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Hi ninja nerds in this video we’re going to talk about acetaminophen or more commonly referred to as tylenol if you like this video please give it a thumbs up let’s get into it acetaminophen also known as tylenol is a medication that we are typically going to be giving our patients so commonly referred to as tylenol but the active ingredient is acetaminophen and
It’s given for two types of indications we have analgesic which we know is another word for treating pain and we have an antipyretic which is for fever right so we’re going to be giving this medication primarily to treat pain or to treat a fever the reason we do this is we have a mechanism action which is to inhibit the production of the prostaglandins in the
Central nervous system and you’re probably thinking well what are prostaglandins like what what do those do why are we giving this to a patient so prostaglandins are things that play a role in our body to help transmit pain and fever response okay what does that mean our body’s sending signals saying i have pain i have a fever and we’re going to be getting
All these types of symptoms going on and we can give tylenol to help inhibit this area this reaction of a prostaglandin so we can stop producing either the pain or the fever okay and then we treat the source we treat the source of the pain or the fever in some other way so if the person’s having a fever because of an infection they would get secondary antibiotics
And they’re if they’re having pain from something else maybe they are neither appendix removed we’re going to help with that as well so prostaglandins transmit the pain and fever response so if we’re inhibiting that we’re going to cut off this response and then we’re not going to have as much pain or we’re not going to have a fever tylenol is typically used as an
Anti or as an alternative to nsaids okay and what are nsaids nsaids are a type of pain medication that we can give that acts on the bleeding cascade right and it can help thin the blood we’re going to look at tylenol to somebody if they have some type of bleeding disorder so let’s think about that real quick because in the nclex they like to ask questions about
Certain types of patients with certain disorders right so right here we have a little stomach and someone who has a bleeding disorder or any type of irritation in the stomach they can have either peptic or gastric ulcers so you want to think about giving tylenol to a patient who has ulcers okay that’s a good thing and you want to think about giving it to somebody
Who has some type of genetic or hereditary bleeding disorder and we’re doing that because remember tylenol disorder let’s finish writing that and then i’ll explain we want to remember this is good these are things we want to give tylenol to because they don’t act on any type of bleeding tylenol doesn’t act on any type of bleeding issue remember it’s only given
For pain or fever as an alternative to an nsaid before we administer the medication to our patient we want to think about some contraindications that we don’t want to be giving tylenol two so we said that tunnel is typically given for patients that have some type of bleeding issue so that we can not give them an inside or something that’s going to help trigger
The bleeding however with tylenol there are a couple things we want to keep in mind or just you know keep our eye on with our history the first thing is here is any type of hepatic or renal disease a patient that has something an issue with their kidney or an issue with their liver you want to keep an eye on it typically with with certain doctors they’re just
Going to want to maybe check some labs prior to giving tylenol okay or anything else that can indicate that maybe we shouldn’t be giving them tylenol another thing is hypersensitivity if they’ve had tylenol before and they have any type of like allergy or issue with acetaminophen as the active ingredient let’s try not to give them this medication right you
Want to also think about alcohol abuse why alcohol abuse remember what happens with with alcohol where does it get processed through the body where does it get filtered right here the liver so if they have a history of alcohol abuse or have some other problems going on with the kidney and the liver you want to you know think if they have a long-standing abuse
With alcohol they probably have some type of kidney or renal disease so we want to make sure that we’re looking at this as well the last thing is warfarin and i know before i said that if someone has some type of bleeding disorder we may want to look into giving them tylenol however warfarin is one medication you just want to keep an eye on and why that’s because
When you give someone warf or give someone tylenol that’s on warfarin it actually can increase bleeding okay and why is that why does warfarin increase bleeding can you think of like why that happens what is the one test that we test for warfarin it’s our inr so you want to make sure that you’re monitoring the inr because you’re going to be increasing possibly
Increasing bleeding with warfarin and that has to do with tylenol slowing the metabolism of warfarin so it’s going to last longer in the body so when you have a longer lasting medication in the body and you’re still taking it as you normally do you may also increase your bleeding so just keep an eye on that patient’s on warfarin just make sure you ask the doc hey
Is this okay are you okay with this so we have all of these contraindications that maybe we don’t want to give a patient this medication okay but when we do go to administer this medication there are different ways that the medication will interact in the body and different times okay so let’s think about this really quickly we have iv which is what intravenous
We have po which is oral and then we have pr some of you may not know what this abbreviation is what is the abbreviation for pr do you know it’s rectal okay so three different ways we can give this medication and we want to think about the mechanism or the time of the onset right the answer is 15 to 30 minutes right so someone is having some type of fever or
Pain you’re not going to get any relief at least until the 15 probably 30 30 minute mark when i give tylenol to my patients i typically like to tell them that it’s going to be 30 minutes okay until they maybe feel some pain relief what about po what is po again that’s oral how fast is someone going to get some relief from a pain or a fever in the oral category
When you give it to them through a pill or capsule a little longer right iv is going to be fast this one’s going to be 30 to 45 minutes and we have the last one here rectal if you’re going to be giving somebody a suppository how long is that going to take it’s going to take longer than these two right so this is going to be up to an hour until we get some relief
Okay so we are giving them a medication we know how long it’s probably going to take till they get some relief there is a couple things that we need to consider especially with adults and with people that have an alcohol abuse history or an alcoholic you want to look at their amount that they’re going to be taking daily so the recommended amount for adults is 4
Grams daily okay but for alcoholics if they have some type of history you’re only going to do two grams daily okay and that again remember we talked about it up here has to do with someone who has a history of abuse probably has some type of liver or kidney disease more than likely a liver issue okay so don’t exceed four grams daily if you’re an adult or two grams
Daily if you have a history of alcohol abuse what are some side effects then of tylenol today we’re just going to talk about the more typical side effects of tylenol so we have a little guy right here and he is having we have a big x over the head so they are probably going to have a headache which you would think aren’t you going to give tylenol for someone to
Train headache but some people do actually get a refurbished common side effect of a headache sweating so you want to keep an eye on this and these can be also early indicators of toxicity maybe they’ve had too much because remember we want to be at that four grams daily what else we have some nausea or vomiting okay we have a rash we have abdominal pain and
The abdominal pain could also be here in the right upper quadrant and keep that in mind for a little later and the last is dark urine right and this should start ringing some bells for you especially the abdominal pain that more than likely will be in the upper white right quadrant and the dark urine because what organ is typically the right upper quadrant pain
What does the anglex like to ask on there we talked about it earlier it’s the liver so remember that okay so we’re looking at possibly some toxicity there so these are the early side effects right and then all of a sudden maybe the patient is having some more side effects having something more serious which is a toxicity they’re taking too much time they’re having
Some issues we know that that can also lead to possibly coma death right those are like the two big things and then any type of kidney issue okay a long-standing kidney or liver issue so keep that in mind okay so what are some interventions that we want to make sure that when we’re giving someone tylenol we aren’t getting to that toxic level what are some of the
Things we’re going to be looking at first thing is just going to be looking at vital signs remember in our nursing interventions we’re always reassessing the patient so the patient was given tylenol for pain or given tylenol for a fever we’re always going to reassess so i’m going to put that down here that’s one of the things we’re going to keep doing over and
Over but we’re also going to be checking the other vital signs right we’re not going to just check their temp to see if it came down or just check their pain and see if it’s getting better we’re also going to check is their heart rate increasing is their blood pressure dropping are their lungs lung sounds junky and that all has to do with typically pain or fever
Comes secondary to something else that’s going on an infection somewhere so we want to make sure that we’re not missing it maybe their x-ray yesterday when they first came in looked nice and clear and then all of a sudden today it’s starting to look a little more cloudy because maybe they are developing a pneumonia and this was our early sign so we want to make
Sure we’re always assessing our patient and reassessing to making sure that the medication was working what’s another thing we’re going to be making sure we ask do they have any history of any type of reaction okay want to make sure we’re checking their history do they have any history of reaction to tylenol do they have any of that history we talked about earlier
Any type of kidney liver problems what else are we going to be looking at you want to make sure that with nursing interventions if we think something’s going on we can check blood worker tell the doc and they’re going to order blood work we’re going to be looking here at the ast and the alt okay what are those we’re going to be looking at our liver enzymes making
Sure our liver looks okay when we move into adults and peds we also want to keep in mind and telling our patients that if you’re having a fever for subsequent days or you’re taking tylenol for a pain medication you want to make sure you’re not using it too many days in a row for adults that’s going to be 10 days if they’ve used tylenol for 10 days in a row even
Though they’re staying right at that four grams daily that’s going to be an issue you want to make sure that you’re telling them to seek help and you want to make sure that you’re telling them to tell a doctor tell the pcp you’ve been taking towel for 10 days what about pediatrics pediatrics is three to five if they’re taking it for anywhere up to three to five
Days they should be seeing their pediatrician so we’ve been reassessing their vitals we’re making sure their blood work looks good they maybe have been taking it for too long and god forbid we get into an overdose situation or a toxicity that we need to reverse what are we going to do we’re going to give the antidote okay so keep that in mind this is another
Nclex nursing intervention that we can do with tylenol and what is the antidote do you know remember the medication we’re giving is acetaminophen so the antidote is ace thai cysteine okay so i always remember it as acetaminophen and tylenol and then cysteine so remember that the antidote is acetylcysteine and that’s the medication that we’re going to talk about
Now god forbid our patient overdose accidentally or on purpose unfortunately our patient may have overdosed either intentionally or accidentally and there are some things as a nurse you need to know or find out if you can either from the patient or family or friends that have brought the patient in first thing we want to just figure out is how much did they take
Of the tylenol and how long ago how long has it been okay so those are the first two things we’re going to ask did the how much did the patient take do you proximally know and then how long ago was it and that that is going to help us figure out do we need to just keep assessing them because we’re maybe out of this initial window or we took so much that we’re
Going to be looking at possibly then slipping into a coma or just being very lethargic and altered so we’re going to be given again our antidote right if they are able to sit up and drink you’re going to give them the acetylcysteine typically in juice you can mix it or water if they’re able to drink okay so fantastic you’re going to mix all this in here and
They’re going to drink okay you want to make sure you tell the patient drink it at a nice comfortable pace don’t try to chug it because i don’t want you throwing up but i also want you to get this into your body so you want to make sure that they are drinking this and you’re keeping an eye on them so what are some things you’re going to do you’re going to keep
Reassessing to every you know this is going to be longer than two to four hours but immediately in the two to four hours after they have ingested we’re going to be looking for things like bradycardia sweating vomiting or nausea and i always tell my patient if you’re feeling nauseous let me know i can give you medications for that i can give you an anti-nausea
Medication and we’re going to keep recessing vital signs keep an eye on them maybe keep drawing blood work of the patient or if the doc wants that up to seven days a patient can have some liver issues or liver problems and what are some of those issues so let’s think about it if the liver is having issues eliminating or getting rid there may be a buildup of
What’s this what’s the one thing that the liver helps get rid of in the body you know bilirubin all right so if bilirubin is building up or increasing in the body what are we going to have we’re going to have jaundice okay i have some darker urine okay what else is going on they’re going to have altered labs they’re alt in their ast probably right so we want
To keep an eye on our patient so when they take an overdose or too much acetaminophen you want to be giving them the antidote acetyl cysteine in our juice or water you can mix it and you want to keep remon revitalizing or reassessing your patient keeping an eye on them monitoring them that’s what we’re talking about those nursing interventions but god forbid
Our patient came in and maybe took it a little longer prior and now they’re not really reacting they’re kind of unconscious or maybe they have an altered mental status you know you’re trying to give them a cup and they can barely hold it up they’re you know not really able to put their lips on a straw or anything you want to maybe move into a gastic gastric lavage
Now this is a nursing intervention that’s not commonly used anymore i haven’t seen it used in my experience but this is something that we can do the reason we do a gastric lavage is we’re either going to insert this patient for this drawing has an og you can put an og tube in an orogastric tube or you can put a nasal gastric an ng tubing the whole idea is to put
That tube in through the oral and nasal cavity down into the stomach okay insert it so that we can either take out as much as we can pump out as much suck out as much as we want and then put in activated charcoal right we want to put this activated charcoal in and you’re probably thinking why can’t we put the acetyl cysteine that’s the antidote in the patient
Already has a stomach full of tylenol we’re going to try to get out as much as we can activated charcoal is going to inhibit any absorption which is great so if you’re inhibiting the absorption of the rest of the tylenol it’s just going to ingest through patient might also get very nauseous from this so that’s why we put in either an ng and og because as they
Get nauseated and as they start putting this activated charcoal you can wait about a certain amount of time and then start taking it out okay hooking it up to suction and taking it out so activated charcoal goes in and inhibits all of that absorption great wonderful the reason then we can’t give the acetyl cysteine is because now this activated charcoal if you
Put this in after you’ve put activated charcoal to help stop absorption acetyl cysteine is also inhibited because activated charcoal also does that and there isn’t a way to get they don’t like this going through ng or og tubes so just keep that in mind the gastric avalanche is the nclex thing you want to be looking at if the patient comes in and somewhere in that
Question it says they have an altered mental status they’re acting confused you know or they’re in a coma or non-responsive you want to look for that answer that’s possibly picking gastric lavage because that’s what they’re hinting at patients not gonna be able to drink out of a straw if they’re acting altered or they’re confused so keep that in mind all right
In nerds in this video we talked about acetaminophen i hope it made sense and i hope you liked it as always until next time you
Transcribed from video
Acetaminophen (Tylenol) | NCLEX By Ninja Nerd
