A patient requires a nonopioid medication. The nurse knows that which medication will cause the least gastrointestinal distress?

Nalbuphine (Nubain) is an opioid agonist-antagonist used for moderate to severe pain. While effective, it carries opioid-related risks such as respiratory depression and CNS effects, requiring close nursing monitoring and thorough patient teaching.

Rationale for correct answers:
A. Monitor any changes in respirations:
As with other opioids, nalbuphine can depress the respiratory center. Monitoring rate, depth, and pattern is critical, especially after IV administration.

B. Instruct the patient to report bradycardia:
Nalbuphine can slow heart rate. Patients must promptly report dizziness, faintness, or slow pulse to prevent complications.

C. Administer IV nalbuphine undiluted:
This drug may be given undiluted IV, usually slowly over 2 minutes, to reduce adverse effects like hypotension or respiratory depression.

E. Instruct the patient to avoid alcohol when taking nalbuphine to avoid respiratory depression:
Alcohol potentiates CNS and respiratory depression from opioids, so complete avoidance is essential.

Rationale for incorrect answer:
D. Explain to the patient to expect an excessive amount of urine output:
This is false. Nalbuphine does not increase urine output; instead, opioids may cause urinary retention.

Take-home points:

• Always monitor respiratory status and heart rate with nalbuphine.
• Give IV doses undiluted, administered slowly.
• Warn patients about alcohol and CNS depressant interactions.

Celecoxib is a COX-2 selective inhibitor that provides anti-inflammatory and analgesic effects while sparing COX-1 activity, which helps protect the gastric mucosa. Because of this selectivity, it causes less gastrointestinal irritation and ulceration than nonselective NSAIDs.

Rationale for correct answer:
C. Celecoxib: Unlike traditional NSAIDs, celecoxib selectively inhibits COX-2, reducing pain and inflammation while minimizing gastric irritation, ulcer risk, and GI bleeding associated with COX-1 inhibition.

Rationale for incorrect answers:
A. Aspirin: Strongly inhibits COX-1, making it highly irritating to the gastric mucosa and increasing the risk of ulcers and GI bleeding.
B. Ketorolac: A potent nonselective NSAID with a high risk of GI ulceration and bleeding, especially with prolonged use.
D. Ibuprofen: Less irritating than aspirin or ketorolac but still a nonselective COX inhibitor, so it carries moderate risk for GI upset and ulceration.

Take-home points:

• Celecoxib (COX-2 inhibitor) causes the least GI distress compared with other NSAIDs.
• Aspirin, ketorolac, and ibuprofen all inhibit COX-1, which increases the risk of gastric irritation and ulcers.
• Patients on any NSAID should be advised to take with food and report GI symptoms promptly.