Lecture 9 GI Tract NutritionElimination

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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

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Antidiarrheals

• Reduce fluidity of BM frequency
• Act locally or systemically

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Lomotil

• a synthetic Rx close to Demerol
• schedule V
• Decreases peristalsis in intestines
• combined with Atropine
• Used to Tx acute non-specific diarrhea

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Drug Interactions

• Increases effect of
• barbiturates
• ETOH
• narcotics
• sedatives other CNS depressants

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Adverse Reactions

• GI - N/V, discomfort
• CNS depression
• physical dependence

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Nursing Implications

• Check fluid electrolyte status
• insure 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

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Kaopectate

• mixture of Kaolin pectin (OTC)
• Local acting
• Acts as absorbents protectants
• Binds irritants
• Used in mild to moderate diarrhea
• Interacts to decrease absorption (Digoxin)

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Adverse Reactions

• Constipation
• Generally safe mild

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Nursing Implications

• Monitor GI response
• Document frequency consistency of BMs

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Laxatives

• Used to eliminate soft, formed stool
• Cathartics
• used to cause fluid evacuation

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Hyperosmolar Laxatives

• Produces osmotic effect
• Causes fluid accumulation distention
• Increases peristalsis

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Lactulose (Cephulac)

• Used to decrease ammonia levels
• r/t liver dysfunction encephalopathy
• Manages chronic constipation

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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

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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

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Nursing Implications

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

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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

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Nursing Implications

• Made with different salts
• Use caution w/ k in renal dysfunction
• Na in cardiac pt.
• Hold if having diarrhea

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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

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Uses

• Empty bowel before surgery/ GI procedures
• Constipation r/t bedrest
• Neurologic dysfunction of colon
• Constipation r/t narcotics

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Adverse Reactions

• weakness
• Nausea/cramps
• Suppository may cause burning
• electrolyte imbalance
• K Ca loss
• Metabolic Acidosis or Alkalosis

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Nursing Implications

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

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Lubricant Laxative

• Mineral oil increases water retention
• Used for fecal impaction
• Given po or rectally
• Treats constipation
• softens stool
• avoids straining

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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

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Nursing Implications

• Obtain pt history
• R/O pathologic abdominal problem
• Monitor effectiveness
• Encourage activity
• exercise decreases bloating Rx need

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Digestives

• Replace specific substances to digest food
• May lack in GI tract, Liver or Pancreas
• Natural body substances
• Action same as substance they replace

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Pancrease

• replaces pancreatic enzymes
• act to digest proteins, CHO, fats
• Used in pancreatitis, Cystic Fibrosis
• Interact with antacids
• Side Effects N/D

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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

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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

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Adverse reactions

• prolonged vomiting in children
• Abuse in bulimia, anorexia nervosa
• serious, fatal r/t cardiac effect electrolyte
  imbal.

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Nursing Implications

• Do not use if unconscious, loss gag reflex
• Call poison control first
• Do not use if swallowed petroleum product
• caustic substance

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Antiemetics - Antihistamine

• Benedryl, 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

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Interactions - additive effects

• Anticholinergics
• Tricyclic antidepressants
• antiparknsons
• CNS depressants

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Adverse Reactions

• r/t anticholinergic effects
• CNS depression
• Sedation
• Dizziness

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Nursing Implications

• Caution with glaucoma, urine retention, ulcer or
  GI obstruction
• Caution with enlarged prostate, asthma
  (anticholinergic effects)
• Caution if sedated, dont drive, dont use ETOH

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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

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Adverse Reactions

• CNS depression
• Lowers threshold for seizures
• Low BP, postural hypotension
• Decreased muscle tone
• Skin effects, photosensitivity

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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

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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

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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)

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Uses

• relieve pain heart burn
• promote healing of ulcer
• prevent stress ulcer
• Aluminum to decrease phosphorus in renal failure
• Best 1 hr PC and 3 hr PC HS

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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.

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Nursing Implications

• No high Mg in renal disease- cant excrete
• Caution in elderly, decrease bowel motility,
  fluid retention
• May cause constipation or impaction
• Monitor color of stools and numbers

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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

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Protonix (pantoprazole)

• Gastric acid pump inhibitor

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Interactions

• Antacids decrease absorption of acid
• Cimetadine inhibits liver enzyme and changes Rx
  action

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Adverse Reactions

• HA, dizzy, N/D, constipation, skin rash
• Loss of libido impotence (Tagamet)

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Nursing Implications

• Decrease dose in elderly
• May cause confusion
• Caution if renal or hepatic impairment

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Sucralfates (Carafate)

• Short term Tx duodenal ulcers
• In acid forms paste adheres to ulcer
• Adverse Reactions- constipation, N, metallic taste

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Nursing Implications

• Give on empty stomach 1 hr ac and HS
• DO not give with antacids (wont work)
• Avoid giving aspirin to patients with ulcers
  GI bleed or irritation

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Gastrointestinal System
Antacids

• Carafate

H2 Blockers
Parietal Cell