ACQ rationales Flashcards
Bulk- forming stool methylcellulose
Methylcellulose is a bulk-forming stool softener that absorbs water and increases solid intestinal bulk. It is a drug of choice for chronic constipation and is available in powder form.
The nurse should instruct the patient to mix the powder with at least 250 mL of water or juice and swallow it quickly; if not, it could cause constipation.
Bulk forming agents are least irritating, most natural, and safest type of laxatives.
Regular use of stimulant laxatives should be avoided to prevent dependence on the stimulus for defecation. Methylcellulose may cause the passage of stools 12 to 24 hours after taking the medication.
the patient need not report to the health care provider if he or she does not pass stools within 8 to 10 hours of taking the medication.
Increased gas formation and flatus may occur when the patient first starts taking methylcellulose; this will subside after 4 or 5 days. Therefore the nurse should not instruct the patient to stop taking the medication in such situations.
Hypertonic enema
Enemas that use hypertonic solutions are low volume and are designed for patients who cannot tolerate a large volume of fluid. This type of enema is contraindicated in infants and dehydrated patients. A patient with a dangerously high serum potassium level may receive a medicated enema that contains sodium polystyrene sulfonate.
How to give enema
The nurse should not give an enema to a patient sitting on the toilet because the position of the rectal tubing could injure the rectal wall. When giving an enema to an immobilized patient, it is always recommended that the patient be positioned on a bedpan. The use of sterile technique is not necessary when administering an enema because the colon already contains bacteria. However, the nurse should wear gloves to prevent the transmission of fecal microorganisms. Itis appropriate to ask the patient to retain the enema solution for a specific length of time before defecation.
Tincture of opium
Rationale
Tincture of opium is an antidiarrheal drug that is used to manage chronic severe diarrhea in patients with diseases such as Crohn’s disease, ulcerative colitis, andacquired immunodeficiency syndrome. Bisacodyl and casanthranol are cathartics, and methylcellulose is a laxative; they may be used to manage constipation, not diarrhea.
Soapsuds
Rationale
Soapsuds enemas may cause electrolyte imbalance or damage to the intestinal mucosa in pregnant. women and older adults. All people should use caution if ordered to repeat tap-water enemas because water toxicity or circulatory overload develops if thy body absorbs large amounts of water.
Oil-retention enemas and normal saline enemas may not have any adverse effect. Normal saline enemas are the safest.
Fecal impaction test
Digital examination of the rectum may be recommended for a patient in whom fecal impaction is suspected.
Gastroscopy is used to gain direct visualization of the upper gastrointestinal tract.
A barium swallow is a radiographic examination using an opaque contrast medium (barium, which is swallowed) to examine the structure and motility of the upper gastrointestinal tract.
The fecal occult blood test is a stool test to measure microscopic amounts of blood in the feces. These examinations may not be recommended for a patient in whom fecal impaction is suspected.
Opoid analgesics
Opioid analgesics slow peristalsis and contractions, thereby causing constipation. Therefore a patient taking opioid analgesics has a high risk of constipation. A patient who is taking antibiotics may have diarrhea because antibiotics decrease intestinal bacterial flora, resulting in diarrhea. Patients who have undergone diagnostic procedures that require visualization of the gastrointestinal tract may experience increased gas or loose stools, not constipation. A person should drink at least 1.5 L of fluids per day to avoid constipation.
Moving immobilized patient
Rationale
When positioning an immobilized patient on a bedpan, the nurse should roll the patient onto the bedpan to ensure the patient’s safety. The nurse should never try to lift the patient onto a bedpan. After a patient is positioned on a bedpan, the nurse should elevate the head of the patient’s bed 30 to 45 degrees, not 15 to 25 degrees. A smaller fracture pan should be provided to patients with hip or leg fractures, not arm fractures.
