fast. Salicylate has a half-life of between 3.5 and 4.5 hours.
Drug Interactions with Aspirin
Some medications may interact with Aspirin. These includes the following:
- Anticoagulant Medications. Antiplatelet medications, such as low-dose aspirin, carry their own risks of gastrointestinal bleeding and consequences. These hazards can be exacerbated by using aspirin or another NSAID. Anticoagulants and NSAIDs taken together enhance the risk of GI hemorrhage. NSAIDs can diminish aspirin’s cardioprotective effect in patients on an aspirin regimen.
- Anti-hypertensive medications. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) have been linked to slight elevations in blood pressure. They may reduce the effectiveness of several antihypertensive medications, such as beta blockers, ACE inhibitors, and diuretics.
- Corticosteroid. When aspirin or other NSAIDs are used with corticosteroids, the risk of serious stomach bleeding increases, presumably because steroids reduce the formation of protective gastric mucus, which can delay the repair of NSAID-induced erosions.
Contraindications and Cautions for Aspirin
- Individuals who have severe renal failure (a GFR of less than 10 mL/min) should not be prescribed aspirin.
- Patients with severe hepatic insufficiency should not be given aspirin.
- Patients with sodium-retentive conditions (e.g., congestive heart failure, renal failure) are frequently put on sodium-restricted diets and must avoid high-sodium buffered aspirin.
- Hepatic enzymes, blood urea nitrogen, and serum creatinine can all be elevated by aspirin. Hyperkalemia, proteinuria, and a longer bleeding time are all possible side effects.
- Patients with a documented NSAID allergy, as well as those with asthma, rhinitis, or nasal polyps, should avoid using aspirin. Anaphylaxis, laryngeal edema, severe urticaria, angioedema, or bronchospasm are all possible reactions (asthma).
- All salicylate products are also labeled with the conventional Reye’s syndrome warning, which states that they should not be used in children or teenagers who have a viral infection, whether or not they have a fever.
- Alcoholic beverages should be avoided. The consumption of alcohol raises the risk of gastrointestinal bleeding.
- Anticoagulant/antiplatelet herbs and supplements should be avoided. Garlic, ginger, bilberry, danshen, piracetam, and ginkgo biloba are some examples.
- Should be taken after meals. This lessens the irritant effects on the gastrointestinal tract.
- Should be taken with a full glass of water.
Pregnancy and Lactation
- Despite the fact that teratogenic effects were demonstrated in animals at very deadly levels, there is no proof that this medicine is teratogenic in humans. However, unless absolutely necessary, avoid using aspirin throughout the first and second trimesters of pregnancy. If acetylsalicylic acid-containing medicines are taken by patients attempting to get pregnant, or during the first and second trimester of pregnancy, the lowest possible dose at the shortest possible duration should be taken.
- Aspirin can be passed into breast milk. It is not recommended to breast-feed while using this drug because it may harm a nursing infant when used in large amounts (such as to treat pain or fever). If the healthcare provider recommends it, the patient can take low-dose aspirin to prevent a heart attack or stroke. Before starting breastfeeding, a consultation with the healthcare provider is warranted.
- Aspirin can cause an accidental or intentional acute overdose, as well as persistent intoxication in patients. Tinnitus is one of the first indications. Tinnitus, on the other hand, may not be audible if the patient has a history of high-frequency hearing loss, and hence cannot be used as a valid indicator of overdosage. If a patient has tinnitus, the pharmacist should advise the patient to stop using aspirin.
Adverse Reactions of Aspirin
Aspirin can induce the following:
- Stomach pain
- Severe gastrointestinal (GI) bleeding
- Dyspepsia is the most frequent adverse reaction
Pharmacists should advise the patients to report any symptoms of ulceration or bleeding right once. Aspirin should be avoided by patients having a history of active peptic ulcer disease. In children, aspirin can cause hypoglycemia (or hyperglycemia).
Some people intentionally take poisons or poison others for a number of reasons. Some of the causes are as follows:
- Attention-seeking behavior
- Child abuse
Unintentional aspirin poisoning is possible, and it used to be the most prevalent cause of accidental poisoning in children. It has become less common as a result of safety procedures such as child-resistant packaging.
One of the reasons that unintentional aspirin poisonings continue to occur is due to inadvertent dosing in both the young and the elderly.
Aspirin or aspirin-like compounds are found in hundreds of medications, both over-the-counter and prescription. If these medications are used together, at incorrect amounts, or for an extended period of time, unintentional poisoning can occur. This is more likely to happen in older adults who have chronic health issues.
Symptoms of Aspirin Poisoning
These are some of the more clinically significant signs and symptoms of aspirin poisoning:
- Tinnitus (ringing in the ears) and hearing loss are two of the first symptoms of acute aspirin poisoning.
- Rapid breathing (hyperventilation)
- Double vision
- Feeling faint
Drowsiness or disorientation, unusual behavior, unsteady walking, and coma are later indicators of aspirin poisoning, or signs of more serious poisoning. Aspirin overdose causes irregular breathing that is frequently fast and deep.
After consuming too much aspirin, vomiting may occur 3-8 hours later. Hyperventilation, vomiting, and fever can all cause serious dehydration.
If the person is taking aspirin and is experiencing ringing in the ears, consult the doctor to see if it is needed to stop taking it or reduce the dosage of Aspirin.
The following are serious symptoms:
- Blood pressure that is too low
- Rapid Breathing
- Vomiting and nausea
Diagnosis of Aspirin Poisoning
- Physical Assessment. To rule out poisoning, the healthcare provider will obtain a medical history and conduct a physical examination including the vital signs with the body temperature, and make sure that the patient can breathe.
- Blood Tests. The healthcare provider will request laboratory tests to check for damage to organ systems that could be affected by the aspirin overdose, as well as to check for the level of aspirin in the bloodstream, depending on the timing.
- Neurological Assessment. The healthcare provider will assess the patient’s alertness by having to answer questions. If the patient is unconscious, the healthcare provider will administer oxygen and may utilize breathing devices to assist the patient in breathing.
Medical Management for Aspirin poisoning
To limit further aspirin absorption into the body, the healthcare provider may perform gastric lavage, or pumping out the stomach contents. Dialysis is also sometimes used to lower salicylate levels in the body.
- Medications. Drugs used to treat aspirin poisoning may include:
- Activated charcoal – used to absorb the salicylate from the stomach to prevent further absorption. To transport the activated charcoal mixture through the gastrointestinal tract more quickly, a laxative may be given alongside it. Repeated doses of activated charcoal may be given to people who have been seriously poisoned.
- Intravenous fluids – dehydration is a common side effect of aspirin toxicity. The healthcare provider will start an IV to administer fluids to correct dehydration and will also work to rectify any chemistry imbalances in the body’s blood.
- Alkaline diuresis – a method of lowering salicylate levels in the body. Alkaline diuresis is the process of giving poisoned people substances that change the chemistry of their blood and urine, allowing their kidneys to eliminate more salicylate. Sodium bicarbonate is given intravenously to make the blood and urine less acidic (more alkaline). This causes the kidneys to catch more salicylate, which can then be excreted in the urine. Other molecules, such as potassium, may be required at times to aid this process.
In the case of a dangerous aspirin overdose, the emergency healthcare provider may have to perform other procedures and give other medications as supportive care, these may include the following:
- Intubation – when the patient is in coma and has ineffective airway clearance or requires mechanical breathing, a breathing tube (intubation) is placed and a ventilator is used to support breathing.
- Catheterization- It is inserted into the bladder to monitor urine flow and to assess the acidity (pH) of the urine on a regular basis.
- Other medications may be given as needed to manage agitation, convulsions (seizures), or other aspirin poisoning effects.
Nursing Care Plan for Patients on Aspirin
- Risk for Bleeding
- Risk for Impaired Renal Function
- Disturbed Sensory Perception (Auditory) secondary to aspirin poisoning
|Aspirin Nursing Interventions||Rationale|
|Assess the patient for signs and symptoms of pain, fever, and/or inflammation..||To confirm the indication for administering aspirin.|
|Check the patient’s allergy status.||Alternatives to aspirin should be considered in case of allergy.|
|Assess if the patient is pregnant or lactating.||Pregnant women are encouraged to avoid the use of aspirin on the first and second trimester of pregnancy. It is also important to let the breastfeeding mother know that aspirin may be passed into breast milk.|
|Assess the patient’s ability to self-administer the medication.||To check for any potential problems with administration.|
To ensure that the right form of aspirin is given through the right route.
|Check the patient’s renal function. Check for current medications that include anticoagulants as these should be used cautiously with aspirin.||An increased risk of dehydration and renal impairment may occur when a patient consumes long-term or excessive amounts of aspirin. Aspirin increases a patient’s risk for bleeding and should be used cautiously in patients who are taking anticoagulants.|
Nursing Planning and Intervention
|Aspirin Nursing Interventions||Rationale|
|Administer aspirin at the same time each day.||To ensure medicine compliance and lower the risk for pain to develop.|
|Advise the patient that aspirin should be taken on a full stomach with a full glass of water.||Aspirin may irritate the lining of the stomach, so it should be taken with or immediately after meals.|
|Advise the patient to prevent drinking excessive amounts of alcohol while on aspirin.||Aspirin combined with excessive amounts of alcohol may cause gastrointestinal upset and GI bleeding as evidenced by hematemesis, nausea and vomiting.|
|Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking aspirin. Instruct the patient on how to self-administer aspirin.||To inform the patient on the basics of aspirin, as well as to empower him/her to safely self-administer the medication.|
|Advise the patient to report any ringing in the ears, hearing loss, a feeling of nausea or episode of vomiting.||Nausea and vomiting, hearing loss, and tinnitus are signs and symptoms of aspirin poisoning.|
|In case of aspirin poisoning, administer activated charcoal as prescribed.||Activated charcoal is effective in absorbing the salicylate from the stomach to prevent further absorption.|
|Aspirin Nursing Interventions||Rationale|
|Ask the patient to repeat the information about aspirin, such as the right dose and the maximum dose per day.||To evaluate the effectiveness of health teaching on aspirin.|
|Monitor the patient’s renal function.||To ensure that the aspirin did not cause any damage to the kidneys.|
|Monitor the patient’s response to aspirin.||To check if aspirin is effective or if another type of pain or fever relief is needed.|
|Routinely check for signs and symptoms of bleeding.||Excessive aspirin can cause bleeding, especially in the stomach.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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