Chapter 15: Constipation Flashcards
when evaluating a patient with constipation, what are the steps involved?
- determine cause of constipation (food/drugs)
- if prescription drug induced, contact Dr
- if likely caused by food, recommend high fluid-fiber intake and inc exercise if needed
- if fluid/fiber isn’t working, recommend a bulk former or hyper-osmotic
- if OTC products don’t work, see Dr
exclusions for self-treatment of constipation:
- notable abdominal pain or unexplained flatulence
- fever
- nausea/vomiting
- chronic medical condition
- laxative use
- changes in bowel habits and weight loss
- bloody/dark stool
- symptoms persisting over 2 weeks or recur within 3 months
- anorexia
- under 2 years old
bulk-forming agents (aka fiber supps.) should not be used in children under?
6
what are the names of OTC bulk-forming agents?
methylcellulose
calcium polycarbophil
psyllium
what are the names of OTC hyperosmotic agents?
Polyethylene glycol 3350 (PEG)
glycerin
Polyethylene glycol 3350 (PEG) comes in what dosing strength?
children under what age should not use?
17g
17
how is glycerin used?
rectally
what are the names of OTC emollient agents?
docusate sodium
docusate calcium
what is the daily dosing range of docusate sodium?
50-300mg
what is the daily dosing range of docusate calcium?
children under what age should not use?
1 capsule (240mg) 12
what is the name of the lubricant agent?
mineral oil
what are the names of the saline laxative agents?
magnesium citrate
magnesium hydroxide
magnesium sulfate
monobasic sodium phosphate/ dibasic sodium phosphate
what are the names of the stimulant agents?
senna
bisacodyl
castor oil
what dose does senna come in?
daily dose?
8.6mg tabs
2 tabs once or twice daily
what dose does bisacodyl come in?
daily dose?
5mg tabs
1-3 tabs qd
Bulk-Forming Agents:
onset of action
common adverse effects
12-72 hours
abdominal cramping and flatulence
why should you take bulk-forming laxatives with plenty of water?
could get stuck in throat and when they swell up could cause choking
how do hyperosmotic agents work?
draw water into colon or rectum to stimulate bowel movement
common adverse effects of hyperosmotic agents?
bloating, abdominal discomfort, cramping, and flatulence
how do emollients (stool softeners) work?
increase wetting efficiency of intestinal fluid to soften fecal mass
common adverse effects of emollients?
none unless using more than recommended
common adverse effects of saline laxatives?
abdominal cramping, nausea, vomiting, or dehydration
how to prevent dehydration from saline laxatives?
take with 8oz of water
how do stimulant laxatives work?
increase intestinal motility and increase secretion of water and electrolytes in intestine
separate bulk-forming laxatives with other medications by at least _ hours due to drug absorption interferance
2
do not use docusate salts with what other laxative due to increasing its absorption?
mineral oil
do not mix bisacodyl with?
milk or PPIs
how to insert an enema:
- if administered by someone else, like on left-side with knees bent or go into the knee-to-chest position
- if you are administering, like on back and bring knees to chest and raise your buttocks.
- make sure enema tip is lubricated and the anal area as well
- gently insert 2-3 inches into rectum
- allow solution to flow into rectum slowly and retain it inside rectum for 1-5 minutes
how to insert a suppository:
- make sure it is firm enough to insert and cool it down
- unwrap it and dip into lukewarm water for a few seconds
- loe on left side with knees bent or go into the knee-to-chest position
- relax buttocks before inserting and then insert
- continue to lie down for a few minutes while holding the buttocks together
- avoid a bowel movement for roughly an hour after insertion
what are some complementary therapies for constipation?
flaxseed, aloe, cascara, and probiotics
