Chapter 41 GI Conditions 1. What puts hospitalized clients at risk for constipation?

Lack of exercise; insufficient food intake, especially dietary fiber; diminished fluid intake; or a medication regime that includes drugs that reduce intestinal motility. Also while in the hospital a patient could be receiving drugs such as: Opioids, anticholinergic, antihistamines, certain antacids, and iron supplements; which can also promote constipation. 2. What recommendations can nurses make that might minimize constipation? A nurse could mention to make lifestyle changes that incorporate an increased dietary fiber intake, an increased physical activity level, limit consumption of refined white flour, dairy products, and chocolate. 3. What is the primary purpose of using a cathartic? Cathartics are usually the drug of choice preceding diagnostic procedures of the colon, such as a colonoscopy or barium enema. What concerns do we have for clients getting cathartics, especially the elderly? I couldnt find a definite answer on this one but Im pretty sure these can cause fluid and electrolyte depletion and dehydration especially in old people. Pg, 627 4. How can psyllium (Metamucil) treat both diarrhea and constipation? Incease
absorption of water into the stool, which treats diarrhea, and increase mass of stool, which helps constipation.

5. What does the client need to do to make psyllium effective, and what is the risk if this is not done? Psyllium should be taken with a full glass of liquid to decrease the risk
of obstruction if the product does not clear the esophagus or if a stricture exists.

6. How do docusate (Colace) and (Dialose) work? Increases systemic absorption of mineral oil. It also causes more water and fat to be absorbed into the stools. Only use this to prevent constipation, not to treat it. 7. Why is docusate (Colace) ordered for patients with increased intracranial pressure or patients on heparin? Because this medication will prevent straining which will reduce the intracranial pressure and reduce the risk of bleeding from hemorrhoids if they are present.

8. How does bisacodyl (Dulcolax) work and what concerns should we have for our clients? This medication irritates the bowel and promotes peristalsis. Concerns are: Increased risk or causing diarrhea and cramping; bowel rupture if obstruction is present; and rebound, severe constipation if this medication is withdrawn completely. 9. How do osmotic laxatives, like MOM and polyethylene glycol work? They pull water into the fecal mass to create a more watery stool. How are these osmotics different? Milk of Magnesia is a saline based osmotic and Polyethylene is a non-absorbable sugar based osmotic 10. What is an advantage to using osmotic laxatives? They are highly potent, work within hours, and are often a part of bowel prep. Why are oral saline laxatives a concern in clients with CHF or HTN? Oral salines are sodium based and could disrupted the fluid electrolyte balance which would exacerbate HTN and CHF. 11. How is lactulose (Cephulac) useful in clients with cirrhosis? Lactulose increases the water content and softens the stool. This lowers the PH of the colon, which inhibits the diffusion of ammonia from the colon into the blood, thereby reducing ammonia levels. Pretty much it treats high ammonia in the blood. 12. Why is sorbitol almost always prescribed with Kayexelate? Because too much Sorbital can cause diarrhea. 13. Why should mineral oil use be discouraged? Because it may interfere with the absorption of fat-soluble vitamins and can cause other potentially serious adverse effects. 14. Why are docusate and mineral oil not to be administered concurrently? Because docusate increases systematic absorption of mineral oil. This could disrupt vitamin absorption. 15. Why MIGHT docusate be discouraged in clients with HTN or CHF? Do not give Docusate sodium (Colace) to clients on sodium restriction (HTN). Do not give docusate potassium (Dialose) to clients with renal impairment (possible CHF). Docusate increases systemic absorption of mineral oil.

16. Which type of laxative should be used in clients on opioids? Opioids block mu
receptors in the gut, slowing GI motility. Chronic opioid use requires addition of stimulant laxatives, usually senna, to irritate the bowel and increase peristalsis. Doses should be increased as opioid doses increase.

17. Which is, likely, the safest laxative for long-term use? Bulk-forming agents 18. Which laxative is most likely to be given for quick relief? Stimulant laxatives 19. Before giving any laxative, what must the nurse know? The patients vital signs, any underlying disorders such as intestinal obstruction, nausea and vomiting, and undiagnosed abdominal pain. 20. What must be ruled out before administering antidiarrheal agents? If the patient has infectious diarrhea. Stool culture 21. What risks are associated with uncontrolled diarrhea? Fluid, acid-base, or electrolyte disorders. 22. To which class of drug are antidiarrheal agents related, and what risks are associated with that class? Opioids. The anticholinergic effects, sedation, respiratory depression 23. Why is atropine added to diphenoxylate? To discourage the client from taking too much of the drug. Pg. 629 24. Why shouldnt clients with ulcerative colitis take antidiarrheal agents? Because it could worsen or mask those symptoms and could lead to toxic megacolon. What must be done to manage diarrhea in these patients? Use an antiinflammatory agent like a steroid. One could also administer drugs that can be used for organ rejection because Krohns and ulcerative colitis are autoimmune diseases. 25. How do bismuth salts treat diarrhea? By binding and absorbing toxins. This is for the travelers diarrhea. 26. On what type of nausea/vomiting are anticholinergic and antihistamine drugs most effective? Motion sickness What adverse effects are associated with these classes? Anticholinergics,
antihistamines, and opioids are common causes of constipation, can interfere with sweating leading to overheating, sedation, and the usual anticholinergic effects (urinary retention, dry mouth, glaucoma, and contributes to constipation).

27. Prochlorperazine (Compazine) is a phenothiazine (remember antipsychotics?). This class of drug works by blocking dopamine receptors. What adverse effects are related to this effect? Neuroleptic malignant syndrome, extrapyramidal effects. 28. Phenothiazines also have anticholinergic effects, antihistamine effects, and alpha blocking effects. What adverse effects might be seen from each these actions (think back to antipsychotics)? Anticholinergic effects: Dry mouth, constipation, Urinary retention, blurry vision. Antihistamine: Sedation. Alpha blockade: Decreased blood pressure, syncope. 29. Dolasetron (Anzemet), a serotonin antagonist, is most effective against which type of nausea? Emetogenic cancer chemotherapy. 30. What is dronabinol? An antiemetic that can relax a person without the feeling of euphoria produced by marijuana. 31. What benzodiazepine is most likely to be given for nausea? Lorazepam (Ativan) What education should accompany this drugs use? Dont drive until the effects of the drug are known (cuases drowsiness), take drug exactly as directed, for short term use, must be tapered off, avoid alcohol. 32. Why arent amphetamines used for weight loss? Because they are addictive. 33. What class of drugs does sibutramine (Meredia) belong to? It belongs to anorexiants and the selective serotonin reptake inhibitors (SSRIs). Why is its use limited to one year, only? Since it can cause tachycardia and
hypertension, it is contraindicated in CV disease and use is limited to one year.

Why shouldnt this drug be used with MAOIs (think back to antidepressants)? You could get serotonin syndrome. 34. How does orlistat (Xenical) contribute to weight loss? Blocks lipid absorption What nutritional deficiency is associated with its use? Decrease absorption of fatsoluble vitamins and warfarin (Coumadin). What happens when clients eat high-fat meals while using this drug? Flatus with discharge (aka a shart), oily stools, abdominal pain, and discomfort. 35. What 2 diseases are most likely to require pancreatic enzymes? Those with pancreatitis and cystic fibrosis.

36. What is the most likely cause of pancreatitis? Usually gallstones in women and alcoholism in men. 37. When should pancreatic enzymes be administered? With meals and snacks.