GI + Liver Flashcards
Sodium bicarbonate
Cimetidine
Omeprazole
Sucralfate
Ondansetron
Docusate
Bisacodyl
Polyethylene glycol
Loperamide
Lactulose
What are common disorders of the upper GI?
— heartburn
— GERD
— peptic ulcer disease
— duodenal ulcer
Which drugs are for upper GI secretions?
— sodium bicarbonate
— cimetidine
— Omeprazole
— Sucralfate
Drugs used for GI motility:
— docusate
— Bisacodyl
— polyethylene glycol
— loperamide
What do you focus on with assessment?
Baseline hx and prognosis including allergies and medications
— FOCUS: GI and abdominal assessment related to disorder/AE
FOLLOW ADMIN PROTOCOL
Education:
— non-pharm interventions
— proper admin
— shortest duration to reduce risk of AE
What are examples of non-pharm interventions?
Eating small meals
Sitting up after admin of drug + meals
What are common adverse affects with your GI secretion drugs?
— nausea
— vomiting
— diarrhea
— constipation
— abd discomfort
— rash
When reviewing the health hx of a pt prescribed an antacid, the nurse knows that antacids containing magnesium need to be used cautiously in patients with which condition?
A. HTN
B. Renal failure
C. Peptic ulcer disease
D. HF
B. Renal failure
Both calcium and magnesium based antacids are more likely to accumulate to toxic levels in pts with renal disease. Pts with renal failure cannot regulate electrolytes
A client has taken Omeprazole for many years; which test should the nurse anticipate the HCP will order to assess for a potential complication?
A. EGD
B. Creatinine
C. Bone density scan
D. H. Pylori test
C. Bone density scan
Long term use of PPIs have a potential to develop osteoporosis
Nursing assessment with laxatives:
Baseline
Focused: bowel sounds, I&O, electrolytes
CONTRAINDICATED IN ACUTE BOWEL DISORDERS such as lieu’s, obstruction, ischemia, perforation
*laxatives will not help these issues
What are some adverse effects with laxatives? What is the therapeutic effect?
— LOOSE STOOLS (diarrhea); hold medication if pt is having frequent BM
— nausea
— vomiting
— abd pain
— DEHYDRATION
— ELECTROLYTE IMBALANCE
Therapeutic effect:
Achievement of soft BM within 24hr of admin of laxative
Implementation and teaching of laxatives:
Implementation:
— HOLD if loose stool
— encourage 3L water daily, high fiber diet, increase activity
— if multiple laxative orders: admin Docusate FIRST (most gentle); use Bisacodyl next then polyethylene
Teaching:
— do not take laxative if experiencing nausea, vomiting, abd pain
— contact provider if experiencing SEVERE abd pain, muscle weakness, cramps, dizziness
— do not use laxative for more than 7 days; can develop dependency
What are contraindications for anti-diarrheals?
— diarrhea caused by poisoning or by bacterial toxins
— acute abd disorders including GI obstructions
What is the therapeutic effect for anti-diarrheals?
Decrease number of BM
Teaching for anti-diarrheal
— take as prescribed; overuse can lead to constipation
— notify HCP is symptoms persist after 2 days or experiencing signs of dehydration (may need fluids to replace from diarrhea)
— DO NOT USE FOR INFECTIOUS DIARRHEA can make it worse
— keep hydrated: 3L water/day
The nurse is reviewing the uses of oral laxatives. Which conditions are general contraindications or cautions for the use of oral laxatives?
A. Nausea + vomiting
B. Ingestion of toxic substances
C. Undiagnosed abdominal pain
D. Fecal impaction
E. Acute surgical abdomen
F. Irritable bowel syndrome
A, C, D, E
Mineral oil enemas are used for fecal impaction
Assessment with antiemetics:
Focus: GI, I&O, neuro/LOC
— s/s of dehydration, electrolyte imbalance from vomiting
— fall risk
— drug-drug: CNS DEPRESSANTS
Implementation of antiemetic drugs:
Give PRN medication as appropriate (Ondansetron is first line tx)
— use least invasive
— VERIFY ROUTE
Preventative therapy: admin 30-60 min prior to chemo dose or end of surgery
What are the different routes for antiemetic drugs? What route with you use if the pt is vomiting?
— oral
— oral disintegrating tablet
— transdermal patch
— suppository
— IM
— IV
Oral preffered; if pt is vomiting used alternative route
— suppository used in hospice
Teaching and therapeutic effect:
Teach:
— timing of admin; take before other medications for antiemetic to have effect
— do not operate heavy machinery; sedation
FALL RISK
Therapeutic effect:
Absence of nausea/vomiting
AE: drowsiness, dizziness, CV
FALL RISK
What is hepatic encephalopathy?
Liver cirrhosis, increase in ammonia levels
Tx: Lactulose
— excretes ammonia in stool
— loose stools are expected in therapeutic effect
Liver metabolizes ammonia to urea
— Ammonia stays in blood stream, going to the brain leading to toxicity; confusion
The nurse is teaching a client who has been prescribed an antiemetic. What should the nurse include in the teaching?
A. Occasional problems with taste may be experienced
B. It is safe to take med with glass of wine
C. Avoid driving as medication can cause drowsiness
D. Periodic monitor BP
C
The nurse is caring for a client prescribed Ondansetron and baclofen. The nurse should prioritize which assessment?
A. Bowel sounds
B. LOC
C. Intake and output
D. ROM
B. LOC
Combo of these drugs = drowsiness; fall risk. Bowel sounds and I&O are a priority with Ondansetron, but not with baclofen.
