Nursing care
Aspirin: what to check before you give it
Written and reviewed by Dana Whitfield, RN, MSN · 4 min read · Updated September 2026
Short answer
Aspirin is dosed low for cardioprotection and higher for pain or inflammation, and these are not interchangeable indications. It is never given to a child or teenager with a viral illness because of the risk of Reye's syndrome. Tinnitus, or ringing in the ears, is the classic early sign of salicylate toxicity and should prompt an immediate hold and salicylate level.
What it does and why it is prescribed
Aspirin irreversibly inhibits cyclooxygenase, and that irreversibility is what separates it from other NSAIDs. At low dose, roughly 75 to 100 mg daily, it permanently disables platelet COX-1 for the platelet's lifespan, giving durable antiplatelet protection against myocardial infarction and stroke.
At higher dose, in the range used for pain, fever, or inflammation, it acts more broadly across tissues to reduce prostaglandin-mediated pain and inflammatory signalling. The dose is the indication here: a cardiology patient on 75 mg daily is not receiving analgesia, and a patient taking 600 mg for a headache is not receiving cardioprotection at that single dose.
Nursing considerations before giving it
Confirm the indication matches the dose ordered, since a mismatch is a common medication error, particularly on transfer between care settings where a prescription is copied without review. Check for concurrent anticoagulant or antiplatelet therapy, since combined use raises bleeding risk without a proportional benefit in most patients.
Ask about age and the presence of a viral illness before giving aspirin to anyone under 18. Aspirin in a child or adolescent with chickenpox, influenza, or another viral infection is linked to Reye's syndrome, a rare but potentially fatal hepatic and encephalopathic condition, and this contraindication is absolute, not a judgement call.
What to monitor
For a patient on low-dose aspirin long-term, monitor for bruising, occult GI bleeding, and, periodically, haemoglobin. For higher analgesic or anti-inflammatory dosing, monitor renal function and GI symptoms the same way you would for any NSAID.
Ask specifically about tinnitus at each assessment for a patient on higher-dose or prolonged aspirin therapy. Ringing or buzzing in the ears is the classic early warning of salicylate accumulation and often appears before more dangerous signs, so it should never be dismissed as unrelated.
Side effects versus adverse effects
Expected side effects include mild dyspepsia, easy bruising, and, at higher doses, tinnitus that resolves once the dose is reduced. These are uncomfortable but manageable without stopping therapy entirely in most cases.
Adverse effects requiring immediate action include GI bleeding, hypersensitivity with bronchospasm, and salicylate toxicity itself: tinnitus progressing to hyperventilation, confusion, hyperthermia, and metabolic acidosis. Severe toxicity is a medical emergency and can be fatal, particularly in children or older adults where the toxic threshold is reached at lower total doses.
What to hold for and when to call
Hold aspirin and call the prescriber for new tinnitus, hyperventilation, confusion, or any sign of GI bleeding. Hold it before any surgery where the prescriber has not explicitly continued it, since its antiplatelet effect lasts the lifespan of the platelet, roughly seven to ten days, not just one dosing interval.
Never give aspirin to a child or teenager with a suspected viral illness regardless of the reason for the order. Hold it in a patient with active peptic ulcer disease, known salicylate hypersensitivity, or a bleeding disorder unless the prescriber has weighed that risk explicitly.
Patient teaching
Tell the patient exactly why they are taking aspirin at their prescribed dose, since a patient on low-dose cardioprotective aspirin who also takes an over-the-counter aspirin-containing product for pain may unknowingly double their bleeding risk. Advise against stopping cardioprotective aspirin without medical advice, since abrupt discontinuation can increase clotting risk in patients with cardiovascular disease.
Warn parents never to give aspirin to a child or teenager with a fever, flu-like symptoms, or chickenpox, and to check any combination cold or flu product for hidden aspirin content. Tell any patient on higher-dose or long-term aspirin to report ringing in the ears immediately, since this is the sign that means the dose needs review before it becomes dangerous.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our pharmacology practice questions are the closest set to what this page covers.
One question from the pharmacology set
A client with heart failure is started on furosemide 40 mg PO daily. Which findings should the nurse report to the provider before administering the next dose? Select all that apply.
Rationale
Furosemide is a loop diuretic, so the two things you are watching are potassium and kidney function. A potassium of 2.9 mEq/L is below the 3.5–5.0 reference range and puts the client at risk for dysrhythmia — hold and report. Muscle cramps with palpitations are the clinical face of that same hypokalemia, so they are reported together, not separately. A creatinine that doubles signals the diuresis has outrun renal perfusion. A blood pressure of 132/78 and a 1 kg loss are the expected response to the drug working, not reasons to hold it.
Answer: A, D, E
Common questions
Why is aspirin dangerous for children with a fever?
Aspirin given to a child or teenager during a viral illness such as influenza or chickenpox is linked to Reye's syndrome, a rare but potentially fatal condition causing liver failure and brain swelling. Because of this, aspirin is not used for fever or pain in this age group regardless of the illness.
What is the first sign of aspirin toxicity?
Tinnitus, a ringing or buzzing in the ears, is the classic early sign of salicylate toxicity. It typically appears before more severe symptoms like hyperventilation, confusion, or metabolic acidosis, so it should trigger an immediate hold and reassessment.
Why do cardiac patients take low-dose aspirin?
At low dose, aspirin irreversibly inhibits platelet cyclooxygenase, preventing thromboxane-mediated platelet aggregation for the platelet's full lifespan. This gives durable protection against arterial clot formation, which is why low doses of around 75 to 100 mg daily are used for cardiovascular protection rather than pain relief.
Should aspirin be stopped before surgery?
Its antiplatelet effect lasts roughly seven to ten days because it permanently disables each affected platelet, so it is usually held before elective surgery unless a prescriber has explicitly decided the cardiovascular risk of stopping it outweighs the bleeding risk of continuing it. This decision should always come from the surgical or cardiology team, not be assumed by nursing staff.
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