NUR 635 Topic 3 DQ 1

Sample Answer for NUR 635 Topic 3 DQ 1 Included After Question

Steve, a 19-year-old male college basketball player, fell during practice. He is now complaining of leg pain. His trainer recommends a combination of rest, acetaminophen, and ibuprofen for pain control. Use the guidelines and relevant literature in your topic Resources to discuss the following:

  • How does acetaminophen treat pain? Include pathophysiology and mechanism of action, and determine if it treats the perception of pain or the site of trauma.
  • Describe how ibuprofen treats pain. Be sure to include the pathophysiology and mechanism of action, and determine if it treats the perception of pain or the site of trauma.
  • Explain your rationale for combining the two medications for treatment of Steve’s pain.
  • Develop a plan to treating Steve’s pain, include non-pharmacologic and pharmacologic approaches, include monitoring parameters and relevant counseling points.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education 

This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 6.4, 9.2 

A Sample Answer For the Assignment: NUR 635 Topic 3 DQ 1

Title: NUR 635 Topic 3 DQ 1

How does acetaminophen treat pain? Include pathophysiology and mechanism of action, and determine if it treats the perception of pain or the site of trauma.

Acetaminophen is processed through the liver and has analgesic and antipyretic properties that are equivalent to aspirin. It reduces signals within th nervous system. Acetaminophen is devoid of clinically clinically useful antiinflammatory and antirheumatic actions. It does not suppress platelet aggregation, does not cause gastric ulceration and does not decrease blood flow or cause impairment (Rosenthal & Burchum, 2020). 

Describe how ibuprofen treats pain. Be sure to include the pathophysiology and mechanism of action, and determine if it treats the perception of pain or the site of trauma.

Ibuprofen inhibits cyclooxygenase. It blocks the body’s production of prostaglandins that cause inflammation. It has anti-inflammatory, analgesic and antipyretic actions. It is processed through the kidneys. It treats fever, mild to moderate pain, and arthritis (Rosenthal & Burchum, 2020). 

Explain your rationale for combining the two medications for treatment of Steve’s pain.

Acetaminophen and ibuprofen work a little differently, the combination of targeting different pathways is beneficial for pain control and fever reduction, however, if you have kidney, digestive, bleeding or liver problems, you need to be careful with taking these over-the-counter (OTC) medications (Cleveland Clinic, 2023). 

Develop a plan to treating Steve’s pain, include non-pharmacologic and pharmacologic approaches, include monitoring parameters and relevant counseling points.

Non-pharmacologic:
•    Physical therapy
•    Occupational therapy
•    Exercise 
o    Tai Chi
o    Yoga
o    Exercise regimens
•    Chiropractic
•    Massage
•    RICE protocol (rest, ice, compression, elevation)
•    MEAT protocol (movement, exercise, analgesia, treatment)
•    Heat applied to joint

Pharmacologic: Nonnarcotic pain relievers and NSAIDs are first line of treatment. Acetaminophen dose of 650-1,000 mg q 4-8 hr; max QID. For Ibuprofen, 1,200-3,200 mg/day divided into 3-4 doses. 
Monitoring:
Acetaminophen:
•    Side effects: headache, decreased appetite
•    Allergy: rash, itching, angioedema, severe dizziness, shortness of breath
•    Rare but severe: liver toxicity, Stevens-Johnson syndrome, thrombocytopenia, lymphopenia
•    Caution: hepatic impairment, chronic alcohol use
Ibuprofen:
•    Side effects: tinnitus, hearing loss, nervousness
•    Caution: 
o    Women trying to conceive
o    Asthma
o    Fluid retention
o    Dehydration
o    Smoker
o    Alcohol use
o    May interfere with effectiveness of loop and thiazide diuretics
Follow-up:
•    Within 2-4 weeks after initiating medication
•    As needed for increased pain or disability
•    For complaints of swelling, increased warmth, or erythema in the affected joint(s) (Care on Point, 2021).

References:

Rosenthal, L. D., & Burchum, J. R. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants – e-book (2nd ed.). Elsevier Health Sciences.

Wilbur, V. (2021). APEA terms & conditions. COP . https://app.careonpoint.com/Search.aspx

Cleveland Clinic. (2023, February 24). Is it safe to take acetaminophen with ibuprofen? https://health.clevelandclinic.org/acetaminophen-with-ibuprofen/ 

A Sample Answer 2 For the Assignment: NUR 635 Topic 3 DQ 1

Title: NUR 635 Topic 3 DQ 1

  • Acetaminophen, known by alternative names such as N-acetyl para-aminophenol (APAP) or paracetamol, is a commonly utilized non-prescription analgesic and antipyretic substance (Gerriets, Anderson, & Nappe, 2023).    Ohashi and Kohno (2020) assert that Acetaminophen is frequently employed as an analgesic drug to mitigate both acute and chronic pain. Furthermore, it has been included in all three tiers of pain management intensity as outlined in the World Health Organization’s analgesic ladder for the purpose of addressing cancer-related pain. Nevertheless, the metabolism of this substance is intricate, and a comprehensive understanding of its analgesic mechanisms has yet to be achieved. In the past, the prevailing belief was that the mechanism of analgesic action of acetaminophen involved the inhibition of the enzyme cyclooxygenase (COX). However, current understanding suggests that acetaminophen undergoes metabolic processes resulting in the formation of p-aminophenol. This compound is able to traverse the blood-brain barrier and subsequently undergo metabolism by fatty acid amide hydrolase, ultimately yielding N-acylphenolamine (AM404). AM404 exerts its effects on the transient receptor potential vanilloid 1 (TRPV1) and cannabinoid 1 (CB1) receptors located in the midbrain and medulla. These receptors are co-localized and serve as mediators of pain modulation.Hence, the analgesic effects of acetaminophen are elicited by its direct interaction with cerebral receptors, which serve as the primary agents responsible for mediating acetaminophen-induced analgesia (Ohashi, N., & Kohno, T. 2020).
  • The main mode of action of ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), is the suppression of prostaglandin precursors. Following a physiological or pathological stimulation, the release of arachidonic acid from membrane phospholipids occurs as a result of the action of the enzyme phospholipase A2. Subsequently, arachidonic acid is subjected to enzymatic conversion through three distinct routes, namely cyclooxygenase (COX), lipoxygenase (LOX), and cytochrome P450 (CYP450). The cyclooxygenase pathway is responsible for the conversion of arachidonic acid into prostaglandins, prostacyclins, and thromboxanes. On the other hand, the lipoxygenase pathway is involved in the production of hydroxyeicosatetranoic acids (HETEs), leukotrienes, and lipoxins through the metabolism of arachidonic acid. Finally, it should be noted that arachidonic acid undergoes conversion to hydroxyeicosatetraenoic acids (HETEs) and epoxyeicosatrienoic acids (EET) through the cytochrome P450 route. The aforementioned metabolic pathways give rise to eicosanoids, which are molecules that play a crucial role in intercellular and intracellular signaling processes associated with various physiological functions. These functions include the regulation of smooth muscle tone, vascular permeability, transporter proteins, platelet aggregation, and cell proliferation. Similar to the cyclooxygenase pathway products, eicosanoids also play a role in other biological processes such as autoimmune, angiogenesis, atopy, inflammation, and cancer. The involvement of the cyclooxygenase pathway is significant in the present therapeutic applications of ibuprofen. The COX pathway encompasses three discrete isoforms, namely COX-1 (also known as PGH synthase), COX-2, and COX-3. The COX-1 isoform is consistently present in the body, and its levels remain relatively constant in response to various physiological or pathological events. On the other hand, the expression of COX-2 is significantly responsive to both mitogenic and inflammatory stimuli. Among these, the more widely recognized growth factors are transforming growth factor, fibroblast growth factor, vascular endothelial growth factor, and tumor necrosis factors. The precise role of the COX-3 isoform remains mostly elusive and continues to be a subject of current investigation (Ngo VTH, Bajaj T. 2023).
  • There is a perceived disparity in the mechanism of action between ibuprofen and acetaminophen. Ibuprofen belongs to the class of nonsteroidal anti-inflammatory medicines (NSAIDs) that function by inhibiting the activity of cyclooxygenase enzymes. Although the precise mechanism by which acetaminophen exerts its effects is not fully elucidated, it is hypothesized to impede a specific subset of cyclooxygenase enzyme isoforms within the central nervous system. Additionally, it has the potential to regulate the endogenous cannabinoid system and the descending serotonin pathways.  According to Bondarksy et al. (2013), the concurrent use of acetaminophen and ibuprofen may have the capacity to produce an additive or synergistic impact on pain alleviation. 
  • Steve has sustained a lower extremity injury. Pharmacological plan treatment can include Acetaminophen 500 mg every 6 hours, not exceeding 4 grams daily, and combined with Ibuprofen 200 mg every 4 to 6 hours, not exceeding 1200 mg in 24 hours; both medications should be taken with food to avoid gastric irritation. Non-pharmacological treatment for Steve, which results from acute sports injury, can be treated safely at home using the P.R.I.C.E. principle, according to Zeigler, T. (2023). The acronym is an abbreviation that represents:
  • The initial principle concept of protection. The primary objective of using protective measures is to prevent exacerbation of the injury by safeguarding the affected structures. The selection of protective measures employed is contingent upon the specific location of the injury, and may encompass the utilization of an ace bandage, aluminum splint, sling, protective tape, or over-the-counter brace.
  • The second component, principle is rest. The primary objective of rest is to facilitate the intrinsic healing mechanisms of the body, enabling them to operate unhindered by any motion in the affected region. The augmentation of movement in a damaged tissue leads to an escalation in blood flow to the affected region, perhaps leading to more harm to the wounded tissue and/or heightened swelling.
  • Ice is an additional constituent of the P.R.I.C.E. principle. Various forms of cryotherapy can be employed with efficacy in the treatment of injuries. Ideally, the composition of ice packs predominantly consists of crushed ice due to its enhanced comfort for athletes and superior ability to adhere to the anatomical contours of the affected region, as compared to cubed ice. It is recommended to apply ice for a duration of 20 minutes before removing it. The aforementioned activity can be performed at regular intervals of two hours during the athlete’s waking hours.
  • Upon removal of the ice pack, it is recommended to apply a compression wrap to the affected region. The compression wrap functions as a mechanical obstruction to decrease swelling in the affected region. 
  • The final element of the P.R.I.C.E. principle entails elevation. Elevating the wounded area immediately following an injury is crucial in order to mitigate the volume of blood flow directed towards the affected region. To address lower extremity injuries, athletes may opt to recline and elevate their leg by placing the afflicted limb on supportive cushions. It is imperative that the athlete positions the affected area at a level higher than the heart.

The utilization of the P.R.I.C.E. principles is recommended within the initial 48 to 72 hours following an accident. The objective throughout this temporal interval is to regulate the extent of edema in the affected region, avert additional harm, and alleviate discomfort.

References:

Bondarsky, E. E., Domingo, A. T., Matuza, N. M., Taylor, M. B., Thode, J. H. C., & Singer, A. J. (2013). Ibuprofen vs acetaminophen vs their combination in the relief of musculoskeletal pain in the ED: a randomized, controlled trial. American Journal of Emergency Medicine31(9), 1357–1360. https://doi-org.lopes.idm.oclc.org/10.1016/j.ajem.2013.06.007

Gerriets V, Anderson J, Nappe TM. (2023). Acetaminophen. [Updated 2023 Jun 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482369/#

Ngo VTH, Bajaj T. (2023). Ibuprofen.  In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542299/#

Ohashi, N., & Kohno, T. (2020). Analgesic Effect of Acetaminophen: A Review of Known and Novel Mechanisms of Action. Frontiers in pharmacology, 11, 580289. https://doi.org/10.3389/fphar.2020.580289

Zeigler, T. (2023). P.R.I.C.E treatment. The SportsMD editors.