Lecture 9GI Tract - Nutrition/Elimination

• Assessment of bowel habits first

• gather data on diarrhea or constipation

• Poor dietary habits

• Rx side effects

• Interventions to promote normal elimination

Antidiarrheals

• Reduce fluidity of BM & frequency

• Act locally or systemically

Diphenoxylate

• a synthetic Rx close to Demerol

• schedule V

• Decreases peristalsis in intestines

• combined with Atropine

• Used to Tx acute non-specific diarrhea

Drug Interactions

• Increases effect of:

• barbiturates

• ETOH

• narcotics

• sedatives& other CNS depressants

Adverse Reactions

• GI - N/V, discomfort

• CNS depression

• physical dependence

Nursing Implications

• Check fluid & electrolyte status

• ensure 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

Kaopectate

• mixture of Kaolin & pectin (OTC)

• Local acting

• Acts as adsorbents & protectants

• Binds irritants

• Used in mild to moderate diarrhea

• Interacts to decrease absorption (Digoxin)

Adverse Reactions

• Constipation

• Generally safe & mild

Nursing Implications

• Monitor GI response

• Document frequency & consistency of BMs

Laxatives

• Used to eliminate soft, formed stool

• Cathartics– used to cause fluid evacuation

Hyperosmolar Laxatives

• Produces osmotic effect

• Causes fluid accumulation & distention

• Increases peristalsis

Lactulose (Duphalac,Cephulac)

• Used to decrease ammonia levels– r/t liver dysfunction & encephalopathy

• Manages chronic constipation

Milk of Magnesia

• Complete bowel evacuation

• Can cause fluid & electrolyte imbalances

• N/V, diarrhea, abd. distention, flatus

• Nursing Implications– Check Fl. & Elec., Acid-base, dehyd.– check cardiac status– Teach proper use of laxatives & bowel training

Bulk-Forming (metamucil)

• 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

Nursing Implications

• Educate patient about– low salt & sugar diet– need for exercise– increase fluids

Emollient (Surfax, Dialose, Colace)

• 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

Nursing Implications

• Made with different salts

• Use caution w/ k in renal dysfunction

• Na in cardiac pt.

• Hold if having diarrhea

Stimulants (Irritant Cathartics)Ducolax and Golytly

• Stimulates peristalsis by irritating mucosa

• Stimulates nerve endings in intestinal smooth muscles

• Alters fluid & electrolyte absorption

• Act on colon

Uses

• Empty bowel before surgery/ GI procedures

• Constipation r/t bedrest

• Neurologic dysfunction of colon

• Constipation r/t narcotics

Adverse Reactions

• weakness

• Nausea/cramps

• Suppository may cause burning

• electrolyte imbalance

• K & Ca loss

• Metabolic Acidosis or Alkalosis

Nursing Implications

• Contraindicated in:– abdominal pain – sx appendicitis– rectal bleeding

Lubricant Laxative

• Mineral oil increases water retention

• Used for fecal impaction

• Given po or rectally

• Treats constipation– softens stool– avoids straining

Antiflatulants (mylicon, simethicone)

• Disperse gas pockets

• Antifoaming, Water repellent

• Not absorbed, Distributed in intestines

• used post op, diverticulitis– spastic colon, peptic ulcer

• May increase rectal flatus

Nursing Implications

• Obtain pt history

• R/O pathologic abdominal problem

• Monitor effectiveness

• Encourage activity

• exercise decreases bloating & Rx need

Digestives

• Replace specific substances to digest food

• May lack in GI tract, Liver or Pancreas

• Natural body substances

• Action same as substance they replace

Pancrease

• replaces pancreatic enzymes

• act to digest proteins, CHO, fats

• Used in pancreatitis, Cystic Fibrosis

• Interact with antacids

• Side Effects N/D

Patient 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

Emetics Syrup of Ipecac

• 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

Adverse reactions

• prolonged vomiting in children

• Abuse in bulimia, anorexia nervosa– serious, fatal r/t cardiac effect & electrolyte

imbal.

Nursing Implications

• Do not use if unconscious, loss gag reflex

• Call poison control first

• Do not use if swallowed petroleum product– caustic substance

Antiemetics - Antihistamine

• Diphenhidramine (Benadryl), 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

Interactions - additive effects

• Anticholinergics

• Tricyclic antidepressants

• antiparknsons

• CNS depressants

Adverse Reactions

• r/t anticholinergic effects

• CNS depression

• Sedation

• Dizziness

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

Phenothiazines (Compazine, 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

Adverse Reactions

• CNS depression

• Lowers threshold for seizures

• Low BP, postural hypotension

• Decreased muscle tone

• Skin effects, photosensitivity

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

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

Antacids

• Contains aluminum, Magnesium, Calcium• 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)

Uses

• relieve pain & heartburn

• promote healing of ulcer

• prevent stress ulcer

• Aluminum to decrease phosphorus in renal failure

• Best 1 hr PC and 3 hr PC & HS

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.

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

Histamine 2 Receptor Antagonists Cimetidine (Tagamet) and

Ranitidine (Zantac)

• Treats duodenal ulcers

• Blocks stimulant action of histamine at parietal cells

• decreases acid secretion so ulcer can heal

Protonix (pantoprazole)

• Gastric acid pump inhibitor

Interactions

• Antacids decrease absorption of acid

• Cimetidine inhibits liver enzyme and changes Rx action

Adverse Reactions

• HA, dizzy, N/D, constipation, skin rash

• Loss of libido & impotence (Tagamet)

Nursing Implications

• Decrease dose in elderly

• May cause confusion

• Caution if renal or hepatic impairment

Sucralfates (Carafate)

• Short term Tx duodenal ulcers

• In acid forms paste & adheres to ulcer

• Adverse Reactions- constipation, N, metallic taste

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

Gastrointestinal System

Antacids Carafate

H2 Blockers

Parietal Cell