Unit 7 pt 2 - GI meds/IV & Blood Flashcards
What are some important nursing assessments to do before diagnosing and giving meds for an abdominal problem?
- Look at the s/s we’re treating. Varies based off of each quadrant even! **If they complain of heartburn or chest pain you have to rule out cardiac first.
- Health history - food poisoning, traveling outside of the US, appendicitis, etc.
- Bowel patterns - any pain? How often are you going? Appearance of the stool? Dark/tarry or red are a concern… unless they ate a food that could cause that, lol
Anti-ulcer medications include…
Antacids, H2 blockers, PPIs, and mucosal protectants
Nursing considerations for all anti-ulcer medications:
- Encourage fluid + fiber intake to mitigate risk of constipation
- Teach the patient to avoid irritating triggers while on treatment (examples: alcohol, spicy foods, smoking)
- Monitor for therapeutic effects / decrease in symptoms because we don’t want to take these long term - acid-base imbalances.
- Anti-ulcer agents can lead to microbiome superinfection, so take probiotic while on these meds.
Antacids (Tums)
MOA: Elevating PH of the stomach to make it more alkaline / less acidic.
Uses: Acid-related diseases: GERD -> can lead to esophageal erosion, PUD -> can lead to GI bleed, and stress ulcers -> treat prophylactically.
Considerations:
- Monitor renal/liver function tests prior to administration for dosing purposes only, not because it’s a side effect
- Do not administer within 1-2 hours of other meds because they impact a lot of medication absorptions
- Don’t use calcium-channel blockers with calcium containing antacids.
Side effects: Hypercalcemia, rebound hyperacidity, constipation OR diarrhea, electrolyte imbalances.
H2 Blockers (rantidine/famotidine)
MOA: Blocks H2 receptors to decrease acid production and pepsin
Uses: Same as antacids - any acid related diagnosis like GERD, PUD, or stress ulcers
Considerations:
-Monitor renal/liver panel.
- increase fluid/fiber intake to mitigate constipation and dehydration effects
- Don’t drive until you know how it effects you
- *Cimetidine has high risk for drug interactions so it’s typically not used.
Side effects: Constipation OR diarrhea, headache, dizziness/drowsiness, dry eyes/mouth
Memory hint: the same side effects as the others, but since it’s an antihistamine it can cause headache and drowsiness just like Benadryl
Proton-pump inhibitors (the -zoles/Omeprazole/Esomeprazole/Pantoprazole/Lansoprazole)
MOA: Prevents damage to the mucosa by binding to parietal cells that produce digestive enzymes, stopping the release of acid. Stronger than antacids and H2’s.
Uses: All the acid conditions like GERD/PUD/Stress Ulcers + Zollinger-ellison syndrome (tumor) + in combination with antibiotics it treats H.pylori too.
Considerations:
- Not used in children under 5 years old.
- Caution in pregnant patients, elderly patients, and any patient with hepatic issues.
- Watch for electrolyte imbalances with IV administration only.
- Take probiotics to mitigate risk of superinfection just like the others, but specifically because this medication is linked to C.diff and pneumonia!
Side effects: Headache, dizziness/drowsiness, nausea, diarrhea, rash, rebound hyperacidity, electrolyte imbalances (hypomagnesemia and B12 deficiency).
Long term use/adverse effects: Acute kidney disease, lupus, osteoporosis, dementia, C.diff, pneumonia.
Memory hint for adverse effects: KOLD CP REND
Mucosal Protectant (Sucralfate)
MOA: Protect and coat mucosal ulcers
Uses: Mucosal ulcers
Considerations:
- Take on an empty stomach 1 hour before eating.
- Caution in renal failure or dialysis.
Side effects: Constipation, N/V, bloating.
Memory hint: It’s a mucosal protectant so it’s protective of our bodies, leaving few side effects, but not for dialysis
Antiflatulent medications (Simethicone)
MOA: Breaks mucosa-coated gas bubbles into smaller ones to decrease bloating or flatulence.
Uses: Pain, bloating, abdominal distention.
Considerations: Can be used for babies in liquid drops! Patients should avoid acidic triggers (spicy foods, carbonated drinks) just like with anti-ulcer medications.
Side effects: None really.
Memory hint: safe for babies, safer side effects for me
Considerations for antidiarrheals
- Diarrhea is three or more loose stools per day.
- Important to determine the cause of the diarrhea - a side effect of a medication, a virus, or a disease process?
- Important to monitor electrolytes also because lots of electrolyte loss from diarrhea can cause cardiac abnormalities - increase fluids and electrolytes.
- Patients also should avoid caffeine and switch to BRAT diet or softer foods while having diarrhea.
- Taking probiotics is also important.
- If s/s or amount of diarrhea doesn’t improve within 48 hours, call HCP (it could be something like C.diff!). Usually antidiarrheals are not taken for more than 48 hours.
Antidiarrheals include…
adsorbents and antimotilities (loperamide and hyoscyamine)
Adsorbents (Bismuth subsalicylate)
MOA: Coat the walls of GI Tract and bind to bad bacteria/toxin to be eliminated in the stool. Also slow down peristalsis.
Considerations: General considerations/teaching for antidiarrheals + Don’t give to young patients who are recovering from chickenpox or those with flu-like symptoms because of Reye’s syndrome. Don’t take this with aspirin due to salicylate poisoning.
Side effect: Black/dark tongue. Reye’s syndrome (changes in behavior, increased N/V). Salicylate poisoning (tinnitus!).
Antimotilities (Loperamide)
MOA: Slow fluid into bowel and slow down peristalsis by acting on opioid receptors.
Uses: Diarrhea like the others + Can help decrease s/s of opioid withdrawal.
Considerations: Don’t give to patients under 2 - risk for respiratory depression and arrhythmias just like opioids. Avoid using this med with alcohol or any other CNS depressant.
Side effects: N/V, constipation, dizziness/drowsiness, fatigue, abdominal discomfort, allergic reaction.
Antimotilites (Hyoscyamine)
MOA: An anticholinergic! Decreases peristalsis by drying things out and slowing them down.
Considerations: Same as any anticholinergic - don’t give to elderly patients, or those with glaucoma, MG, or perilitic elias (post-op).
Side effects: Dizziness/drowsiness, dry mouth, constipation, blurred vision, confusion/sedation.
Nursing considerations for anti-constipation medications (laxatives):
- Constipation is three or fewer BM’s per week.
- Important to determine the cause of the constipation - side effects of medication, surgery, injury, dehydration? Determine their last BM and their diet/routine. More sedentary or low-fiber diets could cause this.
- Monitor bowel sounds (usually in constipation, there will be an absence of them) and for worsening s/s (distention, pain). Constipation can cause blockages in the intestine or even infections.
- If they start having diarrhea on a constipation med/laxative, the patient needs to stop taking it.
Bulk-Forming Laxatives (Psyllium, fiber)
MOA: Increase weight of stool / bulk the stool so they’re easier to pass.
Uses: Constipation, maintenance of BM (safe to take every day), lowering blood sugar and cholesterol, aiding in weight loss.
Considerations: Similarly to antacids, take these 2 hours apart from other medications because they can affect how they’re absorbed. These should produce BM within 72 hours or you may need to move on to a stronger med.
Side effects: Not really any - these are safe to take everyday.
Osmotic Agent Laxatives (Milk of magnesia, Polyethylene glycol/Miralax, Lactulose)
MOA: Draw water into the colon to soften the stool; stimulate peristalsis.
Uses: Constipation, **Lactulose is used in liver failure/cirrhosis as well.
Considerations: Use cautiously or treat with something else first for abdominal pain or h/o inflammatory conditions like Chron’s, IBS, or fecal obstruction. - Be cautious in those with eating disorders because these can be abused for that.
Side effects: Belching, bloating/ abdominal distention, flatulence, N/V/D, dehydration.
Misc laxatives : Docusate
Brings fats and water into the stool to soften and move it out.
Misc laxatives: mineral oil enema
Lubricate the stool to help it pass - it’s an enema so it works pretty fast, within 15-30 minutes.
Misc laxatives: Bisacodyl
Increases peristalsis to move the stool through (like a prokinetic). Just like osmotic agent laxatives, probably don’t use it if there’s a bowel obstruction or some kind of blockage that could worsen. Can be used orally or as a rectal suppository - kind of like an enema.
Nursing considerations for a patient on an antiemetic:
- Severe vomiting (where we would start thinking about giving a medication) is vomiting for greater than 24 hours; blood in the vomit; or vomiting with extreme pain.
- Determine the cause just like diarrhea & constipation - are they pregnant? Are they having migraines? Is this a virus or a disease process?
OLD CARTS for vomiting. How often is it? What color/odor? - Monitor metabolic panel (H&H).
- Monitor for s/s dehydration like dark urine, skin turgor (tenting) / Monitor for electrolyte loss just like diarrhea.
- Cautious use of these medications with alcohol and other CNS depressants and don’t drive until you know how these affect you because they will mostly all cause dizziness/drowsiness.
Anticholinergics (Scopolamine)
MOA: Block acetylcholine in the vestibular center to dry secretions and reduce smooth muscle spasms.
Uses: Motion sickness or N/V for pre or post-op surgery.
Considerations: Put the patch on prior to traveling or surgery to prevent those symptoms and change it out every 72 hours. Remove before doing an MRI. No patients with glaucoma, BPH, old age, or MG.
Side effects: Drowsiness/dizziness
Antihistamine (Meclizine)
MOA: Blocks H1 receptors in vestibular center.
Uses: Motion sickness (nausea)
Considerations: No alcohol or driving. Don’t give to patients with glaucoma or BPH because that can aggravate that; cautious use in elderly patients too.
Side effects: Dizziness/drowsiness/sedation, headache ,GI upset.
**Meclizine is an H1 antihistamine. Glaucoma or BPH puts meclizine out of safe range.
Dopamine Blocker (Prochlorperazine)
MOA: Block dopamine which calms CNS and may block acetylcholine.
Uses: N/V; Off-label use for psychosis.
Considerations: Teach patients that it may turn urine darker color. Teach patients to call HCP if they’re getting symptoms of EPS. No driving or alcohol like the others.
Side effects: Dizziness/drowsiness, hypotension, constipation, uncoordinated movements and EPS/tardive dyskinesia (involuntary movements of the head/neck/trunk).
Prokinetic (Metoclopramide)
MOA: Block dopamine which promotes peristalsis and relaxes pyloric sphincter.
Uses: N/V, gastroparesis, delayed gastric emptying (diabetics), GERD.
Considerations: Don’t give to patients with GI bleed or any obstruction/perforation. Teach patients to call HCP if they’re getting symptoms of EPS.
Side effects: Dizziness/drowsiness, fatigue, lethargy, depression, EPS/tardive dyskinesia.
**Prokinetic causes movement so think EPS (too much movement)
