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Pharm II > GI > Flashcards

GI Flashcards

1
Q

Types of Acid-Controllling Drugs

A

Antacids
Histamine-2 (H2) antagonists
PPIs (Proton Pump Inhibitors)

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2
Q

Acid-Related Diseases

A

Acid-realted diseases are caused by an imbalance of the three cells (parietal cells, Chief cells, Mucous cells) of the gastric gland and their secretions
Most common disease is hyperacidity
Lay terms for overproduction of HCl by the parietal cells include: Indigestion, sour stomach, heartburn, acid stomach

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3
Q

GERD

A

Gastroesophageal reflux disease:
Known as heartburn
Symptoms: burning, bloating, belching, regurgitation
Reflux of gastric secretions such as pepsin and hydrochloric acid into the esophagus

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4
Q

PUD

A

Peptic Ulcer Disease:
Several stomach disorders - commonly gastric and duodenal ulcers
Symptoms: burning, gnawing, aching

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5
Q

H. Pylori

A

Helicobacter pylori:
Bacterium found in GI tract of 90% of patients with duodenal ulcers and 70% of those with gastric ulcers (can be detected by serum antibody tests)
Antibiotics are used to eradicate H. pylori

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6
Q

Antacids: Mechanism of Action

A

Neutralize stomach acid
Promote gastric mucosal defence mechanisms. Secretion of: Mucus (protective barrier against HCl); Bicarbonate (helps buffer acidic properties of HCl); Prostaglandins (prevent activation of proton pump)
Antacids do neutralize the acid once it’s in the stomach but do not prevent the overproduction of acid

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7
Q

Antacids: Drug Effects

A

Reduce pain associated with acid-realted disorders
Raising gastric pH only 0.3 points neutralizes 50% of the gastric acid
Raising gastric pH one point neutralizes 90% of the gastric acid
Reducing acidity reduces pain

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8
Q

Antacids: Aluminum Salts

A

Have constipating effects
Are often used with magnesium to counteract constipation
Are often recommended for patients with renal disease (more easily excreted)
Include: Aluminum hydroxide salt (Almagel [with Mg hydroxide]); Combination products (aluminum and magnesium): Maalox, Mylanta

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9
Q

Antacids: Magnesium Salts

A 
Commonly cause diarrhea; usually used with other drugs to counteract this effect
Are dangerous when used in patients with renal failure - the failing kidney cannot excrete extra magnesium, resulting in accumulation
Examples: 
- Carbonate salt: Magmix
- Hydroxide salt: milk of magnesia
- Oxide salt: Magnesium oxide
- Trisillicate salt: Gasulsol Tablets
- Combination product: Calmax, Maalox
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10
Q

Antacids: Calcium Salts

A

Come in many forms, but carbonate is most common
May cause constipation, kidney stones
Are not recommended for patients with renal disease - may accumulate to toxic levels
May cause increased gastric acid secretion (rebound hyperacidity)
Are often advertised as an extra source of dietary calcium (Tums)

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11
Q

Antacids” Calcium Salts

A

Used to prevent or treat calcium deficiency (calcium acetate, calcium liquid, and calcium carbonate)
Used in patients with kidney failure to bind dietary phosphate and reduce the amount of phosphorus absorbed from food (aluminum hydroxide, calcium acetate, calcium carbonate, calcium liquid, and sevalamer [Renagel])

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12
Q

Antacids: Sodium Bicarbonate

A 
Highly soluble
Buffers the acidic properties of HCl
Has a quick onset but short duration
May cause metabolic alkalosis
May cause problems in patients with heart failure, hypertension, or renal insufficiency because of high sodium content
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13
Q

Antacids and Antiflatulents

A

Antiflatulents are used to relieve he painful symptoms associated with gas
Several drugs are used to bind or alter intestinal gas and are often added to antacid combination products

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14
Q

Antacids and Antiflatulents

A

OTC Antiflatulents
Simethicone (Oval Drops, Pediacol, Phazyme)
Alters elasticity of mucus-coated bubbles, causing them to break
Is used often to reduce the discomforts of gastric or intestinal gas, but there is limited data to support its effectiveness
Results in decreased gas pain and increased expulsion via mouth or rectum

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15
Q

Antacids: Contraindications

A

Known drug allergy
Severe kidney failure or electrolyte disturbance (because of the potential toxic accumulation of electrolytes in the antacids themselves)
GI obstruction (PT presents with and. pain; no antacids)

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16
Q

Antacids: Adverse Effects

A

Adverse effects are minimal and depen on the compound used
Aluminum and calcium : Constipation
Magnesium: Diarrhea
Calcium Carbonate: Produces gas and belching; combining it with simethicone reduces discomfort

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17
Q

Antacids: Drug Interactions

A

Adsorption of other drugs to antacids: Reduces the ability of the other drug to be absorbed into the body
Chelation (chemical binding, or inactivation, of another drug): Produces absorption of basic drugs; Decreased absorption of acidic drugs
Increased urinary pH: Increased excretion of acidic drugs; Decreased excretion of basic drugs

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18
Q

Antacids: Nursing Implications

A

Assess for allergies and pre-existing conditions that may restrict the use of antacids, such as: Fluid imbalances, pregnancy, renal disease, GI obstruction, heart failure (Patients with heart failure or hypertension should not use antacids with a high sodium content)

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19
Q

Antacids: Nursing Implications

A

Use with caution with other medications due to the many drug interactions
Most medications should be given 1-2 hours after giving an antacid
Antacids may cause premature dissolving of enteric-coated medications, resulting in stomach upset

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20
Q

Antacids: Nursing Implications

A

Be sure that chewable tablets are chewed thoroughly and that liquid forms are shaken well before giving
Administer with at least 240 ml of water to enhance absorption (except in the case of rapid-dissolve forms)
Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as cancer or bleeding ulcers
If symptoms remain ongoing, patient should seek medical evaluation

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21
Q

Antacids: Nursing Implications

A

Monitor for adverse effects: N/V, abdominal pain, diarrhea; With calcium-containing products constipation, acid rebound
Monitor for therapeutic response: Notify health care provider if symptoms are not relieved

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22
Q

Histamine-2 (H2) Antagonists

A

Reduce acid secretion
Are available OTC in lower dosage forms
Are the most popular drugs for treatment of acid-related disorders: Cimetidine, Famotidine (Pepcid), Nizatidine (Axid), Ranitidine (Zantac)

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23
Q

H2 Antagoonists: Mechanism of Action and Drug Effects

A

Block histamine at the H2 receptors of acid-producing parietal cells
Reduce production of hydrogen ions, resulting in decreased production of HCl
Suppresses acid secretion in the stomach

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24
Q

H2 Antagonists: Indications

A

GERD
PUD
Erosive esophagitis
Adjunct therapy in control of upper GI bleeding
Pathological gastric hypersecratory conditions

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25
Q

Common Stomach Disorders

A

GERD: Known as heartburn
Symptoms: burning, bloating, belching, regurgitation. Reflux of gastric secretions such as pepsin and hydrochloric acid into the esophagus
PUD: Several stomach disorders - commonly gastric and duodenal ulcers
Symptoms: burning, gnawing, aching

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26
Q

H2 Antagonists: Adverse Effects

A

Overall, there are very few adverse effects
Cimetidine may induce impotence and gynecomastia
Other possible effects include: Headaches, lethargy, confusion, diarrhea, urticaria, sweating, flushing

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27
Q

H2 Antagonists: Drug Interactions

A

Cimetidine binds with P-450 microsomal oxidase system in the liver, resulting in inhibited oxidation of many drugs and increased drug levels
All H2 antagonists may inhibit the absorption of drugs that require an acidic GI environment for absorption
Smoking has been shown to decrease the effectiveness of H2 blockers

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28
Q

H2 Antagonist: Nursing Implications

A

Assess for allergies and impaired renal or liver function
Use with caution in patients who are confused or disoriented and in older adults
Give 1 hour before or after antacids

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29
Q

Proton Pump

A

The parietal cells release positive hydrogen ions (protons) during HCl production
This process is called the “proton pump”
H2 blockers and antihistamines do not stop the action of this pump

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30
Q

PPIs: Mechanism of Action

A

PPIs irreversible bind to the hydrogen-potassium-ATPase enzyme
This bond prevents the movement of hydrogen ions from the parietal cell into the stomach
Result: achlorhydria - ALL gastric acid secretion is temporarily blocked: In order to return to normal acid secretion, the parietal cell must synthesize new hydrogen-potasssium-APTase

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31
Q

PPI: Drug Effect

A

Total inhibition of gastric acid secretion

  • Ianosprazole (Prevacid)
  • Omeprazole magnesium (Losec, Nexium)
  • Rabeprazole
  • Rabeprazole Sodium (Pariet)
  • Pantoprazole (Pantoloc): Only one that can be given IV
  • Esomeprazole (Mexium)
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32
Q

PPI: Indivcations

A

GERD maintenance therapy
Erosive esophagitis
Short-term treatment of active duodenal and benign gastric ulcers
Zollinger-Ellison syndrome
Treatment of H. pylori-induced ulcers: Given usually with an antibiotic

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33
Q

PPI: Adverse Effects

A

Safe for short-term therapy
Some approved for long-term therapy (maintenance of healing)
Adverse effects uncommon

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34
Q

PPI: Nursing Implications

A

Assess for allergies and history of liver disease
Pantoprazole is the only proton pump inhibitor available for parenteral administration and can be used in patients who are unable to take oral medications
PPIs may increase serum levels of diazepam (anti anxiety) or phenytoin (anti epileptic) and cause increased chance for bleeding with warfarin
PPIs often work best when taken 30 to 50 minutes before meals

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35
Q

Other Drugs

A

Sucralfate (sulcrate)
Misoprostol
Simethicone (Oval drops, Pediacol, Phazyme)

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36
Q

Sucralfate (Sulcrate)

A

Is a cytoprotective drug (combines ulcers by ^ mucosal secretion)
Is used for stress ulcers, PUD
Is attracted to and binds to the base of ulcers and erosions, forming a protective barrier over these areas
Protects these areas from pepsin, which normally breaks down proteins (making ulcers worse)
Absorbs little from the gut
May cause constipation, nausea, and dry mouth
May impair absorption of other drugs - give other drugs at least 2 hours before giving sucralfate
Should not be administered with other medications
Binds with phosphate; may be used in chronic renal failure to reduce phosphate levels

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37
Q

Misoprostol

A

Misoprostol is a synthetic prostaglandin analgue
Prostaglandins have cytoprotective functions: Protect gastric mucosa from injury by enhancing local production of mucus or bicarbonate, promote local cell regeneration, help to maintain mucosal blood flow
Misoprostol is used for the prevention of NSAID - induced gastric ulcers
Doses that are therapeutic enough to treat duodenal ulcers often produce abdominal cramps, diarrhea

38
Q

Antidiarrheals: Meachanism of Action

A

Adsorbents: Coat the walls of the GI tract, bind to the causative bacteria or toxin, which is then eliminated through the stool
Include bismuth subsalicylate (Bismuth, Maalos Multi Action, Pepto-Bismol, activated charcoal, attapulgite (Kaopectate), others)

39
Q

Antidiarrheals: Mechanism of Action

A

Antimotility drugs: anticholinergics: Decrease intestinal muscle tone and peristalsis of GI tract, slow the movement of decal matter through the GI tract, Include belladonna alkaloids, atropine, hyposcyamine, hyoscine

40
Q

Antidiarrheals: Mechanis, of Action

A

Antimotility drugs: opiates: Decrease bowel motility and relieve rectal spasms, decrease transit time through the bowel, allowing more time for water and electrolytes to be absorbed, reduce pain by relieving rectal spasms
Include paregoric, opium tincture, codeine, loperamide (Imodium), diphenoxylate

41
Q

Antidiarrheals: Mechanism of Action

A

Intestinal flora modifiers:
Are also known as probiotics or bacterial replacement drugs
Are bacterial cultures of Lactobacillus organisms, which work by: supplying missing bacteria to the GI tract, suppressing the growth of diarrhea-causing bacteria
Include L. acidophilus

42
Q

Antidiarrheals: Combination Products

A

Diphenoxylate with atropine (Lomotil)
Diphenoxylate is combined with sub therapeutic amounts of atropine, this discourages recreational opiate drug use. Large doses will result in extreme anticholinergic effects (dry mouth, abdominal pain, tachycardia, blurred vision)

43
Q

Antidiarrheals: Adverse Effects (Adsorbents)

A
  • Increased bleeding time
  • Constipation, dark stools
  • COnfusion, twitching
  • Hearing loss, tnnitus, metallic taste, blue gums
44
Q

Antidiarrheals: Adverse Effects (Anticholinergics)

A

Urinary renention, hesitancy, impotence
Headache, dizziness, confusion, anxiety, drowsiness
Dry skin, rash, flushing
Blurred vision, photophobia, increased intraocular pressure
Hypotension, hypertension, bradycardia, tachycardia

45
Q

Antidiarrheals: Adverse Effects (Opiates)

A 
Drowsiness, sedation, dizziness, lethargy
N/V, anorexia, constipation
Respiratory depression
Bradycardia, palpitations, hypotension
Urinary retention
Flushing, rash, urticaria
46
Q

Antidiarrheals: Interactions

A

Adsorbents decrease the absorption of many drugs, including digoxin, clindamycin, quinidine, hypoglycemic drugs, others
Adsorbents cause increased bleeding time and bruising when given with anticoagulants
Antacids can decrease effects of anticholinergic antidiarrheal drugs
Many other interactions exist

47
Q

Antidiarrheals: Nursing Implications

A

Obtain thorough history of bowel patterns, general state of health, and recent history of illness or dietary changes, and assess for allergies
Do NOT give bismuth subsalicylate (Pepto-Bismol) to children or teenagers with chicken pox because of the risk of Reye’s syndrome
Teach patients to take medications exactly as prescribed and to be aware of their fluid intake and dietary changes
Assess fluid volume status, intake and output, and mucous membranes before, during, and after initiation of treatment
Teach patients to notify their physician immediately if symptoms persist
Monitor fo therapeutic effects

48
Q

Laxatives: Mechanism of Action

A 
Bulk-forming
Emolient
Hyperosmotic
Saline
Stimulant
49
Q

Laxatives: Mechanism of Action (Bulk-forming)

A

Are high in fibre
Absorb water to increase bulk
Distend bowel to initiate reflex bowel activity
Include: psyllium (Metamucil), methylcellulose (Entrocel solution), polycarbophil

50
Q

Laxatives: Mechanism of Action (Emollient)

A

Are also referred to as stool softeners and lubricants
Promote more water and fat in the tools
Lubricate the decal material and intestinal walls
Include: Stool softeners (docusate salts: Colace), lubricants (mineral oil: Fleet enema mineral oil)

51
Q

Laxatives: Mechanism of Action (Hyperosmotic)

A

Increase fecal water content
Result in bowel distention, increased peristalsis, and evacuation
Include: polyethylene glycol (PEG) (Klean-Prep, Peglyte), sorbitol, glycerin, lactulose (also used to reduce elevated serum ammonia levels)

52
Q

Laxatives: Mechanism of Action (Saline)

A

Increase osmotic pressure within the intestinal tract, causing more water to enter the intestines
Result in bowel distention, increased peristalsis, and evacuation
Include: magnesium sulfate (Epsom salts), magnesium hydroxide (milk of magnesia), magnesium citrate (Citro-Mag, Citrodan), sodium phosphate

53
Q

Laxatives: Mechanism of Action (Stimulant)

A

Increase peristalsis via intestinal nerve stimulation

Include: castor oil, senna (senokot preparations), cascara sagrada, bisacodyl

54
Q

Laxatives: Contraindications

A

Drug allergy
To be used with caution in the presence of the following: acute surgical abdomen, appendicitis symptoms (abd. pain, N/V), intestinal obstruction, undiagnosed abdominal pain

55
Q

Laxatives: Adverse Effects

A 
Bulk-Forming:
- Impaction
- Fluid overload
- Electrolyte imbalances
- Esophageal blockage
Emollient:
- Skin rashes
- Decreased absorption of vitamins
- Electrolyte imbalances
- Rectal irritation
Hyperosmotic:
- Abdominal bloating
-Electrolyte imbalances
Saline:
- Magnesium toxicity (with renal insufficiency)
- Cramping
- Electrolyte imbalances
- Increased thirst
- Diarrhea
Stimulant:
- Nutrient malabsorption
- Skin rashes
- Rectal/ Gastric irritation 
- Electrolyte imbalances
56
Q

Antiemetic and Antinausea Drugs (VC and CTZ)

A

Vomiting Centre (VC)
Chemoreceptor trigger zone (CTZ)
- Both are located in the brain
- Once stimulated, they cause the vomiting reflex

57
Q

Antiemetic Drugs: Mechanism of Action

A

Many different mechanisms of action

Most work by blocking one of the vomiting pathways, thus blocking the stimulus that induces vomiting

58
Q

Antiemetic Drugs: Indications

A 
Specific indications vary per class of anti emetics
General use for each type: prevention and reduction of N/V
59
Q

Mechanism of Action and Other indications (Anticholinergic drugs: ACh blockers)

A

Bind to and block acetylcholine (ACh) receptors in the inner ear labyrinth
Block transmission of nauseating stimuli to CTZ
Also block transmission of nauseating stimuli from the reticular formation to the VC
Include scopolamine (also used for motion sickness)

60
Q

Mechanism of Action and Other Indications ( Antihistamine drugs (H1 receptor blockers))

A

Inhibit ACh by binding to H1 receptors
Prevent cholinergic stimulation in vestibular and reticular areas, thus preventing N/V
Include dimenhydrinate (Gravol), diphenhydramine (Benadryl), meclizine (Bonamine), promethazine (Histanil)
Are also used for motion sickness, nonproductive cough, allergy symptoms, sedation

61
Q

Mechanism of Action and Other Indications (Neuroleptic drugs)

A

Block dopamine receptors on the CTZ
Include chlorpromazine, promethazine (Histanil), perphenazine, several others
Are also used for psychotic disorders, intractable hiccups

62
Q

Mechanism of Action and Other Indications (Prokinetic drugs)

A

Block dopamine in he CTZ
Desensitize CTZ to impulses it receives from the GI tract
Also stimulate peristalsis in the GI tract, enhancing emptying of stomach contents
Include metoclopramide (Apo-Metoclop)
Are also used for GERD, delayed gastric emptying

63
Q

Mechanism of Action and Other Indications (Serotonin blockers)

A

Block serotonin receptors in the GI tract, CTZ, and VC
Include dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran)
Are used for N/V in patients receiving chemotherapy and for postoperative N/V

64
Q

Mechanism of Action and Other Indications (Tetrahydrocannabinoids)

A

Are a major psychoactive substance in marijuana
Have inhibitory effects on reticular formation, thalamus, cerebral cortex
Alter mood and body’s perception of its surroundings
Include dronabinol (Marinol), nabilone (Cesarmex)
Are used for N/V associated with chemotherapy and anorexia associated with weight loss in patients with AIDS

65
Q

Adverse Effects

A

Vary according to drug used

Stem from their nonselective blockade of various receptors

66
Q

Nursing Implications

A

Assess complete N/V Hx including precipitating factors
Assess current medications
Assess for contraindications and potential drug interactions
Many of these drugs cause severe drowsiness; warn patients about driving or performing any hazardous tasks
Taking anti emetics with alcohol may cause severe CNS depression

67
Q

Nursing Implications

A

When used in patients receiving chemotherapy, anti emetics are usually given 1-3 hours before a chemotherapy drug
Monitor for therapeutic effects
Monitor for adverse effects

68
Q

Nutrition Suplements

A

Dietary products used to provide nutritional support
Malnutrition: The body’s nutritional needs are not met by nutrient intake
Enteral Nutrition: Provision of food or nutrients through the GI tract
Parental Nutrition: Nutrients are delivered directly into the circulation by means of an IV solution

69
Q

Enteral Nutrition

A

Oral consumption is the most common and least invasive route
Feeding tubes through various routes can be used for enteral nutrition
Feeding tubes are used for those with: Abnormal eophageal or stomach peristalsis, altered anatomy secondary to surgery, depressed consciousness, impaired digestive capacity

70
Q

Enteral Formulation Groups

A

Provide the basic building blocks for anabolism
Supply complete dietary needs through the GI tract by oral route or by feeding tube: elemental, polymeric, modular, altered amino acid, impaired glucose tolerance

71
Q

Enteral Formulation Group: Elemental

A

Elemental formulations include Vivonex Plus, Peptamen, Vital HN
Minimum digestion is needed; residual is minimal
These formulations are used for malabsorption, partial bowel obstruction, IBD, other conditions
Hyperosmolarity of formulas may cause GI problems

72
Q

Enteral Formulation Group: Polymeric

A

Include Complete, Ensure, Ensure-Plus, Isocal, Osmolite, Sustagen, others
Are preferred over elemental formulations for patients with fully functional GI tracts and few specialized nutrient requirements; cause fewer GI problems

73
Q

Enteral Formulation Group: Modular

A

There are three types:
- Carbohydrate: Moducal, Polycose
- Fat: MCT Oil, Microlipid
- Protein: Casec, ProMed
Each of these is a single nutrient formula
They can be added to other formulas if needed

74
Q

Enteral Formulation Group: Altered Amino Acid

A

Include Criticare High, Nitrogen, Magnacal Renal, Traumacal, Ultracal High Nitrogen, Vital High Nitrogen
Contain varying amounts of specific amino acids
Are used for patients with diseases associated with altered metabolism capabilities

75
Q

Enteral Formulation Group: Impaired Glucose Tolerance

A

Glucerna

  • Contains proteins, carbs, fat, sodium, potassium
  • Is used in patients with impaired glucose tolerance (diabetic patients)
76
Q

Enteral Nutrition: Interactions

A

Various nutrients can interact with drugs to produce significant food-drug interactions
Enteral nutrition can delay absorption of some medications
Enteral nutrition may inactivate some medications (tetracycline and nutrient formulations that contain calcium)

77
Q

Parenteral Nutrition

A

Totally digested nutrients are given IV, directly into the circulatory system
- The entire GI system is bypassed, eliminating the need for absorption, metabolism, or bowel elimination

78
Q

Parenteral Nutrition

A 
Amino Acids
- Nonessential amino acids
- Essential amino acids
- Semiessential amino acids
Trace elements
- Chromium
- Iodine
- Copper
- Manganese
79
Q

Parenteral Nutrition

A

Parenteral nutrition is also known as total parenteral nutrition (TPN) or hyperalimentation
Formulations will vary according to individual patient nutritional needs
- Amino acids
- Carbs
- Lipids
- Trace Elements

80
Q

Parenteral Nutrition

A

Peripheral administration
- Temporary, short-term use (less than 2 wks)
- Dextrose concentration generally less than 10%
Central administration
- Long-term use (over 2 weeks)
- Dextrose concentration may be 10-50%

81
Q

Peripheral TPN

A

Used to provide nutrients to patients who need more nutrients than present oral intake can provide

  • Procedures that restrict oral feedings
  • Anorexia caused by chemotherapy or radiation treatments
  • GI illnesses that prevent oral food intake
  • After surgery
  • When nutrition deficits are minimal, but oral nutrition will not be started for more than 5 days
82
Q

Peripheral TPN: Adverse Effects

A

Phlebitis is the most devastating adverse effect
- Can lead to loss of a limb
Another potential adverse effect is fluid overload

83
Q

Central TPN

A

Delivered through a large central vein
- Subclavian
- Internal jugular
Used for long term (more than 2 wks)
Disadvantages are the risks associated with central line insertion, use, and maintenance
- Higher risk for infection, catheter-induced trauma, metabolic alterations

84
Q

Central TPN

A

Delivers total dietary nutrients to patients who require nutritional supplementation

  • Patients with large nutritional requirements (metabolic stress or hyper metabolism)
  • Patients who need nutritional support for more than 2 weeks
  • Patients who are unable to tolerate large fluid loads
85
Q

Central TPN: Adverse Effects

A

Most common are those surrounding the use of the central line for the delivery of TPN
- Infection
- Catheter-induced trauma
There is a greater chance of hyperglycaemia due to the larger and more concentrated volumes of supplements given with this method than with the peripheral TPN method

86
Q

Nursing Implications

A

Ensure that a complete nutritional assessment is taken, including a dietary history, weekly and daily food intakes, and weight and height measurements
Consult with a registered dietician
Assess baseline laboratory studies, such as total protein, albumin, urea, RBC count, WBC count, cholesterol
Collect anthropometric data
Assess for allergies to components of enteral nutritional supplements (such as whey, egg whites)
Assess for lactose intolerance

87
Q

Nursing Implications

A

If administering enteral nutrition by tube feedings, follow facility policy for ensuring proper tube placement and for checking residual before giving a feeding
Follow procedures for flushing tubing to prevent clogging the feeding tube with formula
Monitor how the patient is tolerating enteral feedings carefully
Most enteral feedings are started slowly and the rate is increased gradually
Monitor for signs of lactose intolerance
- Cramping, diarrhea, abdominal bloating, flatulence

88
Q

Nursing Implications

A

Follow facility policies and procedures for care and maintenance of TPN IV lines, including tubing and dressing changes
Monitor patient’s temperature; report any increase immediately
Monitor blood glucose levels with a glucometer
Monitor for hyperlgycemia
- Headache, dehydration, weakness
Monitor for hypoglycemia
- Cold, clammy skin, dizziness, tachycardia, tingling of the extremities

89
Q

Nursing Implications

A

While a patient is on TPN, the pancreas is providing increased amounts of insulin to cover the increased glucose levels
If TPN is discontinued abruptly, rebound hypoglycemia may occur until the pancreas has time to adjust to changing glucose levels
If TPN must be discontinued abruptly, then infuse 5-10% glucose to prevent hypoglycemia
Monitor for fluid overload while on TPN
- Weak pulse, hypertension, tachycardia, confusion, decreased urine output, pitting edema
Monitor daily weights and intake and output volumes

90
Q

Nursing Implications

A

Monitor for therapeutic responses to nutritional supplementation

  • Improved well-being, energy, strength, and performance of activities of daily living
  • Increased weight
  • Lab studies that reflect a more positive nutritional status

Pharm II (5 decks)

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