Although we've focused on acetaminophen because of its popularity, many drugs can lead to hepatotoxicity. Nurses should be knowledgeable about potential interactions and always be aware that the more drugs a patient takes, especially those that act in the liver, the greater the risk for hepatotoxicity. One of the best ways, and sometimes only way, to prevent hepatotoxicity is patient teaching.
- Parents should consider over-the-counters to be just as dangerous as prescription drugs, and all medicine should be kept out of children's reach. Parents may also want to be careful if they have depressed older children, as sometimes teenagers will take too many Tylenols without knowing this can actually hurt them (Lilley, 2007).
- Nurses should also teach their patients to be aware of what medications they're taking, including active ingredients and dosages. The maximum daily dose of acetaminophen is 4000 mg (for adults with healthy livers), and it could be present in several different medications the patient takes. If patients complain that the recommended dose doesn't work, then they should talk to their nurse practitioner or doctor about the problem.
- Although nurses should encourage patients to drink moderately, chronic drinkers should receive non-judgmental information about alcohol use and medication. Nurses may need to recommend a different medication that would be safer for them to take. Many serious cases of acetaminophen overdose have occurred in alcoholics (Lilley, 2007).
- When assessing patients, ask patients about:
-their alcohol use
-all medications they take, including prescriptions, OTCs, and
herbals
-any history of liver problems
Reference
Lilley, Harrington, & Snyder, 2007, Pharmacology and the Nursing Process
I think another nursing implication that is important to remember is that parents should also be aware to not give their infant children acetaminophen unless it is directly ordered by their physician. It was not too long ago that I saw a family who was giving their 6 month old baby infant Tylenol because he was cutting a tooth!! I read the bottle and even on the infant Tylenol bottle it says "Ask a doctor" for children under 2. Infants livers are still very much immature and may or may not be able to metabolize the drug properly. Thankfully, this little boy was able to but I still cannot forget that eye popping moment for me!
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