Contraindications: Renal Compromise – NSAIDs (Nursing)

00:01 So what are the reasons that you should be aware of to know like, it is really not a good idea for this patient to either avoid them altogether or to stop them for a period of time? I've got three really important ones up there but first of all, renal compromise.

00:16 If someone's kidneys are already struggling, they're already having a hard time, we're gonna be, whoa, over-the-top careful about them getting an NSAID.

00:28 Let me tell you a story.

00:30 My dad who is elderly at the time got really sick from gall bladder disease and he have nausea and vomiting and he got very dehydrated but he also had bad knees so he was taking some pretty high dose NSAIDs to treat the arthritis in his knees.

00:47 When he got very dehydrated and he wasn't eating food but he continued to take his NSAIDs because he was very compliant with his medications and his knees really hurt, well unfortunately, that ended up in renal failure for him because the NSAIDs in an elderly person and he was very dehydrated, didn't have a lot fluid going through, that caused him to go in renal failure that set us on a trajectory for the rest of his life.

01:13 So anyone with renal compromise of any age but particularly my elderly clients, I watch that very, very closely.

01:21 So that is someone I would be hesitant to give an NSAID to unless I was very aware of their current renal status, knowing how they were doing.

01:29 Now when they work, they do great, right? Because they go after pain and inflammation but you just wanna be aware of the patient's renal function at that moment that you're giving it.

01:41 My dad had taken those drugs every day and had no problems but because he was in such a state of severe dehydration and wasn't taking any even more fluid, that's why we ended up with kidney problems for the rest of his life.

01:55 Now the second category, there's risk of excessive bleeding and gastric impact.

01:59 We'll talk a little bit more about those but we're gonna focus on that renal compromise because like what happened with my dad, it's no question that NSAIDs can induce some adverse renal effects.

02:10 Now we think it's closely related because they have not as much renal prostaglandin synthesis too but NSAIDs, kidneys that are struggling, that's a danger.

02:20 So you always want to know what? Right. Renal function. Well, how would we do that? Lab work would be great, right? BUN, creatinine.

02:30 In older adults with reduced muscle mass and other age-related changes in the kidney, serum creatinine levels and creatinine clearance are not reliable measures of kidney function.

02:42 For this reason, the CKD-EPI equation, which calculates the estimated glomerular filtration rate (eGFR), is a more accurate and preferred method for assessing kidney function in older adults.

02:55 We can also look at how much is their urine output production.

02:59 Putting all that lab work together with your hands on visual assessment can be really helpful in assessing where your patient is because remember, those NSAIDs can really do damage to a kidney.

03:12 So we've got ideas for you there, you know what you should watch, now how would this come to you in a test question? Well, they might ask you, they might give you a list of medications that you need to give the patient and they would ask you which one of these would require for their follow up before administration.

03:28 So it could tie into the lab work that you should draw, the assessment you should do, maybe collaborating with a health care provider but they're gonna try and test you.

03:38 And I say they, it's those people that write NCLEX questions and your exam questions, this is how they can take a known problem with a medication and roll it into an exam question.

03:49 So I'm always gonna watch the lab work and whatever I can do to assess renal function before I'm gonna give a prescription strength NSAID or any NSAID.