Question

The nurse is working on a neurological unit. A client with a hemorrhagic stroke develops a fever of \(101.8^{\circ} \mathrm{F}\). Which drug is best for the nurse to administer? A. Naproxen (Naprosyn) B. Ibuprofen (Advil) C. Acetaminophen (Tylenol) D. Salicylates (Aspirin)

Short answer

Answer: C. Acetaminophen (Tylenol)

Step-by-step solution

Identify the effects of Naproxen (Naprosyn)

Naproxen, also known as Naprosyn, is a nonsteroidal anti-inflammatory drug (NSAID) that is used to treat pain, inflammation, and fever. However, it also has blood-thinning properties and can increase the risk of bleeding in individuals with hemorrhagic stroke. Thus, it is not the best choice in this situation.

Identify the effects of Ibuprofen (Advil)

Ibuprofen, commonly known as Advil, is another NSAID that is used to treat pain, inflammation, and fever. Like Naproxen, it also has blood-thinning properties and can increase the risk of bleeding in individuals with hemorrhagic stroke. Therefore, it is not the best choice for this patient.

Identify the effects of Acetaminophen (Tylenol)

Acetaminophen, commonly known as Tylenol, is a pain reliever and fever reducer that does not have the blood-thinning properties associated with NSAIDs. It is considered to be a safer option for reducing fever in individuals with hemorrhagic stroke, as it does not increase the risk of bleeding.

Identify the effects of Salicylates (Aspirin)

Salicylates, such as aspirin, are also pain relievers, fever reducers, and anti-inflammatory drugs. However, they are known for their blood-thinning properties, which can increase the risk of bleeding in individuals with hemorrhagic stroke. Therefore, they are not the best choice in this situation.

Choose the best drug for the patient

After analyzing the effects of each drug on fever and their potential impact on a patient with a hemorrhagic stroke, we can see that Acetaminophen (Tylenol) is the most suitable option, as it effectively reduces fever without increasing the risk of bleeding. Thus, the correct answer is: C. Acetaminophen (Tylenol)

Key concepts

Fever Reduction in Stroke Patients

Managing a fever in stroke patients is a critical aspect of their care. Fever can exacerbate brain injury and worsen prognosis, so it's essential to reduce the fever efficiently and safely. In the scenario of a hemorrhagic stroke patient developing a fever, the primary goal is to select a medication that can lower the body temperature without increasing the risk of bleeding.

Acetaminophen (Tylenol) is typically the preferred choice for fever reduction in hemorrhagic stroke patients. Unlike NSAIDs, acetaminophen does not exhibit antiplatelet activity and therefore does not increase the risk of bleeding. It's crucial to understand that acetaminophen's mechanism of action focuses on inhibiting the brain's heat-regulating center, effectively lowering body temperature. For patients who have suffered a hemorrhagic stroke, closely monitoring dosage is imperative to avoid any risk of liver toxicity.

It's worth highlighting that other pharmacological measures may be necessary if temperatures remain elevated despite acetaminophen use. In such cases, physical cooling measures, such as cooling blankets or ice packs, might be employed in conjunction with medication. Consistent monitoring of the patient’s temperature and neurological status is crucial in delivering appropriate fever management.

NSAIDs and Stroke Risks

NSAIDs, or nonsteroidal anti-inflammatory drugs, are commonly used to treat pain, inflammation, and fever. However, due to their blood-thinning properties, they present significant risks when administered to hemorrhagic stroke patients. Drugs such as naproxen (Naprosyn), ibuprofen (Advil), and salicylates (Aspirin) inhibit platelet aggregation, increasing the potential for further bleeding within the brain.

This risk necessitates a careful approach in managing fever or pain in hemorrhagic stroke patients. While these medications are generally safe and effective in the general population, their use is not recommended in the context of an ongoing hemorrhagic event. The propensity of NSAIDs to exacerbate bleeding presents a critical challenge and reinforces the importance of selecting safer alternatives, such as acetaminophen, for these patients.

When to Avoid NSAIDs

In patients who've had a hemorrhagic stroke, NSAIDs should be avoided due to their potential to worsen intracranial bleeding. This caution extends to the use of NSAIDs in individuals with risk factors for hemorrhagic stroke, such as uncontrolled hypertension or a history of aneurysms. It's important for both healthcare providers and patients to be aware of these risks when considering pain or fever management options.

Acetaminophen Safety in Hemorrhagic Stroke

Acetaminophen, the active ingredient in Tylenol, is considered safe for use in patients with hemorrhagic stroke when dosed appropriately. Unlike NSAIDs, acetaminophen does not possess anticoagulant properties and does not contribute to an increased risk of bleeding. This favorable safety profile makes it a drug of choice for treating fever and mild to moderate pain in this patient population.

However, safety also depends on adhering to recommended dosage guidelines to avoid hepatotoxicity, especially in patients with pre-existing liver conditions or those consuming other medications that affect liver enzymes. The liver's role in metabolizing acetaminophen becomes a crucial factor to monitor to prevent potential liver damage from overdose.

Dosing Considerations

Healthcare providers must ensure that dosing of acetaminophen remains within the safe range, typically not exceeding 4 grams per day for adults. Careful administration is particularly important for patients with reduced liver function or those who consume alcoholic beverages, as these factors can lower the threshold for toxicity. Ultimately, while acetaminophen stands as a safe and effective option for managing fever in hemorrhagic stroke patients, this reinforces the importance of careful, individualized patient evaluation and monitoring.