Nursing care
Ketorolac: what to check before you give it
Written and reviewed by Dana Whitfield, RN, MSN · 3 min read · Updated September 2026
Short answer
Ketorolac is an NSAID given for moderate to severe pain, usually short-term after surgery. It is limited to five days total across all routes because renal and GI toxicity rise sharply beyond that. Never combine it with another NSAID, including aspirin or ibuprofen, and check renal function and bleeding risk before the first dose.
What it does and why it is prescribed
Ketorolac blocks cyclooxygenase, cutting prostaglandin production, and that gives it analgesic potency close to an opioid without the respiratory depression. You will see it ordered IV or IM after orthopaedic, abdominal, or dental surgery, often alongside a reduced opioid dose to limit sedation and constipation.
It has no role in chronic pain management. The five-day ceiling across oral, IV, and IM routes combined is not a suggestion; it is the point past which renal and gastrointestinal injury climb steeply. A patient transitioning from IV to oral ketorolac still counts every prior IV day toward that total.
Nursing considerations before giving it
Check the medication administration record and the chart for any other NSAID, including over-the-counter ibuprofen or aspirin the patient may have taken at home. Two NSAIDs together do not add analgesia; they add toxicity, so this combination is avoided even for a single dose.
Confirm baseline renal function, current GI bleeding risk, and hydration status. A postoperative patient who is volume-depleted is at higher risk of acute kidney injury from ketorolac because prostaglandins maintain renal perfusion when circulating volume is low. Confirm the day count if the patient has already received doses on a previous shift.
What to monitor
Watch urine output, creatinine, and BUN trends daily. A falling urine output or rising creatinine in a patient on ketorolac is a reason to hold the next dose and notify the prescriber, not wait for the trend to worsen.
Monitor for occult GI bleeding: dark or tarry stools, coffee-ground emesis, or a falling haemoglobin. Track pain scores before and after each dose to confirm the drug is actually working, and note any bruising or prolonged bleeding from IV sites, which suggests platelet inhibition is having a clinical effect.
Side effects versus adverse effects
Expected side effects include dyspepsia, mild drowsiness, headache, and injection site discomfort. These are uncomfortable but do not usually require stopping the drug within the five-day course.
Adverse effects demand action: GI bleeding, acute kidney injury, a hypersensitivity reaction with bronchospasm or facial swelling, or signs of a peptic ulcer such as epigastric pain that does not settle. Any of these means holding the drug and escalating, not documenting and moving on.
What to hold for and when to call
Hold ketorolac and call the prescriber for rising creatinine, urine output under 30 mL/hour, any sign of GI bleeding, uncontrolled hypertension, or a patient reporting new epigastric pain. Hold it if the five-day total has been reached, even if pain control is still incomplete.
Hold it in third-trimester pregnancy, in patients with active peptic ulcer disease, in significant renal impairment, and in anyone with a known NSAID or aspirin hypersensitivity. Do not give it before major surgery when haemostasis is a concern, since it inhibits platelet aggregation for the duration of the drug's action.
Patient teaching
Tell the patient this is a short-course medication, not one to keep taking at home once the prescription ends, and that it must not be combined with any other NSAID, including over-the-counter ibuprofen, naproxen, or aspirin bought without a prescription.
Advise them to report black stools, blood in vomit, decreased urination, or unusual bruising immediately. Encourage adequate oral fluid intake once eating and drinking resume, since dehydration increases the renal risk this drug already carries.
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
How many days can a patient take ketorolac?
Five days total, and that includes any IV or IM doses given before switching to oral. Once the five-day combined limit is reached, the drug is stopped regardless of how well pain is controlled.
Can ketorolac be given with ibuprofen?
No. Giving two NSAIDs together increases GI and renal toxicity without improving analgesia, so ketorolac is never combined with ibuprofen, naproxen, aspirin, or any other NSAID.
Why does ketorolac affect the kidneys?
Prostaglandins help maintain blood flow to the kidneys, particularly when a patient is volume-depleted. Ketorolac blocks that prostaglandin production, which can reduce renal perfusion and, in a dehydrated or hypovolaemic patient, precipitate acute kidney injury.
Is ketorolac safe in pregnancy?
It is avoided in the third trimester because NSAIDs can cause premature closure of the fetal ductus arteriosus and reduce amniotic fluid volume. Use earlier in pregnancy should follow the prescriber's specific risk-benefit assessment.
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