An appropriate nursing diagnosis for clients who are taking NSAIDs and anticoagulants would be which of the following?
A. Risk for injury related to prolonged bleeding time, inhibition of platelet aggregation, and increased risk of GI bleeding.
B. Potential for injury related to GI toxicity and decrease in bleeding time.
C. Altered protection related to GI bleeding and increasing platelet aggregation.
D. Risk for injury related to thrombocytosis prolonged prothrombin time.
Correct Answer: A. Risk for injury related to prolonged bleeding time, inhibition of platelet aggregation, and increased risk of GI bleeding.
The nursing diagnosis addresses all the interactions that pose a threat to the client taking both these drugs. Significant interactions between corticosteroids and other drugs also exist, so concurrent use of other medications should undergo an evaluation as changes in their management may be warranted. The effect of anticoagulants, such as warfarin, may increase, which would require closer monitoring and potential dosage change. This effect would likely be at 3 to 7 days after starting the corticosteroid.
Option B: Bleeding time is prolonged not decreased when both drugs are used. Corticosteroid users who are on concurrent NSAID therapy, or others at higher risk of ulcers or gastrointestinal (GI) bleeding including those with a history of ulcers or GI bleeding and those with severe comorbidities (e.g., advanced cancer) should receive proton pump inhibitor therapy.
Option C: Platelet aggregation is inhibited not increased when both drugs are used. Live vaccine administration while a patient is taking immunosuppressive dosing of a glucocorticoid (40 mg/day of prednisolone or equivalent and greater for more than 7-day duration) may lead to an increased risk of infection. Therefore, the recommendation is to delay any live or live-attenuated vaccination for three months after discontinuing immunosuppressive glucocorticoid therapy.
Option D: Thrombocytosis does not occur with the use of either drug. Contraindications to corticosteroids include hypersensitivity to any component of the formulation, concurrent administration of live or live-attenuated vaccines (when using immunosuppressive doses), systemic fungal infection, osteoporosis, uncontrolled hyperglycemia, diabetes mellitus, glaucoma, joint infection, uncontrolled hypertension, herpes simplex keratitis, and varicella infection. Additional relative contraindications include peptic ulcer disease, congestive heart failure, and viral or bacterial infections not controlled by anti-infectives.