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Major Components of Antacids
- calcium- slows GI system- constipation
- Aluminum- can increase gastric emptying- constipation
- Magnesium- increases GI motility- diarrhea
Nursing Care for Antacids
- evaluate bowel movements
- dehydration if diarrhea and check electrolytes/status
Interventions- do not give with other drugs, decrease acid content in stomach and affect breakdown of other meds.
- shake liquid suspensions to mix
- drink full glass of water- to ensure it gets to the stomach
- take 1-3 hours after meals
- take at bedtime (Hour of Sleep)
- do not take with food, take after
TUMS- (Antacid)- anti-ulcer
- decreases gastric acid
SE: belching, flatulence (release of CO2 in stomach)
TEACHING: assess for hypercalcemia
Antacid/ Anti-ulcer- reduces acid concentration
- caution with warfarin, digoxin, TCN
- mild astringent properties
- increases pH (makes it more basic)
give infants/ gas drops/ - causes a lower surface tension so gas bubbles form into one big one and you burp the baby
- helps pool the gas
- protects your stomach lining by lowering the amount of acid that comes in contact with it.
- given to counteract gastric ulcers associated with NSAIDS/ASA
TEACH: take with meals and at bedtime
- diarrhea & abdominal pain
- BIG DOG! forms a coating over ulcers, protecting the area from further injury. This helps ulcers heal more quickly.
TEACH: take 30 minutes before a meal and at bedtime
- coats and makes a protective barrier.
- may impede absorption of warfarin, phenytoin, theophylline, digoxin and some antibiotics. so take 1 Hour before these meds
(antiulcer)- protect gastric lining from harsh effects of medications and diseases
Proton Pump Inhibitors
- supress gastric acid secretion
- Treatment of active Peptic Ulcer Disease, erosive esophagitis,
SE: HA, diarrhea, nausea, abdominal pain
Proton Pump Inhibitor (5)
Omeprazole- see the most
Pantoprazole- see the most
Proton Pump Inhibitor (5) ends in
Histamine 2 Blockers end in
Histamine 2 Blockers H2
famotidine - seen most (best
ranitidine hydrochloride- 2nd most common
cimetidine - not as potent at the others
Histamine 2 Blockers H2 uses
Suppresses secretion of gastric acid. Decreases acid secretion and decreases pepsin secretion as well.
Decreases heartburn and aids with PUD and stress ulcers
Promotes healing of GERD
Caution with renal and hepatic dysfunction
Histamine 2 Blockers H2 Nursing Care
- give 30 minutes before meals
- If you give it with a meal it decreases nutritional absorption
- monitor for B12 deficiency
- avoid smoking
- avoid foods high in alcohol, spices and caffeine (aggravate stomach)
Antiemetics are used to treat
Nausea (esp. after surgery due to anesthesia)
Antiemetics- Antihistamines end in
Zines & Amines
Antiemetics- Antihistamines (5)
-cyclizine hydrochloride (Marezine)
Meclizine HCL(Antivert)- vertigo room spinning.
Antiemetics- Antihistamines- SE
Anticholinergic - reduces secretions.
makes you sleepy
- can cause night terrors in children (diphenhydramine)
Antiemetics- Phenothiazines end in
promethazine hydrochloride- common
Antiemetics- Phenothiazines SE
Makes you sleepy, can cause severe hypotension, so when giving it, if BP is low may not want to give it or give it very cautiously. May need to decrease the dosage. Can lead to confusion especially in elderly patients. It still has that dry mouth and blurred vision. They have found it leads to necrosis if given IV distal to wherever it was given. (you need to dilute it before given IV over a period of time) Maybe even in big bag over time, may burn the vein. Can eat away at the vasculature. (kills vasculature distal to the IV)- necrosis of digits
Antiemetics- Anticholinergic Meds
- Transdermal patch after surgery- history of nausea & vomiting with surgery. Usually lasts about 3 days
Antiemetics- Anticholinergic SE
Drowsiness, dry mouth, constipation
Nursing Care for Anti-emetics
- Assess nausea
- Signs/Symptoms- dehydration
- monitor VS- fluid volume indication
-monitor mouthcare after emesis
-check bowel sounds for blockage
TEACH- avoid OTC preparations until contacting doctor
- do not consume alcohol
- sedative effects combined may cause profound CNS depression
Anti-emetics- Benzodiazepines end in
Anti-emetics- Benzodiazepines uses
Knocks them out CNS to sedate activation of the nausea, confusion
- Oncology - they may give for chemotherapy patients, it causes nausea, give it a day or 2 before the chemo treatment and then after the treatment.
Antiemetics- Serotonin Receptor Antagonist ends in
Antiemetics- Serotonin Receptor Antagonist
ondansetron hydrochloride (Zofran)
used after suregery to decrease nausea and post op nausea and vomiting.
Antiemetics- Serotonin Receptor Antagonist SE
Sedation, dry mouth, you want them to be able to move after surgery. I would rather keep them awake and alert. Less sedation effect than most.
Antiemetics: Cannabinoids Meds
Antiemetics: Cannabinoids uses
Synthetic version of marijuana- useful for hemo & AIDS patients and is pretty effective- they get nausea, vomiting, lose weight, kekecsic (wasting away) ,
Antiemetics: Cannabinoids SE
increases appetite, and treats nausea
Antiemetics: Prokinetic Agent med (1)
metoclopramide hydrochloride (Reglan)
Antiemetics: Prokinetic Agent uses
- diabetes with gastroparesis because it helps with emptying the stomach, movement, breakdown and peristalsis and treats post surgery ileus
Antiemetics: Prokinetic Agent SE
sedation, fatigue, restlessness, dry mouth
Antiemetic Butyrophenones (1)
Antiemetic Butyrophenones uses
, Blocks dopamine receptors- chemoreceptor trigger zone that induces nausea.
Antiemetic Butyrophenones SE
Drowsiness and hypotension, may lead into extraparemitial symptoms roll of tonge, extra movements, twitches,
Nursing interventions/care for antiemetics
When did it start?
Color, consistency, amount
Black vomit - blood- peptic ulcer
Nursing interventions monitor for
S & S- dehydration, electrolytes, skin turgor, vital signs, fluid volume, mouth care, bowel sounds (vomiting because there is a blockage (can't get it out one way, get it out the other.) hyper/hypo/absent bowel sounds.
Nursing interventions teaching
Avoid OTC preparations without contacting your doctor, no alcohol while taking these- (alcohol- they are going to get really sleepy, profound depression on CNS- they will be really out of it)
Make you throw up/induces vomiting. caustic chemicals should not be vomited back up so they took it off the shelf and now everyone is to call poison control)
ipecac syrup -
Treat underlying cause:
- Somatostatin analogue
General Treatments for diarrhea- non-drug therapy
BRAT diet, Bannanas, rice, applesause/apples/ toast
Obtain history, food poisoning, causative agent, contributing factors and remove them.
Check vital signs to help with understanding volume, fluid and electrolytes, bowel sounds, frequency and consistency.
If diarrhea persists greater than 48 hours they need to seek medical attention. (have had some serious problems and lots of electrolytes, (dysrhythmia, may be more underlying problems than you are aware of)
loperamide hydrochloride (Imodium)
Antidiarrheals- Opiates uses
Good for IBS- same side effects as above. Opiate which is like a narcotic - we must count this one. (IBS) Decreases gastric motility
SE: cause constipation, nausea, vomiting, toxic megacolon (colonic distension- intestines decrease in motility) (severe diarrhea)
Antidiarrheals- Somatostatin Analog
octreotide acetate (Sandostatin)- po inhibits peristalsis activity- constipation if on for a long time.
Antidiarrheals- Somatostatin Analog
think extreme opposite; May be good for IBS- cause constipation, nausea, vomiting, toxic megacolon (colonic distension- intestines decrease in motility) (severe diarrhea)
Antidiarrheals- Absorbents- Meds
bismuth salts (Pepto-Bismol)
Antidiarrheals- Absorbent bismuth salts uses
salicylate type agent- and mainly used for travelers diarrhea and indigestion.
Antidiarrheals- Absorbent bismuth salts Side Effects
(stools turn black tarry color) - it is a metallic taste- aspirin type product, may cause ringing of the ears tinnitus. (one or both ears)
Antidiarrheals- kaolin-pectin used for
- mild to moderate diarrhea
removes excess fluids and helps consolidate stool and excrete it.
Antidiarrheals- kaolin-pectin side effects
When should you avoid laxatives
- already dehydrated
- severe abdominal pain
- intestinal obstruction
-SS of appendicitis, Ulcerative colitis, diverticulitis
Laxatives 4 types
Laxatives- Osmotics work to
Attracts water into the large intestines to produce bulk and stimulate peristalsis
Laxatives- Osmotics - Magnesium hydroxide
Magnesium hydroxide (Milk of Magnesia)- good to produce a bowel movement but not harsh; give first, not as harsh
SE: cramping, diarrhea, abdominal pain, electrolyte imbalance with prolonged use.
Laxatives- Osmotics - Lactulose uses
Lactulose (also the tx of Hepatic Encephalopathy- too much ammonia)
hepatic encephalopathy- ammonia levels are really high and they become lethargic, this pulls in fluid and releases ammonia.
They get tired of having diarrhea stools and they want to refuse the medication but you must weigh the risk and the benefits here. If your ammonia levels are too high you become unresponsive.
Laxatives- Osmotics - Lactulose Nursing implications
Nursing Implication: If diabetic- it can increase blood sugar levels, so check these frequently. Monitor LOC, Hyperglycemia
Other Osmotic Laxatives.
Magnesium citrate- used for colon preps
Polyethylene glycol(GoLytely)- used to be used for colon preps
Laxatives- stimulant meds
bisacodyl (Dulcolax)- makes things move, treat constipation. Works 3-8 hrs. acute constipation or pre-surgery. Induces peristalsis/increases it.
senna (Senokot)- acute constip. Bowel prep.
Laxatives- stimulant side effects
Abdominal cramps, electrolyte imbalances, dehydration, diarrhea
Laxatives- stimulant Nursing considerations
- stop treatment for severe abdominal pain or cramping
- monitor electrolytes
- Assess history of constipation, diet
- check I/O, fluid loss
- encourage increased fluid water intake
- overuse can cause dependence
- do not take within 1 hour of any other drug. (evacuates and will just get rid of it)
not getting enough fruits, fibers, veggies
I/O electrolytes, fluids, stools, results of it, increase fluid intake (helps with constipation and helps prevent dehydration)
Constipation- elderly considerations
Elderly overuse laxatives- may also lead to dependence. Have take tablets whole, not within an hour of any other drug (pulling stuff in and evacuation) if rectal bleeding, severe cramping rule out perforation.
Bulk forming Laxative
psyllium hydrophilic mucilloid
Bulk forming laxative uses
For chronic constipation provides fiber. Gives you the fiber you need. Increases the bulk. Peristalsis follows and then stool occurs.
Bulk forming laxative Nursing implications
Assess renal function, BUN, creatinine, bowel sounds, constipation.
Powder form (8-10 ounces of water) drink immediately. Mix and give it immediately.
Laxatives: Emollient/Stool softeners
- brings in a little bit of the moisture, softens stool, decreases surface tension.
Usually done post-op due to the use of narcotics to counteract the constipation issues. May also mix with sennosides to help.
ducusate sodium (Colace)
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