Considering that aspirin is a commonly used pain medication, nurses should be aware of the potential risks and considerations when administering aspirin to patients. Get to know about the nursing considerations and nursing implications for patients taking aspirin.
What is Aspirin?
Aspirin is a medication used to reduce pain, reduce fever, and reduce inflammation. It is also known as acetylsalicylic acid and is commonly used as a pain reliever and to reduce inflammation and swelling. Aspirin is classified as a nonsteroidal anti-inflammatory drug (NSAID), and it works by blocking the production of certain chemicals in the body that cause inflammation. It is available in a variety of forms, including tablets, chewable tablets, and suppositories. Aspirin is generally safe when taken as directed, but it can cause side effects such as upset stomach, heartburn, and allergic reactions. Aspirin should be used with caution in people who have certain medical conditions, such as ulcers or bleeding disorders, and it should not be given to children or teenagers who have a fever or chickenpox, as it has been associated with a rare but serious condition called Reye’s syndrome.
- acetylsalicylic acid, ASA
Aspirin is available under a number of brand names, including:
Alka-Seltzer, Anacin, Asaphen, Aspergum, Aspir-Low, Aspirtab, Bayer Aspirin, Bayer Timed-Release Arthritic Pain Formula, Bufferin, Easprin, Ecotrin, 8-Hour Bayer Timed-Release, Ecotrin, Empirin, Entrophen, Excedrin, Goody’s Headache Powder, Halfprin, Healthprin, Lowprin, Norwich Aspirin, Novasen, Rivasa, Sloprin, St. Joseph Adult Chewable Aspirin, Therapy Bayer, ZORprin
Drug Classification of Aspirin
The drug classification of aspirin is:
- antipyretics, nonopioid analgesics
Indications and Therapeutic Effects
Aspirin is used for a variety of indications, including:
- Relief of pain. Aspirin is commonly used to reduce mild to moderate pain caused by various conditions, including headache, toothache, muscle aches, and arthritis.
- Reduction of inflammation. Aspirin can also be used to reduce inflammation caused by conditions such as rheumatoid arthritis, osteoarthritis, and other forms of inflammation.
- Reduction of fever. Aspirin is an effective fever-reducing agent and is often used to reduce fever caused by infections or other conditions.
- Prevention of blood clots. Aspirin can help to prevent blood clots from forming, which can be useful in preventing heart attacks and strokes. It is often used in people who are at increased risk of these conditions due to a history of heart disease or other risk factors.
- Unlabeled Use. Adjunctive treatment of Kawasaki disease.
Mechanism of Action
Aspirin works by inhibiting the production of prostaglandins, which are chemicals that are involved in inflammation and pain. It does this by inhibiting the activity of an enzyme called cyclooxygenase (COX). There are two isoforms of COX, COX-1 and COX-2. COX-1 is responsible for producing prostaglandins that are involved in normal physiological processes, such as maintaining the integrity of the stomach lining and helping to regulate blood flow to the kidneys. COX-2 is induced in response to inflammation and produces prostaglandins that contribute to pain and inflammation (Vane & Botting, 2003).
Aspirin is a non-selective COX inhibitor, meaning that it inhibits the activity of both COX-1 and COX-2. This is what makes it effective at reducing pain and inflammation, but it also means that it can cause side effects, such as stomach irritation and bleeding because it disrupts the production of prostaglandins that are involved in maintaining the integrity of the stomach lining. Some newer NSAIDs, such as celecoxib (Celebrex), are selective COX-2 inhibitors, which means that they specifically inhibit the activity of COX-2 and may have a lower risk of causing stomach irritation and bleeding.
Precautions and Contraindications
There are several precautions and contraindications to be aware of when taking aspirin:
- Allergy. Aspirin should not be taken by people who are allergic to it or to other NSAIDs. Signs of an allergic reaction can include difficulty breathing, hives, and swelling of the face, lips, tongue, or throat.
- Stomach bleeding. Aspirin can increase the risk of stomach bleeding, especially in people who have a history of ulcers or gastrointestinal bleeding. It is important to inform the healthcare provider if there’s a history of gastrointestinal bleeding or ulcers before taking aspirin.
- Bleeding disorders. Aspirin can increase the risk of bleeding, so it should be used with caution in people with bleeding disorders or those who are taking blood thinners.
- Pregnancy and breastfeeding. Aspirin should be used with caution during pregnancy and breastfeeding. It is not recommended for use in the third trimester of pregnancy as it may increase the risk of bleeding in the mother and the baby.
- Children. Aspirin should not be given to children or teenagers who have or are recovering from chickenpox or flu-like symptoms, as it has been associated with the development of a serious condition called Reye’s syndrome.
- Other medications. Aspirin can interact with a number of other medications. Cross-sensitivity with other NSAIDs may exist (less with nonaspirin salicylates), so it is important to inform the healthcare provider about all the medications being taken before starting aspirin.
Aspirin should be used cautiously with:
- History of stomach problems such as GI bleeding or ulcer disease
- Substance abuse such as chronic alcohol use
- Severe hepatic or renal disease
- OB: Salicylates may have adverse effects on the fetus and mother and should be avoided during pregnancy, especially during the 3rd trimester
- Lactation: Safety not established
- Geriatric: increased risk of adverse reactions, especially GI bleeding; more sensitive to toxic levels
When administering aspirin, the nurse should consider the following drug interactions:
Aspirin can interact with certain medications and cause side effects or make them less effective. Here are some examples of drugs that may interact with aspirin:
- Blood thinners. Aspirin can increase the risk of bleeding when taken with blood thinners such as warfarin, heparin, heparin-like agents, thrombolytic agents, dipyridamole, clopidogrel, tirofiban, or eptifibatide, although these agents are frequently used safely in combination and in sequence.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin, like other NSAIDs, can increase the risk of stomach bleeding when taken with other NSAIDs, such as ibuprofen or naproxen.
- Selective serotonin reuptake inhibitors (SSRIs). Aspirin can interfere with the blood-thinning effect of SSRIs, such as fluoxetine and sertraline.
- Gout medications. Aspirin can interfere with the effectiveness of medications used to treat gout, such as probenecid and sulfinpyrazone.
- Diabetes medications. Aspirin can interfere with the blood-sugar-lowering effect of some diabetes medications, such as glimepiride and glyburide.
Aspirin can also interact with particular products and cause side effects. Below are some examples of products that may interact with aspirin which may increase the anticoagulant effect and bleeding risk.
- Panax ginseng
Foods capable of acidifying the urine may increase serum salicylate levels.
- Cranberry juice: makes the urine more acidic
- Alkaline foods such as bananas and avocados: make the urine less acidic.
Aspirin is a widely used over-the-counter pain reliever and anti-inflammatory medication. It is generally safe and effective when used as directed. However, like all medications, aspirin can cause serious side effects in some people. Here are some common side effects of aspirin:
- Stomach irritation. Aspirin can irritate the lining of the stomach and cause epigastric distress, indigestion, heartburn, nausea, or vomiting.
- Allergic reactions. Aspirin can cause allergic reactions, including rash, hives, urticaria, difficulty breathing, and swelling of the face, lips, tongue, or throat.
- Bleeding. Aspirin can increase the risk of bleeding, particularly in people with bleeding disorders or those taking blood thinners leading to anemia and hemolysis.
- Ringing in the ears. Aspirin can cause a ringing or buzzing noise in the ears (tinnitus).
- Others: Aspirin can cause allergic reactions, including anaphylaxis and laryngeal edema.
Aspirin is available in the following forms:
- Tablets: 81 mg, 162.5 mg, 325 mg, 500 mg, 650 mg, 975 mg.
- Chewable tablets: 80 mg, 81 mg.
- Chewing gum: 227 mg.
- Dispersible tablets: 325 mg, 500 mg.
- Enteric-coated (delayed-release) tablets: 80 mg, 165 mg, 300 mg, 325 mg, 500 mg, 600 mg, 650 mg, and 975 mg.
- Extended-release tablets: 325 mg, 650 mg, 800 mg.
- Delayed-release capsules: 325 mg, 500 mg.
- Suppositories: 60 mg, 120 mg, 125 mg, 130 mg, 150 mg, 160 mg, 195 mg, 200 mg, 300 mg, 320 mg, 325 mg, 600 mg, 640 mg, 650 mg, 1.2 g.
- In combination with: antihistamines, decongestants, cough suppressants, opioids, and omeprazole (Yosprala).
Dosage for Children
- For pain or fever
- PO, Rect (Children 2 – 11 yr): 10 – 15 mg/kg/dose every 4 – 6 hr; maximum dose: 4 g/day.
- For inflammation
- PO (Children): 60 – 100 mg/kg/day in divided doses (up to 130 mg/kg/day for acute rheumatic fever).
- Prevention of Myocardial Infarction/Antiplatelet Effects
- PO (Children): 3 – 10 mg/kg/day given once daily.
- Kawasaki Disease
- PO (Children): 80 – 100 mg/kg/day in 4 divided doses until fever resolves; may be followed by a maintenance dose of 3 – 5 mg/kg/day as a single dose for up to 8 wk.
Dosage for Adults
- For pain or fever
- PO, Rect (Adults): 325 – 1000 mg every 4 – 6 hr (not to exceed 4 g/day).
- Extended-release tablets — 650 mg every 8 hr or 800 mg every 12 hr.
- For Inflammation
- PO (Adults): 2.4 g/day initially; increase to a maintenance dose of 3.6 – 5.4 g/day in divided doses (up to 7.8 g/day for acute rheumatic fever).
- Prevention of Transient Ischemic Attacks
- PO (Adults): 50 – 325 mg once daily.
- Prevention of Myocardial Infarction/Antiplatelet Effects
- PO (Adults): 80 – 325 mg once daily.
- Suspected acute MI — 160 mg as soon as MI is suspected.
The pharmacokinetics of aspirin refers to the way that the drug is absorbed, distributed, metabolized, and eliminated by the body. Understanding the pharmacokinetics of aspirin can help healthcare providers determine the appropriate dose and frequency of the medication for different individuals and conditions. It is important to note that the pharmacokinetics of aspirin can be influenced by a number of factors, including age, body weight, and liver and kidney function.
- Absorption. After oral administration, aspirin is rapidly absorbed from the gastrointestinal tract and is then distributed to tissues throughout the body.
- Distribution. Rapidly and widely distributed, crosses the placenta and enters breast milk.
- Metabolism and Excretion. Aspirin is metabolized primarily in the liver, where it is converted to salicylic acid, the active metabolite of aspirin. Salicylic acid is further metabolized to inactive compounds that are excreted in the urine. Aspirin is also metabolized by nonhepatic pathways, including the conversion of aspirin to salicylic acid by esterases in the blood and tissues. Amount excreted unchanged by the kidneys depends on urine pH; as pH increases, amount excreted unchanged increases from 2 – 3% up to 80%.
- Half-life. The elimination half-life of aspirin is approximately 20 to 30 minutes, which means that the drug is eliminated from the body relatively quickly. However, the effects of aspirin can last much longer due to its ability to inhibit the synthesis of prostaglandins, which are involved in inflammation and pain. The duration of action of aspirin depends on the dose and the condition being treated: 2–3 hr for low doses; up to 15–30 hr with larger doses because of saturation of liver metabolism.
Nursing Considerations for Aspirin
It is important for nurses to carefully assess the patient’s condition and individual needs, and to develop a plan of care based on the findings. This may include providing patient education, monitoring for side effects and potential complications, and implementing interventions to manage any identified risks or problems. The following are the nursing considerations and nursing implications for aspirin.
There are several important aspects of a nursing assessment for a patient taking aspirin, including:
1. Evaluate patient’s lifestyle.
Determine patient’s alcohol use, tobacco use, and diet, which may impact the effectiveness and safety of aspirin therapy.
2. Review patient’s history for GI bleeding and ulceration.
Review the patient’s health history, including any previous gastrointestinal bleeding or ulceration, liver or kidney disease, or bleeding disorders.
3. Assess patient’s allergy to aspirin.
Ask about any allergies or intolerances the patient may have to aspirin. Patients who have asthma, allergies, and nasal polyps or who are allergic to tartrazine are at an increased risk for developing hypersensitivity reactions.
4. Determine current aspirin regimen.
Assess the patient’s current aspirin regimen, including the dose, frequency, and route of administration.
5. Assess pain and limitation of movement.
Determine type, location, and intensity before and at the peak after administration.
6. Assess fever and note associated signs.
Manifestations such as diaphoresis, tachycardia, malaise, and chills should be documented for baseline data and to determine effectiveness of therapy.
7. Monitor hepatic function.
Monitor the patient’s hepatic function prior to antirheumatic therapy and if symptoms of hepatotoxicity occur; more likely in patients, especially children, with rheumatic fever, systemic lupus erythematosus, juvenile arthritis, or pre-existing hepatic disease. May cause increased serum AST, ALT, and alkaline phosphatase, especially when plasma concentrations exceed 25 mg/100 mL. May return to normal despite continued use or dose reduction. If severe abnormalities or active liver disease occurs, discontinue and use with caution in the future.
8. Monitor serum salicylate levels periodically.
Especially with prolonged high-dose aspirin therapy to determine dose, safety, and efficacy, especially in children with Kawasaki disease.
9. Be aware that aspirin can alter results of some lab tests.
Note that aspirin may alter the results of serum uric acid, urine vanillylmandelic acid (VMA), protirelin-induced thyroid-stimulating hormone (TSH), urine hydroxy indole acetic acid (5-HIAA) determinations, and radionuclide thyroid imaging.
10. Monitor hematocrit.
Monitor hematocrit periodically in prolonged high-dose therapy to assess for GI blood loss.
11. Be aware that aspirin can prolong bleeding time.
Note that aspirin prolongs the bleeding time for 4 – 7 days and, in large doses, may cause prolonged prothrombin time. A prolonged PT means that the blood is taking too long to form a clot. Aspirin alters platelet function through interference with prostaglandin biosynthesis.
12. Monitor for signs of toxicity and overdose.
Monitor for the onset of fever, tinnitus, headache, drowsiness, hyperventilation, agitation, mental confusion, lethargy, diarrhea, and sweating. If these symptoms appear, withhold medication and notify a healthcare professional immediately.
There are several nursing diagnoses that may be appropriate for a patient taking aspirin or who has overdosed on aspirin. Some potential nursing diagnoses that may be relevant for a patient taking aspirin include:
- Acute pain. Aspirin is often used to treat acute pain, such as pain that occurs after surgery, a tooth extraction, or an injury.
- Impaired physical mobility. Aspirin is also being used to reduce pain and inflammation, but it is not typically used as a treatment for impaired physical mobility.
- Risk for bleeding. Aspirin is an antiplatelet agent, which means it can interfere with the normal blood-clotting process and increase the risk of bleeding.
- Risk for injury. Aspirin can cause dizziness and drowsiness, which can increase the risk of falls and other injuries.
- Deficient knowledge. Some patients may not be aware of the proper dosing instructions or potential side effects of aspirin and may benefit from education on these topics.
If the patient is suspected of aspirin overdose or aspirin poisoning, the following nursing diagnosis may be appropriate:
- Risk for fluid volume deficit related to vomiting and diarrhea.
- Risk for altered body temperature related to fever.
- Risk for altered mental status related to overdose.
Aspirin Nursing Interventions
Several nursing interventions for aspirin may be appropriate and these may include:
1. Use the lowest effective dose of aspirin for the shortest period of time.
Using the lowest dose of aspirin or lower than those used previously is still sufficient to exert a maximum inhibitory effect on platelet function. The two main reasons for this are to minimize adverse effects and to attempt to limit prostacyclin production in the vessel wall.
2. Administer aspirin after meals or with food or an antacid.
Taking aspirin after meals is necessary to minimize gastric irritation. Food slows but does not alter the total amount absorbed.
3. Advise the patient not to crush or chew enteric-coated aspirin tablets.
Coated aspirin or enteric-coated aspirin is designed to pass through the stomach and not dissolve until it reaches the small intestine.
4. Advise patient not to take antacids within 1 – 2 hr of enteric-coated aspirin tablets.
Calcium carbonate taken together with aspirin may decrease the effects of aspirin.
5. Manage the side effects of aspirin medication.
If the patient experiences side effects from aspirin, such as stomach irritation, the nurse may recommend taking the medication with food or switching to a different NSAID.
6. Administer medications as prescribed.
It is important to carefully follow the dosing instructions provided by the healthcare provider or physician when administering aspirin or any other medication.
If a patient has overdosed on aspirin, additional nursing interventions for aspirin poisoning may be necessary, such as:
7. Induce vomiting or administer medications to remove aspirin from the stomach.
This may be done to help prevent further absorption of the medication. Note that inducing vomiting is rarely recommended and is not usually appropriate in aspirin poisoning. Inducing vomiting can cause aspiration in case of patients with altered mental status or convulsions.
8. Administer medications to reduce the absorption of aspirin from the intestines.
Administration of activated charcoal can help prevent further absorption of the salicylate from the stomach. Isoardi et al., (2022) notes that early administration of activated charcoal decreased absorption and use of bicarbonate enhanced elimination. A laxative may be given together with activated charcoal to promote GI evacuation more rapidly.
9. Provide supportive care.
This may include administering fluids intravenously to help maintain blood pressure and support the body’s organs.
10. Provide patient education.
This may include teaching the patient about the proper dosing instructions, potential side effects, and precautions to take when taking aspirin.
Patient Education and Teaching
When providing patients education about aspirin, it is important to cover the following topics:
1. Provide patients with written instructions for aspirin and allow time for them to ask questions.
Make sure the patient understands the instructions and feels comfortable asking questions before taking the medication.
2. If the patient has any doubts or concerns, encourage them to speak.
This makes the patient feel comfortable taking the medication as prescribed.
3. Instruct the patient to take salicylates with a full glass of water and to remain in an upright position for 15– 30 min after administration.
This helps to prevent irritation that may lead to trouble in swallowing.
4. Advise patient to report tinnitus; unusual bleeding of gums; bruising; black, tarry stools; or fever lasting longer than 3 days.
Explain and describe these symptoms to the patient as these are signs of adverse reactions and side effects of aspirin.
5. Caution patient to avoid concurrent use of alcohol with this medication.
This is to minimize possible gastric irritation. Three or more glasses of alcohol per day may increase the risk of GI bleeding.
6. Caution patient to avoid taking concurrently with acetaminophen or NSAIDs for more than a few days unless directed by a healthcare professional.
This is to prevent analgesic nephropathy. Analgesic nephropathy involves damage to the internal structures of the kidney caused by the long-term use of analgesics or pain medicines, especially over-the-counter (OTC) medicines that contain phenacetin or acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen.
7. Explain to the patient that aspirin can interfere with the normal blood-clotting process and increase the risk of bleeding.
See Risk for bleeding nursing care plan for more interventions.
8. Advise the patient to use caution when taking the medication, such as avoiding activities that could cause injury.
See Risk for injury nursing care plan for more interventions.
9. Teach patients on a sodium-restricted diet to avoid effervescent tablets or buffered-aspirin preparations.
Some drugs are associated with high-sodium content, particularly effervescent tablets (ETs)
10. Tell the patient not to take the medicine if it has a strong vinegar-like odor.
This odor means the aspirin in it is breaking down and should be discarded.
11. Advise patients on long-term therapy to inform health care professionals of medication regimen before surgery. Aspirin may need to be withheld for one week before surgery.
Despite its usefulness in preventing cardiac and cerebrovascular complications, aspirin treatment is usually discontinued before surgery due to the risk of perioperative bleeding.
12. Centers for Disease Control and Prevention warns against giving aspirin to children or adolescents with varicella (chickenpox) or influenza-like or viral illnesses because of a possible association with Reye’s syndrome.
Aspirin has been associated with Reye’s syndrome, so use caution when giving aspirin to children or teenagers for fever or pain. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin.
13. Advise patients receiving aspirin prophylactically to take only the prescribed dose.
Increasing doses has not been found to provide additional benefits.
Evaluation and Desired Outcomes
Overall, the desired outcomes of using aspirin will depend on the specific reason it is being taken and the specific condition being treated. Some common desired outcomes for using aspirin include:
- Relief of mild to moderate pain. Aspirin is often used to relieve mild to moderate pain, such as headache, toothache, or muscle aches.
- Reduction of inflammation. Aspirin can be used to reduce inflammation, swelling, and redness associated with conditions such as arthritis and other inflammatory conditions.
- Prevention of blood clots. Aspirin can be used to help prevent blood clots from forming, which can help reduce the risk of heart attack and stroke.
- Reduction of fever. Aspirin can be used to reduce fever associated with certain conditions, such as the flu.
- Improvement of blood flow. Aspirin may help improve blood flow in people with certain conditions, such as peripheral artery disease.
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References and Sources
To further your research about aspirin nursing considerations, you can use these sources:
- Burchum, J., & Rosenthal, L. (2018). Lehne’s pharmacology for nursing care (10th ed.). Saunders.
- García Rodríguez, L. A., Martín-Pérez, M., Hennekens, C. H., Rothwell, P. M., & Lanas, A. (2016). Bleeding risk with long-term low-dose aspirin: a systematic review of observational studies. PloS one, 11(8), e0160046.
- Isoardi, K.Z., Henry, C., Harris, K. et al. Activated Charcoal and Bicarbonate for Aspirin Toxicity: a Retrospective Series. J. Med. Toxicol. 18, 30–37 (2022).
- Julian Yaxley & Thomas Litfin (2016) Non-steroidal anti-inflammatories and the development of analgesic nephropathy: a systematic review, Renal Failure, 38:9, 1328-1334
- Laine, L. (2006). gastrointestinal bleeding with low‐dose aspirin–what’s the risk?. Alimentary pharmacology & therapeutics, 24(6), 897-908.
- Vallaerand, A.H. & Sanoski, C.A. (2019). Davis’s Drug Guide for Nurses. Philadelphia, PA. F. A. Davis Company.
- Vane, J. R., & Botting, R. M. (2003). The mechanism of action of aspirin. Thrombosis research, 110(5-6), 255-258.
- Vane, J. R. (2014). Inhibition of prostaglandin biosynthesis as the mechanism of action of aspirin-like drugs. Adv Biosci, 9, 395-411.