Lecture 9
GI 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
