Chapter 45: Gastrointestinal Tract Disorders Flashcards
1
Q
What does nausea mean?
A
Unpleasant feeling that often precedes vomiting
2
Q
What does emesis ( vomiting ) mean?
A
Forcible emptying of gastric and occasionally intestinal contents
3
Q
What does antiemetic drugs mean?
A
Used to relive nausea and vomiting
4
Q
How can we manage vomit and nausea with Nonpharmacologic treatment?
A
Small sips frequently
Weak tea
Flat soda
Gelatin
Gatorade
Crackers
Dry toast
Pedialyte ( use in children )
5
Q
What are some prescription antiemetics we will talk about? (6)
A
Antihistamines
Anticholinergic
Dopamine antagonists
Serotonin antagonists
Cannabinoids
Miscellaneous
6
Q
She said she wanted to bring our attention to the dopamine antagonist
What is their side effect?
A
Extrapydramidal symptoms ( EPS ) - pseudo parkinosnism !!
7
Q
What is that EPS side effects?(7)
A
Stopped posture
Mask like facies ( no expression )
Rigidity
Tremors at rest
Shuffling gait
Pill rolling motions
Bradykinesia ( slow movement )
8
Q
Now we are going to talk about anticholinergic drugs
A
9
Q
What is an example of an anticholinergic drug that we will talk about?
For nausea
Think of the S
A
Scopolamine
10
Q
Scopolamine
How does it work?
Best to put it on what?
A
Patch behind your ear
Best to put it on before your sick
11
Q
Anticholinergic drugs
Scopolamine
Side effects ? (3)
What is this contraindicated for ?
A
Dizziness
Drowsiness
Tachycardia
Glaucoma cause their inter ocular pressure becomes higher
12
Q
Now onto antihistamines
A
13
Q
antihistamines drugs we need to know ? (3)
Think of drama cause of the HistaMine
A
Dramamine (OTC)
Meclizine (OTC)
Hydroxozine ( prescription )
14
Q
antihistamines drugs side effects? (3)
Contraindicated in who?
A
Dizziness
Drowsiness
Confusion
( anticholinergic side effects )
Glaucoma
15
Q
Now !
Antidopaminergics ( dopamine agonists )
Also know as phenothiazines
A
16
Q
Antidopaminergics ( dopamine agonists )
Also know as phenothiazines
What drugs do we need to know for this group? (2)
A
Chlorpromazine - Comparzine
Promethazine - phenergan
17
Q
Antidopaminergics ( dopamine agonists )
Also know as phenothiazines
Side effects? (7)
S,P,H,E,D,D,U
A
Sedation
Photosensitive
Hypotension
EPS
Dry mouth
Dry eyes
Urinary retention
18
Q
Antidopaminergics ( dopamine agonists )
Also know as phenothiazines
Usually can be given what? (2)
A
IV PO
19
Q
Since Dopamine agonist have hypotension, what do we tell patients?
A
Getting up slowly
20
Q
Onto serotonin blockers
A
21
Q
serotonin blockers
What medication!?
A
Ondansetron ( Zofran )
22
Q
serotonin blockers side effects? (7)
H,D,H,P,C,E,F
A
Headache
Dizziness
Hypotension
Palpitations
Constipation
Edema
Fatigue
23
Q
Onto
Tetrahydrocannaboinoids
A
24
Q
Tetrahydrocannaboinoids
Medication?
A
Dronabinol
25
Tetrahydrocannaboinoids
Side effects? (5)
M.E.D.D.O
Mood changes
Euphoria
Dizziness
Drowsiness
Orthostatic hypotension
26
Now to miscellaneous drugs
27
miscellaneous drug we need to know?
Metroclopramide ( Reglan )
28
miscellaneous side effects? (8)
A.D.D.D.F.R.H.E
Anticholinergic side effects
Drowsiness
Dizziness
Dysgeusia
Fatigue
Restlessness
Headache
EPS
29
miscellaneous does what? Like function?
Improves peristalsis of the GI tract
Speed up the process in moving food from stomach into the intestine
30
Another medication we may use for nausea and vomiting is ?
Corticosteroids
31
Corticosteroids medications drug? (2)
Dexmethasone & methylpredinisolone
32
Why may we give corticosteroids to help with nausea and vomit?
Usually given IV
chemo therapy that may cause nausea and vomiting and inflammation is why we give it
33
When we are giving antiemetics medication
What are our biggest concerns?
Fluid electrolytes
Daily weight
What the vomit looks like
Dehydration !!
Provide mouth care, brush their teeth & rinse the teeth
34
Special considerations
Why do we need to watch out with promethazine ( phenergan ) when giving it IV?
And how do we avoid this?
It’s very tissue damage
Dilute at least 10ML of fluid and given in a running IV pot farthest from the patient given in a large vein ( not hand or wrist )
35
If promethazine ( phenergan ) is given in an artery instead of a vein what can happen?
Losing a limb
36
A lot of the nausea medication that we may use on a normal patient may not be safe for someone who is pregnant so who is in charge for looking at good nausea medication for them?
Their OB
37
Since most and all nausea medications can cause drowsiness
So we tell them to avoid what?
Hazardous tasks
38
We also tell patients to avoid alcohol usage with antienemtics why?
Cause it causes a lot of CNS depression and even more fatigue
39
Since a lot of antiemetics cause hypotension we tell patients what?
Getting up slowly and changing position slowly
40
If our patient is getting chemo, we usually give emetics medication how much and when?
30-60mins before their chemo
41
Usually with metoclopramide they will have EPS so what will we do?
Does eps go away when we stop the medication
What if we are on for a long time?
Usually monitor for EPS
Yes
Usually we can residual symptoms
42
For the scopolamine patch, we put it behind the ear but how often do we change it?
And when is it better to use ?
Every 3 days
Before the symptoms
( so like let’s say cruise ship? Use it before getting on a cruise ship )
43
What are emetics??
Medication that induce vomiting
44
Before we give an emetic, we usually want to talk to poison control in order to get a proper order and understanding on why we are making the patient vomit.
What if vomit is indicated
So let’s say they drink bleach but we gave them emetics? What do we give? (2)
Activated charcoal or gastric lavage
45
Now onto diarrhea!!
46
Notes
What are some causes of diarrhea?
Spoiled or spicy foods
Fecal impaction
Bacteria
Viruses
Toxin
Drug reactions
Laxative abuse
Malabsorption syndrome
Stress
Anxiety
Bowel tumor
Inflammatory bowel disease
47
What is our Nonpharmacologic measures for diarrhea?
Clear liquids
Oral solutions ( Gatorade, pedialyte )
Bland diet
IV solutions
48
What is travelers diarrhea?
Usually E.coli causes but it’s when you travel and get it
49
How do we prevent travelers diarrhea?
Drink bottle water
Wash fruit
Eat cooked vegs
Eat meats cooked until well done
50
What is bismuth subsalicylate ( peptobysmal ) can help with what?
This travelers diarrhea
51
What is the purpose of antidirrheals?
Decrease hyper motility
( metabolic acid base imbalances, dehydration, fluid balance )
52
What are the 3 types of anti diarrheal?
Opiates - opiate related agents
( stick to the bowel wall and absorb anything toxic )
Adsorbents
Miscellaneous
53
What is the action or purpose of an opiate or opiate related agents to help with diarrhea?
Decrease GI motility which slows transit time through bowel allowing more water to be absorbed
So like they cause constipation really
54
What are the 5 side effects of opiates?
C,P.A C,R
CNS depression
Physical dependence
Atropine contraindicated in glaucoma
Constipation
Respiratory depression
55
We do not want to give opiates to who?
Severe hepatic impairment
( diphenoxylate, difenoxin, loperamide )
56
Diphenoxylate and didenoxin
Usually are mixed with atropine with opiate
Loperamide is very weak opiate !
57
What does adsorbents do for antidiarrheals?
Quite literally will absorb the bacteria or toxins causing diarrhea
58
What are a big side effect of adsorbents? (2)
Tongue and stool discoloration
Black!!
59
What is a classic adsorbent medication?
Peptilbismal
60
What are miscellenous side effects? (2)
Gas
Dry mouth
61
What type of electrolyte are we really worried about in diarrhea?
Potassium!!
Take potassium supplements
62
Diarrhea should resolve or improves within what time?
48 hours
63
Why should we not drink milk?
It can aggreavate diarrhea
64
Not ontop constipation!!!
65
What are some causes of constipation
- insufficient water intake!!!!
- poor dietary habits!!!!!
- fecal impaction
- bowel obstruction
- chronic laxative
- neurologic disorders
- ignoring urge to defected ( kids )!!
- lack of exercise
- various drugs
66
What type of medication should we think of first when it comes to constipation?
Opiates !!
67
What are some Nonpharmacologic treatment for constipation?
Diet ( high fiber )
Water
Exercise
Routine bowel habits
(30mins after they eat, bed pan )
68
Why do we give laxatives?
Promote soft stool
Or evacuation of stool
69
What are the 5 laxatives ?
Bulk forming
Emollient
Osmotic
Saline
Stimulant
70
What is bulk forming laxative medication? (2)
Psyllium ( Metamucil )
Methyl cellulose ( citrucel)
71
Bulk forming mechanism of action is what?
High fiber
They absorb water to increase bulk Distend bowel to stimulate bowel movement
72
What the most important thing to know about bulk forming medication? (2)
If you’re going to give metamucil, which typically is a powder form, to not mix it or open it unless you are ready to drink it
If it sits for longer than 5mins it turns into this jelly like substances
And after you drink it, to drink 8 ounces of liquid ; to make sure it goes all the way the stomach
73
Emollient is another class
What are the medications? (2)
Stool softeners : docustar sodium ( colace )
Lubricant : mineral oil
74
What is the mechanism of action of emollient drug class?
Allows more water to be absorbed into the stool & lubricate fecal material and intestinal wall
75
What are the medications we need to know for osmotic drug class? (3)
Glycerin
Lactose
Polyethylene glycol (PEG, Miralax)
76
What is the mechanism of action of osmotic drug class? (2)
Increase fecal water content causing distention and increase peristalsis
Lactose decrease serum ammonia levels
77
What are our saline drug clas medications ? (3)
Fleet enema
Milk of magnesia
Magnesium citrate
78
What is the mechanism of action of saline?
Increase osmotic pressure and draw water into stool results in watery stool in 3-6 hours
79
What are stimulant drug medications ?
Bisacodyl-dulcolax
Senokot
80
What is the mechanism of action of stimulant?
Increase intestinal peristalsis
81
What are bulk forming side effects ? (4)
Impaction
Esophageal blockage
Gas
Fluid imbalance
82
What is emollient side effects? (2)
Mineral oil - decrease absorption of vitamins, aspiration causing lipid pneumonia
Fecal urgency / incontience
83
What are 2 side effects of osmotic drug classes?
Abdominal bleeding
Rectal irritation
84
What are side effects of saline ? (4)
Magnesium toxicity
Cramping
Diarrhea
Increase thirst
85
What is side effects of stimulants? (5)
Poor absorption of nutrients
Discolored urine
Rectal irritation
Rash
GI irritation
86
Another medication that is described in the book is chloride channel activators!!
How does it work?
Used ?
- idiopathic constipation in adults
Side effects are
- nausea
- diarrhea
- gas
- abdominal cramps
- edema
Activate chloride channels in the lining of the small intestine, leading to an increase in intestinal fluid secretion and motility
87
What are some contraindication of laxatives?
- instruction
- undiagnosed abdominal pain
- no appendicitis
- diverticulitis
- ulcerative colitis
Spastic colon
Bowel obstruction
Pregnancy
88
Biscacodyl interacts with what?
Milk
Antacids
Juices
89
Practice question 1
Ondansetero has been ordered for a patient undergoing cancer chemotherapy to control the severe nausea and vomiting. What side effects should the nurse observe for?
Headache, dizziness, and fatigue
Anorexia and hair loss
Abdominal cramping and irritability
Psychosis and middle ear disturbances
Headache, dizziness, and fatigue
90
Practice question 2
Bisacodyl has been ordered for a patient who is constipated. Which of the following does the nurse realize about bisacodyl?
Increase peristalsis to produce a bowel movement
Is incompatible with alcohol consumption
Should be avoided during pregnancy as it is teratogenic
May lead to paralytic ileus
Increase peristalsis to produce a bowel movement
91
Practice question 3
A patient is ordered the stimulant laxative bisacodyl. Before administering the drug, it is most important for the nurse to assess the patient for what?
Hypertension
Anemia
Allergic to penicillin
Appendicitis
Appendicitis
92
Practice question 4
Lactulose is ordered for a patient with liver disease. What would indicate the medication is exerting a positive therapeutic effect on the patient?
Decrease ascites
Decrease ammonia level
Decreased jaundice
Decrease blood pressure
Decrease ammonia level
