15.3 Implement Nutritional Strategies to Impact Renal Wellness
3 min read•june 18, 2024
Nonopioid analgesics are crucial pain relievers that don't involve opioids. They include acetaminophen and NSAIDs, each with unique benefits and risks. These medications work by targeting different pathways in the body to reduce pain and inflammation.
Understanding how these drugs work helps nurses choose the right option for patients. Acetaminophen is gentler on the stomach but can harm the liver. NSAIDs are great for inflammation but may cause stomach issues. Proper dosing and patient education are key to safe use.
Nonopioid Analgesics
Characteristics of nonopioid analgesics
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- Acetaminophen (Tylenol)
- Acts on the central nervous system to provide pain relief and reduce fever (antipyresis)
- Decreases the production of pain-causing substances (prostaglandins) in the brain and spinal cord
- Lacks significant ability to reduce inflammation in the body
- Gentler on the stomach lining compared to NSAIDs, less likely to cause ulcers or bleeding
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
- Provide pain relief, lower fever, and decrease inflammation in the body
- Work by blocking enzymes (COX-1 and COX-2) that produce inflammation-causing prostaglandins
- COX-1 inhibition maintains protective functions in the stomach lining, blood clotting, and kidneys
- COX-2 inhibition targets pain and inflammation pathways
- Common NSAIDs include ibuprofen (Advil, Motrin), naproxen (Aleve), and celecoxib (Celebrex)
Mechanism of Action
- Cyclooxygenase (COX) enzymes convert arachidonic acid into prostaglandins
- NSAIDs inhibit COX enzymes, reducing prostaglandin production
- Salicylates (e.g., aspirin) irreversibly inhibit COX enzymes
- Prostaglandin reduction leads to analgesic, anti-inflammatory, and antipyretic effects
Comparisons of nonopioid analgesics
- Acetaminophen
- Best for mild to moderate pain and reducing fever
- Can cause liver damage if taken in high doses or for extended periods
- Avoid use in patients with severe liver disease or a history of alcohol abuse
- Ibuprofen and Naproxen
- Effective for mild to moderate pain, inflammation, and fever
- May cause stomach irritation, ulcers, bleeding, and kidney problems
- Not recommended for patients with a history of stomach ulcers, severe kidney or liver disease, or during the last 3 months of pregnancy
- Celecoxib (COX-2 selective NSAID)
- Prescribed for osteoarthritis, rheumatoid arthritis, and acute pain management
- Carries a higher risk of heart problems and kidney impairment compared to other NSAIDs
- Avoid use in patients allergic to sulfa drugs or those who recently had heart bypass surgery
Nursing considerations for nonopioid analgesics
- Evaluate the patient's pain level and characteristics to select the most appropriate pain medication
- Check the patient's drug history and known allergies before administering any medication
- Watch for potential side effects and adverse reactions
- Acetaminophen: Monitor liver function with long-term use through blood tests
- NSAIDs: Assess for signs of stomach bleeding and check kidney function periodically
- Give NSAIDs with food or milk to reduce stomach irritation
- Modify the dose for patients with kidney or liver impairment
- Teach patients about proper dosing, potential side effects, and important precautions
Patient education for nonopioid analgesics
- Stress the importance of taking the medication exactly as prescribed by the healthcare provider
- Warn patients not to take more than the recommended dose
- Acetaminophen: Limit daily intake to 4 grams (4000 mg) to prevent liver damage
- NSAIDs: Adhere to the prescribed dose to minimize stomach and kidney risks
- Encourage patients to inform their healthcare provider about any side effects or concerns they experience
- Recommend avoiding alcohol while taking acetaminophen due to increased liver damage risk
- Remind patients to disclose all current medications, including over-the-counter drugs and supplements, to their healthcare provider
- Offer clear written instructions and educational resources for patients to refer to at home
Key Terms to Review (30)
Anemia: Anemia is a condition characterized by a reduced number or impaired function of red blood cells, leading to a decrease in the oxygen-carrying capacity of the blood. This can have significant implications for an individual's overall health and wellness, particularly in the context of nursing practice and the management of various medical conditions.
Bioimpedance Analysis: Bioimpedance analysis (BIA) is a non-invasive technique used to estimate body composition by measuring the body's electrical impedance or resistance to the flow of a small, safe electrical current. This method provides insights into an individual's hydration status, body fat percentage, and other important indicators of health and nutritional status, particularly relevant in the context of renal wellness.
Calcium: Calcium is a crucial mineral for the development and maintenance of strong bones and teeth. It also plays essential roles in muscle contraction, nerve signaling, and blood clotting.
Creatinine: Creatinine is a waste product that is produced by the body's normal breakdown of muscle tissue. It is filtered out of the blood by the kidneys and excreted in urine. The level of creatinine in the blood is an important indicator of how well the kidneys are functioning.
DASH Diet: The DASH (Dietary Approaches to Stop Hypertension) diet is a eating plan focused on reducing blood pressure and promoting overall cardiovascular health. It emphasizes the consumption of fruits, vegetables, whole grains, lean proteins, and low-fat dairy products, while limiting sodium, saturated fats, and added sugars.
Dialysis: Dialysis is a medical procedure that filters and purifies the blood when the kidneys are unable to perform this function effectively. It is a critical intervention for individuals with kidney failure or end-stage renal disease, as it helps maintain the balance of fluids, electrolytes, and waste products in the body.
Dietary Protein: Dietary protein refers to the macronutrient obtained from food sources that is essential for various bodily functions, including tissue repair, immune function, and energy production. It is a critical component of a balanced diet, particularly in the context of renal wellness.
Educational strategies: Educational strategies are planned approaches and methods used to facilitate learning and improve knowledge retention. In nursing, these strategies are essential for effectively teaching patients about managing their health conditions.
Electrolytes: Electrolytes are minerals that carry an electric charge when dissolved in body fluids such as blood, urine, and other bodily fluids. They are essential for maintaining proper hydration, regulating nerve and muscle function, and supporting cardiovascular and renal health.
Fat: Fat is a macronutrient essential for energy storage, hormone production, and cell structure. It is categorized into saturated, unsaturated, and trans fats based on their chemical structure and health effects.
Fluid Balance: Fluid balance refers to the equilibrium between the amount of fluids entering and leaving the body, ensuring the proper hydration and functioning of various bodily systems. It is a crucial physiological process that is closely tied to the regulation of water, electrolytes, and acid-base balance within the body.
Fluids: Fluids are substances that have the ability to flow and conform to the shape of their container. In nutrition, they play a crucial role in maintaining hydration, electrolyte balance, and overall renal function.
Glomerular Filtration Rate: Glomerular filtration rate (GFR) is a measure of the kidney's ability to filter waste and excess substances from the blood. It represents the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman's capsule per unit of time, and is a key indicator of overall kidney function.
Health disparities: Health disparities are differences in health outcomes and access to healthcare services among different population groups. These disparities often stem from social, economic, and environmental disadvantages.
Hyperkalemia: Hyperkalemia is a medical condition characterized by an abnormally high level of potassium in the bloodstream. This imbalance can have significant impacts on the body's overall health and wellness, particularly in the context of hydration, treatments, nutrition, and renal function.
Hyperphosphatemia: Hyperphosphatemia is a condition characterized by an abnormally high level of phosphate in the blood. This electrolyte imbalance can have significant implications for the renal system and overall health, making it an important consideration in the context of nutrition and renal wellness.
Kidney Transplantation: Kidney transplantation is a surgical procedure in which a healthy kidney from a living or deceased donor is implanted into a person whose kidneys no longer function properly. It is a treatment option for end-stage renal disease, providing an alternative to long-term dialysis.
Low-Protein Diet: A low-protein diet is a dietary plan that restricts the intake of protein-rich foods, typically to less than 0.8 grams of protein per kilogram of body weight per day. This type of diet is often recommended for individuals with certain medical conditions, such as chronic kidney disease, to help manage the progression of the disease and reduce the strain on the kidneys.
Magnesium: Magnesium is an essential mineral involved in numerous biochemical reactions in the body, including energy production and muscle function. It plays a crucial role in maintaining normal nerve and muscle function, supporting a healthy immune system, and keeping the heartbeat steady.
Malnutrition: Malnutrition refers to a state of nutritional imbalance, where an individual's intake of nutrients is either insufficient, excessive, or imbalanced, leading to adverse effects on their health, growth, and overall well-being. This term is particularly relevant in the context of nursing practice, population health, and the care of vulnerable populations.
Metabolic Acidosis: Metabolic acidosis is a condition in which the body has an excessive accumulation of acidic substances, primarily lactic acid or ketones, leading to a decrease in the pH of the blood and body fluids. This disruption in the body's acid-base balance can have significant implications for renal wellness.
Nephrotic Syndrome: Nephrotic syndrome is a group of symptoms that indicate kidney damage or dysfunction, characterized by high levels of protein in the urine, low levels of protein in the blood, swelling, and high cholesterol levels. This condition is closely tied to the topics of implementing nutritional strategies to impact renal wellness and the impact of nutrition on renal wellness across the lifespan.
Phosphorus: Phosphorus is a mineral essential for the formation of bones and teeth, and it plays a critical role in cellular energy production. It helps maintain normal pH levels in the body and is vital for the function of muscles and nerves.
Potassium: Potassium is an essential mineral and electrolyte crucial for maintaining proper cell function, nerve transmission, and muscle contraction. It plays a significant role in maintaining fluid balance, blood pressure regulation, and overall cardiovascular health.
Protein: Proteins are large, complex molecules made up of amino acids that play many critical roles in the body. They are essential for the structure, function, and regulation of the body's tissues and organs.
Renal Diet: A renal diet is a specialized dietary plan designed to support individuals with kidney-related health conditions, such as chronic kidney disease (CKD), end-stage renal disease (ESRD), or kidney failure. The primary goal of a renal diet is to help manage the progression of kidney disease and prevent or mitigate the associated complications by carefully regulating the intake of certain nutrients.
Sodium: Sodium is an essential mineral that plays a critical role in maintaining fluid balance, nerve function, and muscle contraction. It is commonly consumed through salt (sodium chloride) in the diet.
Subjective Global Assessment: Subjective Global Assessment (SGA) is a comprehensive evaluation tool used to assess a patient's nutritional status by considering their medical history, physical examination, and subjective factors. It is a widely used method to identify individuals at risk of malnutrition or those who require nutritional intervention.
Uremia: Uremia is a condition that occurs when waste products, such as urea and creatinine, accumulate in the blood due to impaired kidney function. This buildup of waste products can have significant impacts on the body's overall health and wellness, particularly in relation to the renal system.
World Health Organization: The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. It sets global health standards and provides evidence-based guidelines to promote wellness, including nutritional strategies for specific conditions like renal disease.