Antidiarrheals And Laxatives Flashcards
What causes diarrhea
Drugs
Bacteria
Viruses
Dietary intolerances
Chronic conditions
How does diarrhea effect BMs
Increases fluidity and frequency
Acute diahrea lasts for how long
Self limiting (resolves on its own)
Usually within 3 days to 2 weeks
How long can chronic diarrhea last for
May last 3-4 weeks
When a person has diarrhea what are you treating for
Treat the cause of the diarrhea (to prevent weight loss)
Nutritional deficits
Fluid and electrolyte imbalances
Anti-diarrheals are contraindicated in
C diff.
E. Coli
(Body wants to flush toxin through)
What is an absorbent anti-diarrheal
Bismuth subsasicyate
bismuth subsalicylate
Is an absorbent diarrheal so it binds to the bacteria/toxins
Nursing implications for bismuth subsalicylate
May cause tongue and stools to darken
bismuth subsalicylate has drug drug interaction with
aspirin
warfarin
NSAIDS
Diarrhea is
The passage of 3 loose or liquid stools per day
(Could be acute or chronic)
Health care associated diarrhea
Diarrhea in a hospitalized patient that was not present on admission and starts 3 days after being hospitalized
(Occurs in 1/3 patients)
Clostridioides difficile
manifestation
Watery diarrhea
Fever
Anorexia
Abdominal pain
Clostridioides difficile
source of infection and susceptibility
Prolonged use of antibiotics followed by exposure to feces contaminated surfaces
(Spores on hands/environment very hard to kill)
Enterohemorrhagic escherichia coli
Manifestations
Severe abdominal cramping, bloody diarrhea, vomiting
Low grade fever
Lasts 5-7 days
Enterohemorrhagic Escherichia coli
Source of infection/susceptibility
• Can cause serious illness, especially in older adults
• May progress to life-threatening renal failure
• Transmitted in water or food contaminated with infected feces
Enterotoxigenic E. coli
Manifestations
Watery or bloody diarrhea, abdominal cramps
Nausea, vomiting, fever may be present
Lasts 3–4 days
Enterotoxigenic E. coli
Manifestations
• Watery or bloody diarrhea, abdominal cramps
• Nausea, vomiting, fever may be present
• Lasts 3–4 days
Enterotoxigenic E. coli
Infection/ susceptibility
Most common cause of travelers’ diarrhea
Transmitted in water or food contaminated with infected feces
What influences a pernon’s susceptibility to pathogens
Age
Gastric acidity
Intestinal microflora
Immune status
*older adults most likely to have life threatning diarrhea
Proton pump inhibitors
Since the stomach acid kills ingested pathogens, taking drugs to decrease stomach acid will increase the chance the pathogens will survive
The normal flora contains? Does?
Contains bacteria (ex. E. Coli)
Viruses
Fungi
*aid in fermentation
*provide a microbial barrier against pathogens
Who is susceptible to GI tract infection
People who are immunocompromised because of disease, or taking immunosuppressive drugs
Drug and food intolerance diarrhea occurs why
Rapid GI transition prevents fluid and electrolyte absorption, bile salts and undigested fats lead to excess fluid secretion into the GI tract
(Osmotic diarrhea)
Severe diarrhea may cause
life-threatening dehydration, electrolyte problems (e.g., hypokalemia), and acid-base imbalances (metabolic acidosis).
Major concerns of in self-limiting diarrhea
Preventing transmission
Replacing fluid and electrolytes
Protecting the skin
*if severe may need to give fluids, electrolytes, vitamins, and nutrition through IV
Why would an antidiarrheal not be used in treating some infectious diarrheas
they potentially prolong exposure to the organism
bismuth subsalicylate
Mechanism of action
Decreases secretions and has weak antibacterial activity. Used to prevent travelers’ diarrhea
Bismuth subsalicylate
Nursing considerations
May cause tinnitus and confusion. Do not use with GI bleeding
diphenoxylate/atropine
Mechanism of action
Opioid and anticholinergic. Decreases peristalsis and intestinal motility
diphenoxylate/atropine
Nursing implications
Blurred vision, dry mouth, drowsiness may occur. Take as directed. Overdose may be life-threatening.
diphenoxylate/atropine does what?
reduce bowel motility and transit time
reduce rectal spam pain
↓ stool frequency and volume
diphenoxylate
synthetic opiate agonist
slows overactive bowel
weak opioid (schedule 5)
AE: drowsiness, dizziness
atropine
(anti-cholinergic effect with larger doses)
discourage recreational use
Loperamide
similar to diphenoxylate
• inhibits peristalsis and prolongs transit time
• direct effect on the nerves in the intestinal muscle wall
• ↓ fecal volume and frequency
• available OTC
loperamide
Mechanism of action
Inhibits peristalsis, delays transit, increases absorption of fluid from stools
loperamide
Nursing considerations
Caution patient to avoid alcohol. Do not use with GI bleeding. May cause drowsiness. Use caution with hazardous activities.
What are the opiate antidiarrheals
diphenoxylate/atropine
Loperamide
Lactobacillus acidophilus
Probiotic
Restore normal intestinal flora
May be helpful for diarrhea d/t antibiotics
Promote “good” bacteria & suppress “bad” bacteria
Affect the gut microbiome
Found in food (ie., fiber, fermented foods)
What is constipation
infrequent passage of abnormally hard and dry stools (two or less per week)
feeling of incomplete evacuation
stools harden the longer it stays in the colon
What do laxatives do
Increase fecal movement
facilitates defecation
PO laxatives taken
Within 2 hours of other meds
Common adverse effects for laxatives
bloating
gas
abdominal
discomfort
cramping
Why are laxatives only for short term use
Overuse of certain laxatives may lead to dependency and decreased bowel function.
risk for contracting CDI is highest in patients
patients receiving antimicrobial, chemotherapy, gastric acid–suppressing, or immunosuppressive drugs
How do laxatives work?
They are drugs that promote bowel evacuation by increasing the bulk of feces, softening the stool, or lubricating the intestinal wall
What are the causes of acute diarrhea
Drugs
Bacteria
Viruses
Nutritional factors
Protozoa
What are the causes of chronic diarrhea
Tumors
Acquired immunodeficiency syndrome
Diabetes mellitus
Hyperthyroidism
Additions disease
IBS
Absorbents work by
Coating the walls of GI tract, they bind the causative bacteria or toxin to their absorbent surface for elimination from the body through stool
Laxatives are contraindicated in
GI obstruction
Bowel perforation
psyllium
bulk forming
increases fecal mass
safest laxative & OTC
prevent and long-term management of constipation
docusate sodium
emollient (stool softener)
promotes H2O & fat absorption
ease passage of stool
Docusate sodium nursing implication
administer with full glass of water
psyllium nursing implications
mixture congeals; drink immediately to prevent obstruction
Only administer if they’ll be able to drink 5-8 oz of water
mineral oil
lubricates fecal material
eases passage of stool
Only lubricant laxative in the emollient category
Emollient laxatives
Directly lubricate stool and the intestines, which prevent water moving out out of the intestines
(Softens and expands the stools)
Bulk forming laxatives
Increase water absorption which results in greater total volume (bulk) of the intestinal contents
*over the counter, safest, recommended for long term use
Probiotics
Suppress the growth of diarrhea causing bacteria and reestablish the flora that normally resides in the intestine
polyethylene glycol 3350
Induce bowel cleansing
osmotic agent
bowel prep for colon procedures
reconstituted with water
Given the day before procedure
NI: drink 8oz. every 10-15mins.
Ex. Golytely &Miralax
How often should Miralax be used
Daily for up to 7 days, any longer could become laxative dependent
What are the hyperosmotic laxatives
polyethylene glycol 3350 (ex. Miralax and golytely)
Saline laxatives
increases osmotic pressure and draws water into the colon
Saline laxatives consists of
Various magnesium or sodium salts
Saline laxatives produce
A watery stool, within 3-6 hours of ingestion
What are the types of saline laxatives
Saline enema (fleet enema)
magnesium hydroxide (milk of magnesia)
Magnesium citrate (citroma)
Saline laxatives are to be used cautiously in
renal insufficiency bc they can be absorbed enough to cause hypermagnesemia (high level of magnesium in blood bc can’t be excreted)
Saline laxatives are most commonly used to
Evacuate the bowel rapidly in preparation for an endoscopic examination and to remove unabsorbed poisons from the GI tract
Milk of magnesia
Contraindicated in renal disease
Laxative and antacid
Osmotically active
Magnesium citrate
Bowel prep
Osmotically active
Milk of magnesia nursing implications
Shake solution
Can lead to F & E imbalance
Magnesium citrate nursing implications
Refrigerate
Can lead to F & E imbalance
What are stimulant laxatives
Induce intestinal peristalsis
Stimulate intestinal nerves to do peristalsis and increase water in the colon
What are the types of stimulant laxatives
Bisacodyl and senna
What class of laxatives are most likely to cause dependence
Stimulant laxatives
(Such as bisacodyl and senna)
bisacodyl and senna
treatment of constipation
stimulates intestinal nerves to do peristalsis and increase H20 in colon
F&E depletion
may be habit-forming
bisacodyl and senna nursing implications
Electrolyte imbalances and increase peristalsis
Forms of stimulant laxatives
Could be PO or suppository
What can happen with laxative use and abuse
Loss of muscle and nerve response
Risk of dependence
Laxatives draw water into the lumen
Increase risk of dehydration in older individuals
Increase risk of F & E imbalances
Aging changes that effect GI
Decrease water intake
Decrease fiber intake
Decrease activity
Chronic illness may delay evacuation
Increase use of laxatives
lifestyle changes that effect GI
Fluid intake
Fiber
Physical activity
Before giving any medications affecting bowel status what should the nurse do
Obtain a through history
Preform assesment of :
the patients bowel patterns
General state of health
Any recent illness
GI complaints
Dietary changes
Possible causes of diarrhea
When listening to the bowel sounds hypoactive is considered
Less than 6 sounds per minute
When listening to the bowel sounds hyperactive is considered
Greater then 32 sounds perfect minute
When listening to the bowel sounds hyperactive is considered
Greater then 32 sounds perfect minute
Probiotics can be obtained through
Supplements
Food such as: fruits and vegetables , whole grain and wheat products, yogurt, cheese, kefir
Probiotics have been used to make better symptoms in
Inflammatory bowel disease
Crohn disease
IBS
Travelers diarrhea
CDI
What health conditions benefit from probiotics
Obesity and gastric cancer
Who should not use probiotics
Immunocropromised patients
Critically ill patients
(Could lead to sepsis in people who lack a normal immune response)
What is fiber, what is it found in
Nondigestible material found in whole grains, fruits, vegetables and legumes
Fibers are fermented by
The microflora in the GI tract, which provides bulk to the stool (insoluble fibers)
What are the health benefits of fiber
Increases fecal mass and promotes laxation **
Promotes growth of beneficial colonic microflora **
Binds bile acids and cholesterol
Slows rise in blood glucose and insulin levels
Assists in weight managment
Protects against colorectal and gastric cancer
An 88-year-old patient is undergoing bowel preparation for a colonoscopy.
What may be ordered for this patient?
Laxative polyethylene glycol or magnesium citrate to cleanse the bowel
What are the nurse’s priorities regarding monitoring the patient during the bowel
preparation?
• Fluid and electrolyte imbalances from the bowel preparation
• Clear liquid diet to NPO status
• Older patients are at greater risk for dehydration and electrolyte disturbances
What follow-up is needed after a colonoscopy?
Monitoring vital signs (BP, HR) for signs of dehydration
If the patient needs to prevent constipation, what OTC drug is the best choice to help prevent
constipation? Why?
Psyllium (Metamucil) is a natural bulk-forming laxative (safest)
• Increases the intake of bulk and fiber, contributing to more normal patterns of bowel
elimination
• Prevents constipation without water and electrolyte loss
