Question

Video Challenge Question The nurse administered acetaminophen to the client at 1010 for an elevated temperature. After reviewing the electronic medical record, what potential safety concerns should the nurse be aware of prior to administering other medication(s) to Ms. Goodman?

Answer 1

Precautions should taken by nurse while administration other medications after Acetaminophen:

You are talking about a combined drug formulation.

The first is acetaminophen. Assuming we are talking about a patient without preexisting liver disease acetaminophen is a very safe drug. Acetaminophen itself does not cause the toxicity. The liver converts the acetaminophen into a liver toxic substance. Even a patient with a history of heavy drinking which with chronic use will cause liver damage eventually, acetaminophen may still be asafe drug. Perhaps because an alcoholic liver will convert acetaminophen at a smaller rate into a liver toxic substance. In fact a patient who overdoses with acetaminophen while heavily drinking may have less toxicity, because there definitely would be competition within the liver for conversion of the acetaminophen to a toxic metabolite.

So how much is too much? Taking twelve grams over 24 hours will definitely badly injure the liver. Acetaminophen overdose will cause symptoms to appear quickly unlike many other types of drug induced liver poisoning. After 24 hours, a patient will experience nausea and vomiting, sweating, and just feel awful. After 48 hours, many abnormalities in liver tests and even kidney tests will become apparent. After 3 days, the patient will become jaundiced with rapid onset of multiple organ system failure resulting in death.

I have personally recommended high doses of acetaminophen in my practice (8 grams in 24 hours). I have never had a case of toxicity.

The other drug in Tylenol PM is benadryl. The benadryl itself has no pain alleviating qualities. It is useful for treating the common cold because of benadryl's antihistamine effects. It can also be used as a sleeping pill because benadryl has sedating effects. It also has some anti nausea effects.

Benadryl has many drug interactions. The main effect of an overdose would be generalized depression of brain function. In other words, an overdose could lead to a coma. In the combined preparation overdose, it would probably be the Tylenol that would kill you first. But again it really depends on what other medications you are taking.