Hyperosmolar laxatives which include sals or saline products, lactulose, and glycerin.
Harsh cathatics that cause a watery stool with abdominal cramping
selective chloride channel activators
New category of laxatives used to treat idiopathic constipation in adults. Activates chloride channels in the lining of the small intestine, leading to an increase in intestinal fluid secretion and motility.
Cause vomiting when stimulated. Located in the medulla oblongata; recieves and propagates impulses to the upper GI tract organs, diaphragm, and abdominal muscles.
Vomiting - diaphragm & GI Vomiting Center (VC) Chemoreceptor trigger zone (CTZ) Toxic substance ingestion Diarrhea Constipation
Antiemetics - Nonpharmacologic measures
Weak tea - dilute with water Gatorade Crackers - no butter Toast - no butter Ginger Ale, Sierra Mist -room temp, make it flat (shake out bubbles)
Butyrophenones Haloperidol (Haldol) - can be anti-hypnotic -called vitamin H Droperidol (Inapsine) Action Blocks dopamine (D2) receptors in CTZ Side effects EPS, hypotension Metoclopramide (Reglan) works for nausea, open heart or GI surgery - delays gastric emptying Action Blocks D2 receptors in CTZ Side effects Sedation, diarrhea, EPS
Antiemetics - Benzodiazepines - suffix -PAMs and -LAMs Lorazepam (Ativan) - also called "Vitamin A"
Use Cancer chemotherapy - used as a premed to avoid nausea Used in combination with a glucocorticoid and serotonin 5-HT3 receptor antagonist
Antiemetics - Serotonin receptor antagonist Ondansetron (Zofran) - ODT under the tongue comes in foil package
Action Blocks serotonin receptors in CTZ and afferent vagal nerve terminals in UGI Use Cancer chemotherapy - to pretreat for nausea Side effects Headache, diarrhea, dizziness, fatigue
Antiemetics - Cannabinoids - 1st approved medical marujuana Dronabinol (Marinol)
Store in a refrigerator - Small white oval pill (like a tic-tac) Side effects Drowsiness, dizziness, dry mouth, impaired thinking, euphoria, mood changes, headaches, confusion, depersonalization, nightmares, incoordination, memory lapse, anxiety
Action Suppress impulses to CTZ Side effects Drowsiness, dry mouth, tachycardia, urine retention, constipation, diarrhea, blurred vision, hypotension, EPS
Antiemetics - Nursing interventions
Provide mouth care Monitor vital signs, bowel sounds Monitor for dehydration Warn not to consume alcohol when taking an antiemetic as it depresses the CNS Warn pregnant females to avoid antiemetics drug of choice is Zofran ODT with a Pregnancy caregory B Avoid driving motor vehicles - causes drowsiness
Emetics - Ipecac (OTC)
- Action ---- Stimulates CTZ & acts directly on gastric mucosa - Use ---- Induces vomiting after toxic substance - Caution ---- Avoid vomiting if substance is caustic or petroleum ---- If vomiting contraindicated, activated charcoal is given - Administration ---- Use ipecac syrup, not ipecac fluid extract ---- Take with a glass of water or fluid, not with milk or carbonated beverage ---- Vomiting occurs in 15 to 30 minutes (lavage likely if nothing after 15 minutes) ---- If vomiting does not occur, give activated charcoal (absorbs toxins) - It is black as grill charcoal, clothing warning ---- Gastric lavage may be needed if vomiting does not occur
Diarrhea -Causes Diarrhea defined as 3 or more episodes per day
Purpose Decrease hypermotility Caution Should not be used for more than 2 days or if fever is present Types Opiates and opiate-related agents (NO MORE THAN TWO DAYS) Somatostatin analog Adsorbents
Antidiarrheals - Opiates and opiate-related agents Paregoric (camporated opium tincture) Diphenoxylate with atropine (Lomotil) Loperamide (Imodium)
Kept in a locked drawer - controlled substance Opiates decrease GI motility this is why they work Opiates may cause respiratory depression Especially children and elderly May cause physical dependence Atropine contraindicated in glaucoma WATCH FOR pernicious anemia
Antidiarrheals - Somatostatin analog Octreotide (Sandostatin) - used with cancer PTs
Monitor BP, Respirations Report more than 10-15 mmHg decrease in BP - HYPOTENSION Monitor frequency of bowel movements and bowel sounds Assess for evidence of dehydration Monitor electrolytes Avoid fried foods, milk, and sedatives If diarrhea persists after 48 hrs, notify MD
Causes Bowel obstruction, fecal impaction _Good for MS patients Chronic laxative use, ignoring urge to defecate Neurologic disorders Side effect of drugs Lack of exercise, fiber, water
Laxatives Laxatives: promote soft stool Cathartics: soft to watery stool with cramping Purgatives: watery stool with cramping
Contraindications Undiagnosed abdominal pain Inflammatory disorders of the GI tract Appendicitis (9-10 times stool is the cause of appendicitis), diverticulitis, ulcerative colitis Spastic colon Bowel obstruction Pregnancy - Benefits outweigh risk when there is a risk of early delivery
Action Hyperosmolar salts pull water into colon, increase water in feces to increase bulk, which stimulates peristalsis Side effects Fluid and electrolyte imbalances, hypotension, weakness
Stimulant (Irritant) Laxatives Phenolphthalein (Ex-Lax, Correctol) reddish brown color urine is mistaken for hematuria Bisacodyl (Dulcolax)
Action Increase peristalsis by irritating sensory nerve endings in intestinal mucosa Results: orally 6-12 hrs, supp 15-60 min Side effects Abdominal cramps, weakness, reddish brown urine, diarrhea
Bulk-Forming Laxatives - Mix with water or juice Psyllium hydrophilic mucilloid (Metamucil) Calcium polycarbophil (Fiber-Con)
Action Absorb water into intestines, increase bulk and peristalsis Results 8-12 hrs
Administration Mix in glass of water or juice, stir, drink immediately, follow with 1 glass water
Side effects Abdominal cramps Excess laxative Nausea,vomiting, gas, diarrhea
Emollients (Stool Softeners) Docusate (Colace)
Action Lowers surface tension Promotes water accumulation in intestine Emulsifies and lubricates feces for easier passage
Use Prevents constipation Reduces straining post surgery or myocardial infarction use with fresh CABG patients, MI, CAD (no vagal)
Side effects Abdominal cramping, nausea, vomiting, diarrhea
Q: A client complains of constipation and requires a laxative. The nurse reviews a common cause of constipation which includes?
A: Lack of Exercise
Q: A client has nausea and is taking andansetron (Zofran). The nurse explains that the action of this drug is what?
A: Block seratonin receptors in the CTZ
Q: A client who has constipation is prescribed a bisacodyl suppository. The nurse explains that bisacodyl does what?
A: Acts on smooth intestinal muscle to increase bulk and peristalsis.
Q: A client is using the scopalimine patch to prevent motion sickness. The nurse teaches the client that which is a common side effect of this drug?
A: Dry mouth
Q: When metoclopramide (Reglan) is given for nausea, the client is cautioned to avoid which substance?
Q: The nurse is administering opium tincture (paregoric) to a client. What five items should be included in the teaching regarding this medication?
1. Warn the client to avoid laxative abuse 2. Record the frequency of bowel movements 3. Encourage the client to increase fluid intake 4. Intruct avoiding this drug if the client has narrow angle glaucoma 5. Warn the client against taking sedatives concurrently.
Q: For what three conditions would a laxative be indicated?
A: (1) A young adult female who is postpartum following a vaginal delivery with an episiotomy (2) A young adult client affected by IBS (3) An older adult client preparing for a colonoscopy
Q: Children and older adults are usually not administered prochlorperazine (Compazine) for nausea and vomiting due to risk for which effect?
A: Extrapyrimidal symptoms such as restlessness, anxiety, and spasms of the face and neck
Q: Laxatives containing sodium are contraindicated for which of the following client conditions?
Q: A nurse is taking a history on a client with IBS and constipation. Which item in the client's history is a contraindication to lubiprostone ( Amitizal)?