Introduction
A 59-year-old man has been drinking heavily for the past ten years, consuming up to 12 servings of alcohol per week. In the past two weeks, he has also been taking up to eight 500 mg tablets of acetaminophen daily due to a recent knee injury. Over the last few days, he began experiencing symptoms of nausea, vomiting, a slight fever, abdominal tenderness, and jaundice. Therefore, he came to the emergency department, where tests revealed elevated liver enzymes, bilirubin, serum glucose, and blood acetaminophen concentration.
The doctors diagnosed the man with acute liver failure caused by alcohol abuse and acetaminophen toxicity. They explained to him that the combination of alcohol and acetaminophen was causing significant damage to his liver. Hence, if he did not take steps to reduce his alcohol consumption and stop taking acetaminophen, he could suffer long-term health consequences.
Scenario Analysis
The patient has indications of liver toxicity or damage, most likely as a result of his acetaminophen and alcohol use. While both of these substances can cause liver damage on their own, their combination has been found to increase the risk of liver damage significantly (Liu et al., 2019). The liver is a vital organ to the human body, and it is responsible for numerous functions, including detoxification, energy storage, and protein synthesis. It is also the primary organ responsible for metabolizing drugs and other substances that enter the body. As such, it is essential to be aware of the potential for liver toxicity or damage and take steps to prevent it.
When taken together, the two substances interact with each other in a way that increases the risk of liver toxicity. Enzymes in the liver metabolize acetaminophen, and when taken with alcohol, these enzymes become overwhelmed and unable to process the drug effectively (Cui et al., 2019). This can lead to a buildup of toxins in the liver, which can cause liver damage.
In addition, the combination of acetaminophen and alcohol can cause irritation and inflammation in the liver, further increasing the risk of liver damage. Furthermore, it is also significant for individuals to be aware of the signs and symptoms of liver toxicity or damage so that they can seek medical help if they experience any of these symptoms.
Symptoms of liver toxicity or damage can include jaundice, dark urine, abdominal pain, and lack of appetite (Moini, 2018). Jaundice is a yellow discoloration of the skin and eyes caused by a buildup of bilirubin in the bloodstream. Bilirubin is a bile pigment produced by the destruction of red blood cells and is normally excreted by the liver. When the liver is damaged, it cannot process bilirubin efficiently, leading to elevated levels in the bloodstream and yellow skin discoloration.
Dark urine is also a common symptom of liver toxicity, as the liver is responsible for processing and excreting toxins and other by-products of metabolism. When the liver is damaged, these toxins can accumulate in the body and be excreted through the urine, leading to a dark color. In addition, the liver is responsible for producing bile, which is necessary for digestion. When the liver is damaged, the bile may be excreted in the urine, causing it to appear dark or reddish.
Abdominal pain is also a frequent indicator of liver impairment or poisoning. The liver is located in the upper right quadrant of the abdomen, and any damage to the organ can cause pain in this area. Moreover, the liver is responsible for excreting toxins from the bloodstream, and any buildup can cause abdominal discomfort (Liu et al., 2019). Furthermore, a lack of appetite is another common symptom of liver toxicity or damage. The liver produces various enzymes and hormones necessary for digestion, and any impairment in its function can lead to decreased appetite.
When alcohol enters the body, it flows to the liver to be absorbed and broken down. When medication is taken after alcohol use, it must compete with the alcohol in the liver to be metabolized. As a result of this interaction, the medication’s metabolism rate slows, reducing its effectiveness. Unfortunately, taking more of something to feel its desired effects is common human behavior.
Since the alcohol in the patient’s system slowed the effect of the acetaminophen he was taking, he had to increase his dosage to 4500 mg per day. The usual adult’s daily acetaminophen dosage is two 500mg pills every six hours and should not exceed six 500mg tablets (Moini, 2018). For the previous two weeks, the patient had overdosed on himself each day; that is, 1000 mg daily. This is far beyond the recommended dosage and can cause a range of health issues.
Furthermore, acetaminophen is one of the most commonly used over-the-counter drugs in the United States. It is a safe and effective pain reliever and fever reducer, used by an estimated 60 million Americans weekly (Gerriets & Nappe, 2019). However, acetaminophen carries with it a risk of serious adverse effects, particularly hepatotoxicity.
In the United States, this accounts for more than 50 % of all overdose-related acute liver failures and approximately 20 % of all liver transplant cases. To put this into perspective, acetaminophen hepatotoxicity has a yearly fatality rate of 0.4%, accounting for around 500 deaths in the United States alone (Gerriets & Nappe, 2019). This is a significant issue that must be addressed.
Therefore, it is important to recognize that while acetaminophen is generally a safe and effective medication, it must be used with caution and only as directed. The risk of acetaminophen hepatotoxicity can be minimized by taking the recommended dosage, not exceeding the maximum daily dose, avoiding alcohol, and avoiding long-term use without consulting a doctor (Cui et al., 2019). It is also essential to be mindful of the potential for interactions with other medications. It is essential to read the label and any other accompanying information to ensure you take the correct dose and are aware of any potential interactions.
Complications from combining alcohol and acetaminophen include skin discoloration, nausea, malaise, and light-colored feces. The impaired function of liver enzymes is a more serious side effect of alcohol and acetaminophen abuse. Any patient taking a hepatotoxic drug must have liver function tests performed, which measure blood levels of the enzymes aspartate aminotransferase and alanine aminotransferase (Moini, 2018). Both of these enzymes are necessary for liver health and amino acid metabolism.
Protein comprises amino acids; the body requires protein to repair and make new cells. For example, a deficiency of protein in the body caused by liver injury might result in cells losing their ability to generate (Moini, 2018). If the liver is unable to synthesize new cells to repair itself, a liver transplant may be required.
Damage to these protein-building enzymes can drastically alter liver function, throwing other body organs into a tailspin. Damage to the liver might also compromise the body’s blood supply. Apart from the heart, the liver is a great source of blood; affecting this blood supply can increase blood vessel pressure, affecting blood flow to all of the body’s organs.
Pharmacological Recommendation
Medication administration is important to a nurse’s job in a healthcare facility. It involves more than simply administering drugs to patients. Nurses must be well-versed in pharmacology and understand how each drug will interact with a patient’s body and what side effects they may experience. This knowledge allows nurses to make informed decisions when administering medications and helps to prevent potentially catastrophic mistakes.
To ensure patient safety, nurses must complete a series of medication checks. This process is called the “six rights of medication administration.” The nurse should ensure the right drug, patient, dose, time, and route are used (Moini, 2018). Additionally, the occurrence should be recorded in the patient’s records. The procedure ensures that the right drug is given to the right patient in the right dose, at the right time, and through the appropriate route.
Another important aspect of the nurse’s job in learning pharmacology is understanding how medications interact. The nurse must be aware of any medications their patient is taking and how any new medicine may affect them. Natural supplements are widely used, and many patients may not reveal their use because they are not technically a drug.
However, these natural supplements can have negative side effects and must be disclosed to medical personnel. Excessive bleeding can occur when certain natural supplements are used with medications such as warfarin (Moini, 2018). Other potentially fatal drug interactions can result in renal failure or high blood pressure. On the other hand, there are some instances where drug interaction has a favorable effect. Acetaminophen and oxycodone, when combined, produce strong pain relief.
Conclusion
Pharmacology plays an increasingly important part in nursing and health care. The 59-year-old man who arrived at the emergency hospital could not have been diagnosed on time if doctors had not understood how drugs interact with one another. A nurse with extensive knowledge of pharmacology would hear the patient describe his symptoms and current treatment and immediately suspect liver problems.
When it comes to the liver, it is critical to intervene quickly; without intervention, the patient would have suffered irreversible liver damage. Furthermore, acetaminophen is an effective and safe medication when taken as directed. However, it is important to be aware of the hepatotoxicity risk and take the necessary precautions to minimize this risk. It is also important to recognize that the risk of hepatotoxicity is not the only potential side effect of acetaminophen and to be mindful of any other potential adverse effects.
Moreover, medication administration is a critical part of a nurse’s job. It requires knowledge of pharmacology and understanding the “six rights” of medication administration. By following these guidelines, nurses can help to ensure patient safety and prevent potentially catastrophic mistakes. The responsibility of medication administration lies with the nurse, who must take it seriously to provide safe and effective care to their patients.
References
Cui, B.-W., Bai, T., Yang, Y., Zhang, Y., Jiang, M., Yang, H.-X., Wu, M., Liu, J., Qiao, C.-Y., Zhan, Z.-Y., Wu, Y.-L., Kang, D.-Z., Lian, L.-H., & Nan, J.-X. (2019). Thymoquinone attenuates acetaminophen overdose-induced acute liver injury and inflammation via regulation of JNK and AMPK signaling pathway. American Journal of Chinese Medicine, 47(3), 577–594. Web.
Gerriets, V., & Nappe, T. M. (2019). Acetaminophen. National Library of Medicine. StatPearls Publishing. Web.
Liu, J., Luo, D., Wu, Y., Gao, C., Lin, G., Chen, J., Wu, X., Zhang, Q., Cai, J., & Su, Z. (2019). The protective effect of Sonneratia apetala fruit extract on acetaminophen-induced liver injury in Mice. Evidence-Based Complementary & Alternative Medicine (ECAM), 1–12. Web.
Moini, J. (2018). Focus on Pharmacology: Essentials for health professionals. (3rd ed.). Pearson.