C7- Lower GI Medications Flashcards
Adults- criteria for constipation
Fewer than three BM per week
Lumpy or hard stools for more than 25% of BM
Straining During more than 25% of BM
Infants and Children- Criteria for Constipation
Pebble-like, hard stools for a majority of BM for at least 2 wks
Firm stools 2X/week or less for at least 2 weeks
Constipation Causes- D.O.P.E.D.
D- drugs
O- obstruction
P- pain
E- endocrine
D- depression
Constipation contraindications
Abdominal pain
Possible appendicitis
Diverticulitis
Ulcerative colitis
Pregnancy/lactation
Constipation Contributing factors
Insufficient water intake
Fecal impaction
Bowel obstruction
Chronic laxative use
Neurological disorders
Ignoring the urge to defecate
Lack of exercise
Some drugs
anticholinergics
narcotics
certain antacids
Indications for Laxatives
Painful elimination
Cardiovascular disease
Elderly with weakened abdominal or perineal muscles
Correcting constipation from opioid use or prolonged bedrest
How are laxatives classified?
By response
Group 1 laxatives
Produce watery stools (osmotic)
Magnesium salts
Sodium salts
Castor oil
Polyethylene glycol
electrolyte solution
Group 1 Laxative response time
2-6 hours
Laxatives- Group 2
Produce Semi-fluid stool
osmotic in low doses
Magnesium salts
Sodium salt
Polyethylene glycol
Stimulant laxatives
bisacodyl
Senna
Group 2 laxative response time
6-12 hours
Laxatives- Group 3
Bulk forming laxatives
methyl cellulose
psyllium
polycarbophil
Surfactant Laxatives
Docusate sodium
Docusate Calcium
Others
lactulose
lubiprostone
Group 3 laxatives response
1-3 Days
Bulk forming laxatives - Generic Name
Psyllium (powder in water)
Bulk forming laxatives action
Similar to dietary fiber (swell in water)
Increase intestinal volume
Bulk forming laxatives- Indications
Preferred agent for temporary relief
works within 12-72 hours
Bulk forming laxatives- administration
Should be accompanied by a full glass of water
Bulk forming laxatives- Side effects
Esophageal obstruction
Intestinal obstruction
Do not give laxatives with this condition
Undiagnosed abdominal pain
Emollient laxatives:
Docusate
Emollient laxatives- Action
Allow water and fat to penetrate into stool
Emollient laxatives- Administration
Should be accompanied by a glass of water
HOLD MEDICATION FOR LOOSE STOOLS
Emollient laxatives- results show signs of improvement (how long)
12-72 hours
Osmotic Laxatives-
Polyethylene glycol
Magnesium hydroxide (milk of mag)
Osmotic Laxatives- action
Osmotic action draws water into the intestinal lumen
Osmotic Laxatives- adverse effects
Fluid loss
Mg++ accumulation
Na+/Fluid retention
Osmotic Laxatives- in a large volume
GoLytely
for colonoscopies
Stimulant laxatives:
Bisacodyl
Senna
Stimulant laxatives- RISK?
Frequently abused laxative
Stimulant laxatives- Action
Stimulate nerves to increase intestinal motility
Stimulant laxatives- Uses
Opioid induced constipation
Slow intestinal transit
Stimulant laxatives- nursing teaching
May discolor urine
Laxative abuse causes:
Belief that daily and bountiful BM is a requisite of good health
Laxative abuse consequences:
Diminished Defecator reflexes
reliance on laxatives
electrolyte imbalances
Dehydration
colitis
Laxative abuse treatment:
Cessation of laxative use
educate on normal bowel function
fix with diet
Diarrhea
3+ loose/liquid stools per day
Diarrhea Cautions
Fluid and electrolyte imbalance
monitor I/O
Diarrhea Management
Diagnose and treat underlying condition
Replacement fluids/electrolytes
Relief of cramping
Reducing passage of unformed stools
Antidiarrheal Medications (Adsorbents):
Bismuth Salicylate
(Pepto-Bismol)
Antidiarrheal Medications (Antimotility agents)
Loperamide
Opiates and opiate-related agents
Antidiarrheal Antimotility agents: (action)
Slow peristalsis
Antidiarrheal combinations:
Diphenoxylate with atropine
narcotic and anticholinergic drug
reduces GI motility
Probiotics:
Restore normal flora
Adsorbents Action
Coats walls of GI tract and binds to causative bacteria or toxin (trouble maker)
Decreases flow of fluids
Reduces inflammation of intestine
Adsorbents- Cautions
Allergy to aspirin
Children
contains aspirin
Anticoagulant use
DO NOT USE
Adsorbents- Side effects
Black/dark tongue
Dark stools
Bleeding
Tinnitus
Antimotility agents- Anticholinergic
Diphenoxylate with atropine (lomotil)
Antimotility agents- Contraindications (when you should not take)
Glaucoma
Paralytic ileus
Antimotility agents: Side effects
(Anticholinergic)
dry mouth
urinary retention
drowsiness
Antimotility agents: Opioid like
Loperamide (Imodium)
Antimotility agents: loperamide (Contraindication)
Not for children <2yo
Antimotility agents: Loperamide (precaution)
Use as directed
higher doses cause lethal heart rhythms
Antimotility agents: Loperamide (side effects)
CNS depression
Diarrhea Nursing implications- Assessment
Monitor for therapeutic effect
assessment
patient condition b4 therapy and regularly after
fluid and electrolyte balance
hydration status
stool frequency and consistency
Diarrhea Nursing Implications- Planning (outcomes)
Patient will have regular formed BM
Adequate fluid balance will be maintained
Diarrhea Nursing implications (Implementation)
Correct fluid and electrolyte disturbances before starting the drug
