All About Non-Selective NSAIDs

• Non-selective NSAIDs are effective in managing pain and inflammation, but can cause potential side effects such as gastrointestinal bleeding, ulcers, and liver toxicity. 
• Healthcare professionals need to be aware of potential drug interactions and follow nursing processes, such as nursing assessment, key nursing diagnoses, planning outcome goals, and nursing implementations, to ensure safe and effective use of non-selective NSAIDs. 
• Patients should be educated on the potential adverse effects of NSAIDs and monitored for any abnormal changes during therapy to minimize the risks associated with these drugs. 

Non-selective NSAIDs are known for their anti-inflammatory, analgesic, and antipyretic effects. They can help manage conditions such as rheumatoid arthritis, osteoarthritis, and migraines. However, like many drugs, they also come with potential side effects, including gastrointestinal bleeding, ulcers, and liver toxicity. 

To ensure that patients receive the right dosage of NSAIDs with minimal adverse effects, healthcare professionals follow nursing processes such as nursing assessment, key nursing diagnoses, planning outcome goals, and nursing implementations. By following these steps, healthcare professionals can help ensure that their patients receive the best possible care while taking non-selective NSAIDs. 

So, whether you’re a nurse, nursing student, or just someone interested in learning more about non-selective NSAIDs, this post is designed to provide you with the knowledge you need to ensure their safe use. 

An Introduction to NSAIDs

As the name indicates, non-selective NSAIDs help combat pain and inflammation. Their anti-inflammatory effects are similar to aspirin and possess analgesic and antipyretic effects. Non-selective NSAIDs block both the enzymes COX1 and COX2, hence the name is “non-selective.” 

Common examples of non-selective NSAIDs are: 

• indomethacin 
• ibuprofen 
• diclofenac 
• etodolac 
• fenoprofen  
• flurbiprofen 
• ketoprofen 
• ketorolac 
• mefenamic acid 
• meloxicam 
• nabumetone 
• naproxen 
• oxaprozin 
• sulindac 

NSAIDs help control pain and inflammation associated with common health conditions (in addition to general pain relief), including:  

• ankylosing spondylitis 
• moderate to severe rheumatoid arthritis  
• osteoarthritis  
• osteoarthritis accompanied by inflammation 
• acute gouty arthritis  
• dysmenorrhea  
• migraine 
• bursitis 
• tendinitis 

Drug Interactions and Adverse Effects With NSAIDs

NSAIDs and Drug Interactions With NSAIDs

To properly treat their patent, healthcare providers should be aware of potential drug interactions with NSAIDs, including some common interactions like: 

• Indomethacin and sulindac—These drugs interact with NSAIDs because they are highly protein bound. And NSAIDs interact with drugs that are protein bound.  
• Fluconazole, phenobarbital, rifampin, ritonavir, and salicylates—These drugs affect the absorption of NSAIDs. 
• Oral coagulants, aminoglycosides, ACE inhibitors, beta-adrenergic blockers, digoxin, and phenytoin—Taking NSAIDs with drugs that thin blood could lead to an increased risk for bleeding. 
• Lithium toxicity can occur—When taken with ibuprofen, increased risk of lithium toxicity can occur.  

Adverse Effects of NSAIDs

Generally, NSAIDs are well tolerated. However, gastrointestinal adverse effects, such as bleeding, ulceration, and perforation of the stomach and the intestines may occur. NSAIDs can potentially damage the gastroduodenal mucosa by the following mechanisms: 

• Causing a topical irritant effect on the stomach epithelium  
• Suppressing the gastroprotective prostaglandins due to the inhibition of COX1 and 2 
• Impairing the barrier properties of the mucosa 

To prevent gastrointestinal adverse effects, always administer oral NSAIDs with food—not on an empty stomach—as it can lead to various complications.  

Additional, less common side effects of NSAIDs are: 

• anorexia 
• abdominal pain and bleeding 
• diarrhea 
• nausea 
• ulcers 
• liver toxicity 
• drowsiness 
• headache 
• bladder infection 
• blood in the urine 
• kidney necrosis 
• hypertension 
• heart failure 
• pedal edema 
• dizziness 
• confusion 
• tinnitus 
• vertigo 
• depression 

The Nursing Process and NSAIDs

The nursing processes to be followed for patients receiving NSAIDs are: 

Nursing Assessment

• Before starting the therapy, assess the patient’s underlying health condition with the pain and inflammation levels.  
• After starting the therapy, assess the patient’s pain. Here, you will understand the drug’s effectiveness.  
• Monitor the bleeding time. Assess it if the patient has to undergo surgery.  
• Monitor the patient’s ophthalmic and auditory function before and periodically during therapy to detect toxicity. 
• With the therapy, monitor the patient’s complete blood count, renal function tests, platelet count, prothrombin time, and hepatic function tests periodically to detect abnormalities.  
• If the patient has aspirin hypersensitivity, rhinitis, nasal polyps, or asthma, check them for bronchospasm and other adverse drug reactions.  
• Evaluate the patient’s and their family member’s knowledge about NSAIDs. 

Key Nursing Diagnoses

• Pain due to underlying condition  
• Risk for adverse drug reactions 
• Inadequate knowledge of drug therapy 

Planning Outcome Goals

• The patient acknowledges a reduction in pain. 
• While the patient is on drug therapy, no serious adverse drug reactions occur.  
• The patient and his family will verbalize an understanding of the purpose and intended effect of the drug therapy. 

Nursing Implementations

• Administer NSAID with a glass of water to ensure adequate passage of the tablet or capsule. Ask the patient to sit up for at least 15 to 30 minutes to prevent its lodging in the esophagus.  
• To aid swallowing, crush the tablet or mix it with food or fluid.  
• To reduce adverse gastrointestinal effects, administer NSAIDs with food or milk. If the patient has a history of acidity, inform the prescriber.  
• Notify the prescriber if the drug is ineffective.  
• If renal or hepatic abnormalities occur, stop the drug and notify the prescriber. 

Evaluation

• The patient acknowledges the pain relief. 
• The patient remains free from adverse effects throughout drug therapy. 
• The patient and his family have an understanding of drug therapy. 

The Bottom Line

NSAIDs play an essential role in controlling pain and inflammation. Generally, they are well tolerated. However, ask the patient to notify you soon if he notices blood in stool or vomit- a sign of gastrointestinal bleeding that can occur with NSAID therapy.

By regularly monitoring patients for any abnormal changes during therapy and educating them on potential adverse effects, healthcare providers can help minimize the risks associated with these drugs. With proper care and attention, non-selective NSAIDs can be a valuable tool in managing various health conditions and improving patients’ quality of life. 

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