My patient takes ibuprofen for sinus congestion!

[Blackheartednurse]

I have a patient that takes ibuprofen for her sinus, how do I explain to her that this is not a wise idea?

P.s. She is on a diuretic as well so I guess nasal decongestants are contraindicated...

[chloecatrn]

Blackheartednurse said:

Why is this medication prescribed?

I'm confused. What was the point of this?

[SWS RN, ASN, RN]

Um, yes, I have read the literature and you should have before you spoke with your patient or posted that statement on this board.

Did you actually read my former post (where I answered between the lines, not just at the end)...go back and read it again.

I am actually trying to help you by giving some advice--which you say you never get from experience nurses--so whoa Nellie...stop, look and listen (and read)

[chloecatrn]

I'm assuming from the addition of the bolding that either you're trying to convey that an NSAID is a "pain killer" or you're inferring that sinus headaches are not an indicated use for ibuprofen. Again, please see "headache," listed in indications.

Secondly, Ibuprofen is a pain reliever. It is not an addictive pain medication. Third, please see the final line of the first paragraph, which states that it works by "stopping the body's production of a substance that causes pain, fever, and inflammation." The point of this is that ibuprofen decreases the inflammation in your patient's sinus cavities, decreasing the pain that way.

There was no indication that she took the ibuprofen every day until three pages into this thread, when you provided additional information. If your patient is at risk for heart attack and stroke secondary to hypertension, which I'm assuming is what the bolded "high blood pressure" means, because again, there's NO indication anywhere in this thread that your patient has pre-existing hypertension, then perhaps you should encourage her to discuss other pain relief options with her physician. Her physician may not understand the extent of her sinus issues, and may wish to make a referral to a specialist.

There seems to have been so much information missing from the original post that there was NO way we could have given you intelligent discourse on this topic.

[nursej22, MSN, RN]

My 2 cents:

The original poster had a sense, feeling, intuition, whatever, that ibuprofen was not the best treatment for her patient's sinus pain. So, she came onto this site for help in exploring why, and I think some replies were helpful.

So I think the take away message is, not so much that we do all indeed have sinuses, but that when analyzing a drug regimen, it is important to do a complete history, consider the effect and interaction of each med, and any contraindications.

Surely, many of us have seen patients who take OTC meds thinking they are "safe" and end up with serious problems, i.e. renal failure, MI, ulcers.

Or they treat themselves, not realizing there are more effective options.

[rn/writer, RN]

nursej22 said:

My 2 cents:

The original poster had a sense, feeling, intuition, whatever, that ibuprofen was not the best treatment for her patient's sinus pain. So, she came onto this site for help in exploring why, and I think some replies were helpful.

So I think the take away message is, not so much that we do all indeed have sinuses, but that when analyzing a drug regimen, it is important to do a complete history, consider the effect and interaction of each med, and any contraindications.

Surely, many of us have seen patients who take OTC meds thinking they are "safe" and end up with serious problems, i.e. renal failure, MI, ulcers.

Or they treat themselves, not realizing there are more effective options.

The bolded part of the quote contains a number of good points that should indeed be considered in the situation the OP described.

At the same time, it is also important, for the OP to understand that some of her terminology may cause her to sound less than well-informed when communicating with the patient's doc or assisting the patient in making that communication herself.

Saying the patient has "sinus" or takes ibuprofen for "sinus" is akin to the mistake that many lay people make when asking if someone has a "temperature." Everyone has a temperature, even if they are dead. The real question is does the person have an abnormal or elevated temperature.

Similarly, every one has sinus cavities in their skull. So taking a med for "sinus" does not sound medically professional. Taking ibuprofen for sinus pain or inflammation is a legitimate practice but ought to be evaluated according to the points mentioned above. Taking ibuprofen for a sinus infection is another matter altogether and could well require a different or additional course of action. The word, "sinus" by itself does not convey enough information.

Referring to a patient becoming "addicted" to ibuprofen is another problematic phrase. Taking OTC meds can become a habit, certainly, and one that needs further investigation and evaluation by the patient's doc. But using the term "addiction" in relation to NSAIDS suggests a misunderstanding of the addictive process and could get in the way of a arriving at a real and appropriate resolution.

Whether the OP speaks with the patient's doc directly or helps the patient to do so herself, using accurate and complete terminology can improve the chances of bringing about a good outcome.

This isn't nitpicking. It's an opportunity to learn how to express patient concerns in the most effective way. Better to practice here with us than to have a doc dismiss your questions because of the snags that occurred in this thread.

Your gut is reacting. You need to give that hunch an informed voice so that you will be taken seriously as you advocate for your patient.

Good for you for caring about your patient and not just glossing over an OTC med.

[April, RN, BSN, RN]

If a patient is taking ibuprofen every single day, I'd be more concerned about developing an ulcer.

[chloecatrn]

rn/writer said:

The bolded part of the quote contains a number of good points that should indeed be considered in the situation the OP described.

At the same time, it is also important, for the OP to understand that some of her terminology may cause her to sound less than well-informed when communicating with the patient's doc or assisting the patient in making that communication herself.

Saying the patient has "sinus" or takes ibuprofen for "sinus" is akin to the mistake that many lay people make when asking if someone has a "temperature." Everyone has a temperature, even if they are dead. The real question is does the person have an abnormal or elevated temperature.

Similarly, every one has sinus cavities in their skull. So taking a med for "sinus" does not sound medically professional. Taking ibuprofen for sinus pain or inflammation is a legitimate practice but ought to be evaluated according to the points mentioned above. Taking ibuprofen for a sinus infection is another matter altogether and could well require a different or additional course of action. The word, "sinus" by itself does not convey enough information.

Referring to a patient becoming "addicted" to ibuprofen is another problematic phrase. Taking OTC meds can become a habit, certainly, and one that needs further investigation and evaluation by the patient's doc. But using the term "addiction" in relation to NSAIDS suggests a misunderstanding of the addictive process and could get in the way of a arriving at a real and appropriate resolution.

Whether the OP speaks with the patient's doc directly or helps the patient to do so herself, using accurate and complete terminology can improve the chances of bringing about a good outcome.

This isn't nitpicking. It's an opportunity to learn how to express patient concerns in the most effective way. Better to practice here with us than to have a doc dismiss your questions because of the snags that occurred in this thread.

Your gut is reacting. You need to give that hunch an informed voice so that you will be taken seriously as you advocate for your patient.

Good for you for caring about your patient and not just glossing over an OTC med.

As usual, a well thought out and beautifully written post. Thank you for giving voice to the things that were stuck in my head.

[Wile E Coyote, ASN, RN]

^^^Wonderfully put.

[ZippyGBR, BSN, RN]

onaclearday said:

I am taking advil+Pseudoephedrine as I write.

Ibuprofen and Pseudephedrine is a routine combination in most places , it' what i take for sinus pain + congestion well sometimes i use decongestant sprays instead ...

i'm not sure what the OP's issue is ...

[HashimotoMo]

@ blackheartednurse: just a quick response to the following exerpt from your post (and yes, i realize the thread is a year old, but i'm new to the site and came upon it via internet search that brought me to this conversation):

also from my understanding the patient thinks ibuprofen will fix her congestion.or perhaps i misunderstood her.i never had sinuses so i dont know what is like to have a sinus headache.maybe that is why i was surprised that the patient medicate herself with ibuprofen,i always thought that patients takes decongestants or antihistamines.

i'm hoping my reply will offer some insight into the patient mind for the future. patients aren't always able to express in correct medical terms how they feel, but chronic sufferers are often more in-tune w/their own bodies than professionals give them credit for. so i would always recommend you listen as empathetically as you can and i don't just mean listen...but truly hear what they are trying to convey (although i know that may be hard w/some patients, lol).

i'm not sure that the patient you referred to was expecting to "fix" her sinus congestion. rather, i'm sure she was simply looking for relief as others have mentioned; and not just relief of any headaches that may or may not have been associated with the congestion. i personally have extremely horrific allergies and this year (summer, 2011) seems to be worse than ever before. aside from potential surgery, i'm not sure there is a "fix," but her wanting to take an anti-inflammatory to bring down the inflammation in her sinus cavity just makes sense.

your patient may have already tried the antihistamine/decongestant combos if this is a regular problem for her. i'm on allegra and flonase 2x per day every day of the year (dust, dust mites and cat dander allergies...of course, having a cat doesn't help, lol). however, this year neither have worked although flonase is one of the "top runners" in the fight against sinus inflammation. the otc nasal sprays worked for awhile....until rhinitis medicamentosa set in. i then switched to all the alternatives my personal dr. office suggested, allegra-d, zyrtec-d, mucinex-d (all with the flonase). no relief. the only thing that did finally work was taking the allegra-d, flonase and 2-3 ibuprofen every 6 hours until the condition resolved.

with the availability of medical information online these days w/the various sites, a lot of patients do bring some research to the table when consulting their nurses/doctors. this can be bad, but it can also be very good. i just ask that you really take the time to get as much information as possible from the patient and never pass judgment. like i said, sometimes the patient is so in tune to what their body tells them, that all the medical logic in the world would seek to defy it. it might not make sense, but if it works for the patient and isn't doing them harm, sometimes ya just gotta go with it because every once in awhile, they'll surprise ya and be dead-on! in this case, your patient was utilizing a medication that made perfect sense to treat the condition she suffered from.

best wishes to you in your continued education and work in the field.

[Howdy duty]

I was reading an article that was so false I became outraged and decided to search "why isn't ibuprofen also sold as a decongestant. People need to know that ibuprofen will open your sinuses. For me it works way better than other decongestant pills. The article I read claimed ibuprofen does not need to be taken unless you have pain or headache and to use pseudophedrine for congestion. Ummm... Congestion is caused by inflamed sinuses. Ibuprofen treats inflamation. I am completely baffled. However I'm not a doctor and I don't know how safe it is to regularly take ibuprofen verses pseudofed. And the only evidence the article mentioned about pseudofed was that it causes swollen membranes in the sinuses to shrink. We'll it doesn't for me and many others I know and ibuprofen does because that is its sole purpose. Inflamation=swollen. Ibuprofen+inflamation= not swollen!!! I think the public is being mislead

[applewhitern, BSN, RN]

I am not a doctor nor pharmacist either, so take my opinion with a grain of salt! I have read up on the anti-inflammatory properties of ibuprophen, and understood that you would have to take it daily for a longer period of time in order for it to be anti-inflammatory. If you just take it occasionally, it doesn't have the same anti-inflammatory effect. I was studying specifically about arthritis and other chronic conditions, however, and not sinus congestion, and was reading about how much and how long you would have to take it for the anti-inflammatory effects to start. I have arthritis, and take ibuprophen daily; I also have chronic sinus congestion. Ibuprophen nor pseudophed have ever helped my sinuses! I wish it would!