Ibuprofen Nursing Implications and Patient Teachings

Last updated on December 28th, 2023

Introduction

In this article, you’ll learn about ibuprofen (motrin) nursing implications and patient teachings. Also, its dosage, indication, interactions, and side effects.

Ibuprofen is a propionic acid group of nonsteroidal anti-inflammatory drugs (NSAIDs) which is a relatively new class of NSAIDs. These medications are similar to aspirin, except they have a stronger effect and cause less GI irritation.

There are six other propionic acid drugs. Namely, fenoprofen calcium (Nalfon), naproxen (Naprosyn), ketoprofen (Orudis), flurbiprofen (Ansaid), and oxaprozin (Daypro).

Generic Name: Ibuprofen

Brand Names: Advil, Advil Infant, Advil Junior, Advil Migraine, Children’s Advil, Children’s Europrofen, Children’s Motrin, Caldolor, Ibuprohm, Ibutab, Midol, Motrin, Motrin IB, Motrin Infant, Motrin Junior ibuprofen lysine, NeoProfen.

Ibuprofen Class and Category

Pharmacologic class: Propionic acid derivate NSAIDs

Therapeutic class: Analgesic, anti-inflammatory, anti-pyretic, antidysmenorrheal, antirheumatic,

Pregnancy category: C (D, third trimester)

Ibuprofen Dosage

Analgesic and anti-pyretic

Adults: 200-400mg every 4 to 6 hr, PRN.
Children (12yrs and older): 200 – 400mg every 4 to 6 hr, PRN. Max: 1.2 g/day.
Children (11yrs weighing 33 kg [72 lb] to 43 kg [95 lb]): 300mg every 6 to 8 hr, PRN.
Children (9yrs and 10 weighing 27 kg [59 lb] to 32 kg [70 lb]): 250mg every 6 to 8 hr, PRN.
Children (6-8yrs weighing 22 kg [48 lb] to 27 kg [59 lb]): 200mg every 6 to 8 hr, PRN.
Children (4-5yrs weighing 16 kg [35 lb] to 21 kg [46 lb]): 150mg every 6to 8 hrs, PRN.
Children (2-3yrs weighing 11 kg [24 lb] to 16 kg [35 lb]): 100mg every 6 to 8 hrs, PRN.

Anti-inflammatory

Adults: 200-800 mg t.i.d./q.i.d.; max: 2400 mg/day
Children (6 months and over): 20-40 mg/kg/day in 3 or 4 divided doses. Max: 40mg/kg/day.

Intravenous (IV) Infusion (Coldolor)

Adults: 400-800mg infused over at least 30 minutes, q.i.d, PRN. Max: 3,200 mg/day
Adolescents: 400mg infused over at least 10 min, q4h/q6h, PRN. Max: 2,400 mg/day.
Children (6mo to 12yrs): 10 mg/kg up to 400mg maximum for single dose infused over at least 10 min, q4h/q6h, PRN. Max: 40 mg/kg/day or 2,400 mg/day, whichever is the lower dose.

Ibuprofen Pharmacokinetics and Pharmacodynamics

Route	Onset	Peak	Duration
IV	10-30 min	Unknown	Unknown
PO (analgesic)	30 min	Unknown	4–6 hr
PO (anti-inflammatory)	Up to 7days	1-2weeks	Unknown
PO (anti-pyretic)	In 1 hr	2-4hr	6–8 hr

Absorption: Ibuprofen is effectively absorbed from the GI tract when taken orally.

Distribution: Protein bind 91% – 99%

Metabolism: Hepatic.

Half-life: 2 – 4 hr

Excretion: Mostly the kidneys eliminate inactive substances through urine; few via bile

Ibuprofen Mechanism of Action

Blocks cyclooxygenase, an enzyme required for the production of prostaglandins, which regulate the inflammatory response and induce local pain, edema, and vasodilation. This NSAID lowers inflammatory symptoms and discomfort by blocking prostaglandins. Ibuprofen’s antipyretic effect is most likely due to its influence on the hypothalamus, which causes vasodilation and promotes heat dissipation by increasing peripheral blood flow.

What are the indications of ibuprofen?

Ibuprofen indications include:

To alleviate anti-inflammatory pain caused by juvenile arthritis, rheumatoid arthritis, and osteoarthritis
To alleviate mild to moderate pain.
To treat moderate to severe pain along with opioids.
To treat fever.
In order to treat patent ductus arteriosus.
To alleviate migraine headaches and symptoms such as nausea and sensitivity to light and sound.

What are the contraindications of ibuprofen?

The contraindications of ibuprofen are:

Hypersensitivity to ibuprofen or its ingredients
Severe renal disease
Severe hepatic disease
Asthma
Peptic ulcer
Anticoagulant therapy

Caution: Bleeding disorders, pregnancy, lactation, systemic lupus erythematosus

Ibuprofen Interactions

Increases bleeding time with oral anticoagulants.
Increase effects of phenytoin, sulfonamides, many of the cephalosporins, and warfarin (Coumadin).
Decreases the effect aspirin when taken together.
When taken with lithium, it may cause severe side effects.
When ibuprofen is used with insulin or an oral hypoglycemic medication, hypoglycemia can occur.
When ibuprofen is used with calcium channel blockers, there is a substantial chance of toxicity.
Increases BUN, creatinine, LFTs, potassium and decreases Hgb/Hct, blood glucose, WBC, platelets.

Herbal interactions

The following herbs increase the risk of bleeding when used with nonsteroidal anti-inflammatory drugs (NSAIDs).

dong quai
feverfew
garlic
ginger
ginseng
red clover
horse chestnut
ginkgo

What are ibuprofen side effects?

Ibuprofen side effects / adverse reactions include:

Anorexia
Nausea
Vomiting
Diarrhea
Edema
Rash
Purpura
Tinnitus
Fatigue
Dizziness
Light-headedness
Anxiety
Confusion
Fluid retention with edema
GI bleeding
Life-threatening adverse effects: Blood dyscrasias, cardiac dysrhythmias, nephrotoxicity, anaphylaxis

Black Box Warning!

Patients should be examined for thrombotic events such as MI and stroke on a regular basis because NSAIDs increase the risk of them.

Instruct the patient to report signs/symptoms of MI/stroke immediately; discontinue product, seek emergency medical treatment.

Ibuprofen Nursing Implications [Nursing Considerations]

Ibuprofen nursing considerations are divided into nursing assessment, interventions, and evaluation.

Nursing assessment

Assess the patient’s history of NSAIDs allergies. Notify prescriber if an allergy is present.
Assess potential drug-drug and herbs-drug interactions. Because NSAIDs can increase the effects of phenytoin (Dilantin), sulfonamides, and warfarin (Coumadin). Ibuprofen like many NSAIDs have a strong protein-bound effect. Therefore, it has potential to displace other highly protein-bound medicines such as warfarin (Coumadin).
Obtain complete medical history. Because ibuprofen is contraindicated if patient has severe renal or liver disease, peptic ulcer, or bleeding disorder.
Observe the patient for GI symptoms and peripheral edema. Because these are common side effects of NSAIDs.

Nursing interventions/ actions

Assess the patient for signs of bleeding such as tarry stool, presence of occult blood, ecchymosis, petechiae, bruises, gum bleeding.
Observe for evidence of GI upsets such as dyspepsia, heartburn, nausea.
Administer NSAIDs with food or milk to reduce GI irritations.
Check vital signs and look for peripheral edema, especially first thing in the morning.
In individuals with a recent MI, NSAIDs such as ibuprofen should be avoided because the risk of reinfarction increases with NSAID medication. If therapy is inevitable, keep a watchful eye on the patient for signs of myocardial ischemia.
Ibuprofen should be used with caution in hypertensive individuals, and blood pressure should be regularly monitored throughout treatment. The drug may cause or aggravate hypertension.
Monitor LFT, RFT, CBC for patients of long-term ibuprofen therapy.

IV administration considerations

Ensure that the patient is well hydrated before intravenous administration of ibuprofen.
Dilute with 0.9% NaCl, LR, D5W. The final concentration should be less than 4mg/ml
Administer over 30 minutes for adults and over 10 minutes for children.
DO NOT give IM.
Visually examine for particles and residues.
Discard remaining portion of the medicine.
Ibuprofen lysine: dilute with dextrose or saline (10 mg/mL of ibuprofen is recommended).
Administer within 30 minutes of preparation and infuse over 15 minutes.
Use the nearest IV port to the insertion site.
Assess for extravasation.
DO NOT administer in same line with TPN (TPN should be interrupted for 15 minutes before and after product administration).

Evaluation

Evaluate the effectiveness of the drug: reduced body temperature; reduced joint pain; reduced swelling; improved range of motion (ROM); reduced menstrual symptoms.

Pregnancy/breastfeeding considerations for ibuprofen

If ibuprofen is taken during the third trimester of pregnancy, it increases the chances of premature closure of the fetal ductus arteriosus.
Starting at 30 weeks of pregnancy and onward, the drug should be avoided by pregnant women.
Ibuprofen can be safely administered to lactating mothers. Because very low levels of ibuprofen are excreted via breastmilk and it has short half-life.
Some women may experience reversible infertility as a result of the drug’s ability to postpone or prevent ovarian follicle rupture.

What is the patient teaching for ibuprofen?

Teach the patient to take ibuprofen with food or milk to prevent GI upset.
Teach the patient to take the tablets with a full glass of water and to avoid lying down for 15 to 30 minutes to avoid esophageal irritation.
Teach the patient not to consume higher dosages of ibuprofen or for longer periods of time than advised. Because it increases the risk of gastrointestinal (GI) bleeding, myocardial infarction (MI), and stroke.
Advise the patient to consult the prescriber;
- If he/she needs to take the drug for more than 3 days for fever or 10 days for pain.
- If he/she has recently developed gastrointestinal symptoms including heartburn, discomfort, or upset stomach.
- If he/she has a history of GI bleeding, cardiac or renal disease, hypertension, or gastric ulcers.
- If he/she is on any diuretic medication.
- If he/she is over 65 years old.
Warn the phenylketonuric (PKU) patient that Motrin chewable tablets contain aspartame.
Educate the patient that the maximum therapeutic effect for arthritis may take up to two weeks or more.
Advise the patient to avoid taking two different NSAIDs at the same time unless prescribed, to avoid alcohol, and salicylates. Because it increases risk of bleeding.
Inform the patient that if they are taking aspirin to prevent MI or stroke, ibuprofen may interfere with this effect.
Instruct the patient to report any flu-like symptoms, rash, increased joint pain, evidence of GI bleeding, swelling, hematuria, fever, visual problems, urinary pattern change, or weight gain. Because this may indicate drug toxicity.
Teach the patient to wear protective clothing, sunscreen and sunglasses when going outdoor. It helps to reduce photosensitivity and photophobia.
Pregnant patients should avoid using NSAIDs like ibuprofen during the last trimester because they may induce premature closure of the ductus arteriosus.
Teach the patient that ibuprofen may increase the risk of major adverse cardiovascular events. Therefore, to seek emergency medical assistance if signs or symptoms such as chest discomfort, edema, shortness of breath, slurring of speech, swelling in the lower extremities, sudden weight gain, or weakness develop.
Educate the patient that ibuprofen may increase the risk of major adverse GI events. Therefore, to seek immediate medical assistance if patient develops stomach or epigastric pain, black or tarry stools, indigestion, or vomiting blood or material that resembles coffee grounds.
Teach the patient about rare but serious skin reactions. Therefore, to immediate medical assistance for blisters, fever, itching, rash, or any other indications of hypersensitivity.
Alert the patient that ibuprofen may cause dizziness. If dizziness or drowsiness occurs, to avoid driving and other potentially dangerous activities.

Treatment of Overdose

Gastric lavage if recently ingested
Induce diuresis
Monitor blood gases

Conclusion

You learned about ibuprofen (motrin) nursing implications (aka nursing considerations) and patient teaching in this article. In addition, you’ve learned about ibuprofen’s mechanism of action, pharmacokinetics, dosage, indications, contraindications, and side effects.