Acetaminophen (Tylenol) Nursing Implications and Patient Teachings

Last updated on December 28th, 2023

Introduction

In this article, you’ll learn about Acetaminophen / Paracetamol (Tylenol) nursing implications and patient teachings. Also, its dosage, indication, contraindications, interactions, and side effects.

Acetaminophen is a popular OTC medicine used to relieve mild to moderate pain and fever across the life span. Acetaminophen is a para-aminophenol derivative which also known as Paracetamol. It is not an NSAID because does not include any anti-inflammatory properties.

Acetaminophen is the generic name and adopted by the United States while Paracetamol is the international non-proprietary name. The most popular name for this drug outside of the United States is paracetamol. Tylenol is another well-known brand name for acetaminophen.

Basically, acetaminophen is the generic name, paracetamol is the international non-proprietary name, and Tylenol is one of its brand names.

Generic Name: Acetaminophen (Paracetamol)

Brand Names: Tylenol, Abenol (CAN), Acephen, Actimol Children’s (CAN), Actimol infant (CAN), Altenol, Aminofen, Apra, Atasol (CAN), Cetafen, Calpol, Dolono, Febrol, Genapap, Genebs, Mapap, Panadol, Pediaphen (CAN), Pyrecot, Pyrigesic, Redutemp, Silapap, Tylenol 8-hr Arthritis Pain Caplets, Uphamol.

Acetaminophen Class and Category

Pharmacologic class: Non-salicylate, para-aminophenol derivative.

Therapeutic class: nonopioid analgesic; antipyretic

Pregnancy category: B

Acetaminophen Dosage

Adults: PO: 325-650mg q4-8h PRN. Rectal suppository: 650mg q.i.d. IV: 1g q6h or 650 mg q4h PRN. Maximum dose: 4 g/day in divided doses.
Children: PO: 10 – 15 mg/kg q4-8h PRN. Maximum dose: 75 mg/kg/day.

Acetaminophen Pharmacokinetics and Pharmacodynamics

Route	Onset	Peak	Duration
IV	rapid	0.5 – 2 hr	3 – 4 hr
PO	10 – 30 min	30 – 60 min	3 – 5 hr
Rectal	unknown	unknown	4 – 6 hr

Absorption: Acetaminophen/paracetamol is quickly and effectively absorbed in the GI tract when taken orally. Rectal absorption varies.

Distribution: Protein binding is 20%–50%.

Metabolism: Hepatic.

Half-life: 1 – 4 hr

Excretion: The kidneys eliminate inactive substances through urine.

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Acetaminophen Mechanism of Action

Antipyretic: Acetaminophen has a direct effect on the hypothalamic temperature-regulating center by decreasing prostaglandin E2 synthesis.

Analgesic: Acetaminophen inhibits cyclooxygenase, preventing prostaglandin synthesis and thereby reducing pain sensation.

What are the indications of acetaminophen?

Acetaminophen/paracetamol (Tylenol) indications include:

To relieve mild to moderate pain
To reduce fever
To relive dysmenorrhea
To alleviate dental pain
To alleviate headaches
To relieve myalgia

What are the contraindications of acetaminophen?

The contraindications of acetaminophen/paracetamol (Tylenol) are:

Hypersensitivity to acetaminophen
Severe hepatic or renal disease

Caution: pregnancy, breastfeeding, geriatric patients, anemia, active renal or hepatic disease, G6PD deficiency, chronic alcoholism.

Acetaminophen Interactions

Acetaminophen/paracetamol interactions include:

Acetaminophen’s action of onset is slowed by anticholinergics.
Acetaminophen has a decreased therapeutic effect and a higher risk of hepatotoxicity when combined with barbiturates, carbamazepine, hydantoins, isoniazid, rifampin, or sulfinpyrazone.
Dasatinib and imatinib may increase the risk of hepatotoxicity.
Oral contraceptives reduce effectiveness of acetaminophen.
May elevate serum ALT, AST, bilirubin, K+, and prothrombin levels.

Herbal/food interactions

St. John’s wort increases risk of hepatotoxicity
Alcohol consumption increases risk of hepatotoxicity

What are acetaminophen side effects?

Acetaminophen / paracetamol (Tylenol) side effects / adverse reactions include:

Anorexia
Nausea and vomiting
Abdominal pain
Agitation
Rash
Insomnia
Oliguria
Urticaria
Elevated liver enzymes,
Hypoglycemia
Life-threatening adverse effects: hemorrhage, hepatotoxicity, hemolytic anemia, agranulocytosis, leukopenia, thrombocytopenia, seizures, coma, death.

Black Box Warning!

Acetaminophen injection has been linked to acute liver failure. There is a risk of severe liver damage.

Acetaminophen Nursing Implications [Nursing Considerations]

Acetaminophen/paracetamol (Tylenol) nursing considerations are divided into nursing assessment, interventions, and evaluation.

Acetaminophen (tylenol) nursing assessment

Obtain detailed medical and drug related history including hypersensitivity, possible drug-drug and drug-food interactions.
Monitor vital signs
Assess the severity of pain including location, characteristics such as radiating, relieving and aggravating factors, onset, duration.
Monitor LFTs, RFTs, and CBC with long-term acetaminophen therapy.

Acetaminophen (tylenol) nursing diagnosis

Risk for injury related to adverse effects.
Acute pain or chronic pain (indication)
Hyperthermia (indication)
Deficient knowledge related to drug’s mechanism of action and adverse effects.

Acetaminophen (tylenol) nursing interventions/ actions

Monitor vital signs.
Ensure total acetaminophen dose does not exceed 4g/day.
Reassess pain and body temperature after one hours of administering the acetaminophen.
Determine LFTs, RFTs, and CBC with high doses or overdose of acetaminophen.
Monitor serum acetaminophen level with long-term therapy (normal range: 10–30 mcg/mL, toxic level: more than 200 mcg/mL).
Store suppositories at temperatures below 26.6°C (80°F).

IV administration considerations

Administer parenteral acetaminophen over 15 minutes (dilution is not required).
For pediatrics, draw the required dose to a syringe and infuse via syringe pump over 15 minutes.
Use the medication within 6 hours of puncturing the protective seal of the vial or after transferring the content.
Closely observe for air in the IV tubing to prevent air embolism.

Evaluation

Evaluate the effectiveness of the drug: to relieve pain; to reduce fever; taking recommended daily dose without any side effects.

Pregnancy/breastfeeding considerations for acetaminophen/paracetamol (tylenol)

Use with caution during pregnancy and breastfeeding. Because it crosses placenta and excretes in breastmilk.
Acetaminophen should not be used for long-term during pregnancy and lactation without consulting a physician.

What is the patient teaching for acetaminophen?

The nurse should discuss the following points during the acetaminophen/paracetamol (Tylenol) patient teaching.

Teach the patient how to recognize adverse effects (eg; bleeding, easy bruising, and malaise) and interactions.
Advise the patient not to exceed recommended daily dose (4g/day).
Instruct the patient to store medication out of reach of children.
Teach the caretaker how to measure and administer accurate dose for infants and children.
Explain to the patient that acetaminophen can cause both female and male fertility problems.

Treatment of Overdose

Determine serum acetaminophen level
Gastric lavage
Administer acetylcysteine as prescribed
Observe for bleeding

Conclusion

To sum up, acetaminophen, paracetamol, and Tylenol are essentially the same drug. Acetaminophen is the generic name, paracetamol is the international non-proprietary name, and Tylenol is just one of the many brand names.

Furthermore, you learned about acetaminophen/paracetamol (Tylenol) nursing implications (aka nursing considerations), and patient teaching in this article. In addition, you’ve learned about acetaminophen’s mechanism of action, pharmacokinetics, dosage, indications, nursing diagnoses, contraindications, and side effects.