Care of Aging Adult part 6 Flashcards
Infrequent bowel movements or stools are hard, dry, small, or difficult to pass. Can be acute or chronic.
constipation
Is constipation a symptom or a disease?
symptom
What are the causes of constipation?
medications chronic illness weakness/immobility diet: low fiber, dehydration ignoring the urge emotions frequent use of enema, laxatives and suppositories
Clinical manifestations of constipation.
- infrequent BM’s
- abdominal distention
- pain/bloating
- sensation of incomplete evacuation
- straining
- small hard, lumpy dry stool
- increased flatulence
- increased rectal pressure
Complications of Constipation?
- straining —> decrease cardiac output —> drop in BP —> drop in HR —> dizziness and or syncope
- fecal impaction
- incontinence
- hemorrhoids
- anal fisures
When are laxatives contraindicated?
- with certain bowel disorders including acute surgical abdomen
- fecal impaction or obstruction —> bowel perforation
What are the 5 classifications of laxatives??
bulk forming surfactant stimulant osmotic misc.
- acts like dietary fiber
- swell in the intestine, softening fecal mass, and increasing in bulk —> stimulating peristalsis
- preferred agent in treatment
- bowel movement after 1-3 days
- take with full glass of juice or water to prevent esophageal obstruction
bulk forming
What are 3 bulk forming laxatives?
Methylcellulose (citrucel)
Psyllium (metamucil)
Polycarbophil (fibercon)
- lower surface tension, facilitate water movement into stool
- can act on intestinal wall: inhibit fluid absorption, stimulate secretion of water and electrolytes into intestinal lumen
- produces stool several days after onset
- instruct patients to take with full glass of water
Surfactant laxatives
What are the surfactant laxatives?
docusate sodium (colace)
What 2 effects do stimulant laxatives have on the bowel?
- stimulate intestinal motility
- increase amount of water and electrolytes in intestinal lumen
-produces semifluid stool in approx. 6-12 hours
stimulates laxatives
What are the 2 primary applications for stimulant laxatives?
- opioid-induced constipation
- constipation from slow intestinal transit
What are 2 types of stimulation laxatives?
- bisacodyl (correctol, ducolax, fleet laxatives) tablets and suppositories
- senna (senokot)
What is the patient teaching for the stimulant laxative Bisacodyl?
- no sooner than 1 hour after ingesting milk or antacids. Swallow the tablets intact, without crushing or chewing.
- Suppositories may cause a burning sensation; prolonged use can cause proctitis (lining of rectum becomes inflamed)
What is the patient teaching for the stimulant laxative Senna?
-may cause a harmless yellowish-brown or pink color to urine
- poorly absorbed
- draws water into intestinal lumen
- causes fecal mass to swell and soften —> stretching intestinal wall —> stimulates peristalsis
- bowel movement in 6-12 hours or high dose 2-6 hours (for surgery/procedures)
Osmotic laxatives
What are the 3 osmotic laxatives?
- polyethylene glycol (glycolax, miralax, peglax)
- lactulose (cephulac, cholac)
- magnesium hydroxide (milk of mag, phillips milk of mag)
What is the nursing education for osmotic laxatives?
-effects are dose dependent
low dose = soft or semifluid stool 6-12 hours
high dose = watery BM 2-6
-increase fluid intake prevent dehydration
-magnesium salts are contraindicated with renal dysfunction
-sodium phosphate is contraindicated in kidney disease and with drugs that alter renal function
-avoided in patients with heart failure, hypertension, or edema
Basic nursing education for BM’s.
- reduce laxative use
- normal bowel function to correct misconceptions
- provide instruction on establishing good bowel habits
- used only when necessary and in the smallest effective dosage
Who should not use osmotic laxatives?
patients with: renal dysfunction, kidney disease, HF, hypertension, or edema
