Lecture 12 Nursing 100 Flashcards
1
Q
GI Assessment
A
assess normal bowel habits gather data on diarrhea or constipation Poor dietary habits Rx side effects Interventions to promote normal elimination
2
Q
Antidiarrheals
A
Reduce fluidity of BM & frequency
Act locally or systemically
3
Q
Lomotil
A
related to opiates- systemic, central acintg put intestines to sleep a synthetic Rx close to Demerol schedule V Decreases peristalsis in intestines combined with Atropine Used to Tx acute non-specific diarrhea
4
Q
Lomotil Drug Interactions
A
Increases effect of: barbiturates ETOH narcotics Sedatives & other CNS depressants
5
Q
Lomotil Adverse Reactions
A
GI - N/V, discomfort
CNS depression
physical dependence
6
Q
Lomotil Nursing Implications
A
Check fluid & electrolyte status insure adequate fluid volume before Tx Hold if abdominal distention no bowel sounds or no flatus Caution in liver dysfunction HX of narcotics dependence Caution in prostate hypertrophy
7
Q
Kaopectate
A
drink it- coats intestines; absorbs irritants don't give with po meds mixture of Kaolin & pectin (OTC) Local acting Acts as absorbents & protectants Binds irritants Used in mild to moderate diarrhea Interacts to decrease absorption (Digoxin)
8
Q
Kaopectate Adverse reactions
A
constipation
generally mild and safe
9
Q
Kaopectate Nursing implications
A
Monitor GI response
Document frequency and consistency of BMs
10
Q
Laxatives- 4 types
A
Used to eliminate soft, formed stool Cathartics used to cause fluid evacuation 1. hyperosmolar 2.Bulk forming 3. Emollient 4. Stimulants 5. Lubricant
11
Q
Hyperosmolar laxatives
A
Produces osmotic effect
Causes fluid accumulation & distention
Increases peristalsis
12
Q
Lactulose (Cephulac)
A
hyperosmolar laxative
Used to decrease ammonia levels
r/t liver dysfunction & encephalopathy
Manages chronic constipation
13
Q
Milk of Magnesia
A
hyperosmolar laxative Can lose a lot of Ca and K loss eat normal diet Complete bowel evacuation Can cause fluid & electrolyte imbalances N/V, diarrhea, abd. distention, flatus
14
Q
Milk of Magnesia Nursing Implications
A
Check Fl. & Elec, acid-base, dehyd
check cardiac status
teach proper use of laxatives and bowel training
15
Q
Bulk-Forming (metamucil)
A
makes jelly blob in GI tract- pulls in liquid Most natural Prevents or Tx constipation Not absorbed Act by increasing bulk & H20 promotes peristalsis Used for simple constipation r/t low fiber or fluids
16
Q
Bulk-Forming Laxative Nursing implications
A
Educate patient about
low salt & sugar diet
need for exercise
increase fluids
17
Q
Emollient (Surfax, Dialose, Colace)
A
Stool Softeners (reduce surface tension, fluid accumulates) Usually safe Used to prevent constipation Helps pt avoid straining MI, ICP, rectal surgery, hernia Interacts w/ ASA, may inc. absorption
18
Q
Emollient Implications
A
Made with different salts Use caution w/ K in renal dysfunction Na in cardiac pt. Hold if having diarrhea
19
Q
Stimulants (irritant cathartics) Ducolax and golytly
A
Stimulates peristalsis by irritating mucosa
Stimulates nerve endings in intestinal smooth muscles
Alters fluid & electrolyte absorption
Act on colon
20
Q
Stimulants uses
A
Empty bowel before surgery/ GI procedures
Constipation r/t bedrest
Neurologic dysfunction of colon
Constipation r/t narcotics
21
Q
Stimulants Adverse Reactions
A
weakness Nausea/cramps Suppository may cause burning electrolyte imbalance K & Ca loss Metabolic Acidosis or Alkalosis
22
Q
Stimulants Nursing Implications
A
Contraindicated in:
abdominal pain
sx appendicitis
rectal bleeding
23
Q
Lubricant Laxative
A
Mineral oil increases water retention Used for fecal impaction Given po or rectally Treats constipation softens stool avoids straining
24
Q
Antiflatulants (mylicon, simethicone
A
Disperse gas pockets Antifoaming, Water repellent Not absorbed, Distributed in intestines used post op, diverticulitis spastic colon, peptic ulcer May increase rectal flatus
25
Antiflatulants Nursing Implications
```
Obtain pt history
R/O pathologic abdominal problem
Monitor effectiveness
Encourage activity
exercise decreases bloating & Rx need
Make them walk
```
26
Digestives
Replace specific substances to digest food
May lack in GI tract, Liver or Pancreas
Natural body substances
Action same as substance they replace
27
Pancrease
```
replaces pancreatic enzymes
act to digest proteins, CHO, fats
Used in pancreatitis, Cystic Fibrosis
Interact with antacids
Side Effects N/D
```
28
Pancrease Pt Education
Number of BMs will decrease
Consistency of BM improves
Store in air tight case at room temperature
Do not use if allergic to pork or beef
Enc. dietary balance fat/CHO/ Protein
Cystic fibrosis- excessive mucous produced
29
Emetics Syrup of Ipeac
```
Used to stimulate vomiting
Emergency Tx acute poisoning
Onset 10 -30 minutes
Action - stimulates vomit center- medulla
local effect on gastric mucosa
OTC
Interacts- milk, charcoal, antacids
```
30
Antiemetics- antihistamine
```
Benedryl, Vistaril
Dramamine, Tigan, Antivert
Block Histamine receptors
Decrease Nausea/Vomiting & Vertigo
Also anticholinergic effect (dry mouth, blurred vision, urine retention, constipation)
Used to prevent & treat motion sickness
Best for nausea & vertigo
```
31
Antiemetics Additive effects
anticholinergics
tricyclic antidepressants
antiparkinsons
CNS depressants
32
Antiemetics Adverse reactions
r/t antichoilnergic effects
CNS depression
Sedation
Dizziness
33
Antiemetics Nursing Implications
Caution with glaucoma, urine retention, ulcer or GI obstruction
Caution with enlarged prostate, asthma (anticholinergic effects)
Caution if sedated, don’t drive, don’t use ETOH
34
Phenothiazines (compazines, phenergan)
Blocks dopaminergic receptor in medulla (vomit center)
Controls severe N/V due to disease, anesthesia, chemo
Not as effective in motion sickness
Used in acute cases & short term
Interacts with CNS depressant, narcotics, sedatives, ETOH, Anticholinergics
35
Phenothiazines Adverse Reactions
```
CNS depression
Lowers threshold for seizures
Low BP, postural hypotension
Decreased muscle tone
Skin effects, photosensitivity
```
36
Phenothiazines Nursing Implications
Not to pt w/ CNS disorders, C-V disease, Liver disease
Caution if convulsive disorder, brain tumor
Use caution in children
Avoid if has dermatitis
Avoid prolonged sun-light
Monitor BP
37
Peptic Ulcer Agents
Ulcer- open lesion in mucous membrane (esoph., stom.)
5 -10% US population
Due to stress, diet, acid secretions, infection
Aim of TX- neutralize acid
decrease acid secretions
bind to ulcer
38
Antacids
Contains Al, Mg, Ca
Base anion combines with H cation to = H20
Usual pH 1.3 - 2.3 increases to 4.0 or 5.0
Decreases action of pepsin
Decreases acid secretion so ulcer heals
Most effective around the clock schedule (not prn)
39
Antacids Uses
```
relieve pain & heart burn
promote healing of ulcer
prevent stress ulcer
Aluminum to decrease phosphorus in renal failure
Best 1 hr PC and 3 hr PC & HS
```
40
Types of Antacids
Mylanta- More Mg, laxative effect
Maalox - More Al, constipating effect
Interact to decrease absorption of all med..
Caution with high Na in CHF, HTN, & K in Renal Fail.
41
Antacid Nursing Implications
No high Mg in renal disease- can’t excrete
Caution in elderly, decrease bowel motility, fluid retention
May cause constipation or impaction
Monitor color of stools and numbers
42
Histamine 2 receptor antagonists cimetidine and ranitidine
Treats duodenal ulcers
Blocks stimulant action of histamine at parietal cells
decreases acid secretion so ulcer can heal
43
Protonix (pantoprazole)
gastric acid pump inhibitor
44
Protonix Interactions
Antacids decrease absorption of acid
| Cimetadine inhibits liver enzyme and changes Rx action
45
Protonix Adverse reactions
HA, dizzy, N/D, constipation, skin rash
| Loss of libido & impotence (Tagamet)
46
Protonix Nursing Implications
decrease dose in elderly
may cause confusion
caution if renal or hepatic impairment
47
Sucralfates (carafate)
Short term Tx duodenal ulcers
In acid forms paste & adheres to ulcer
Adverse Reactions- constipation, N, metallic taste
48
Sulcrafates Nursing Implications
Give on empty stomach 1 hr ac and HS
DO not give with antacids (won’t work)
Avoid giving aspirin to patient’s with ulcers & GI bleed or irritation
