Transcript Chapter 35 - S3 amazonaws com

Chapter 35
Drugs Used to Treat
Constipation and Diarrhea
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 35
Lesson 35.1
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2
Objectives
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State the underlying causes of constipation
Explain the meaning of “normal” bowel habits
Cite nine causes of diarrhea
Describe medical conditions in which
laxatives should not be used
• Identify electrolytes that should be monitored
whenever prolonged or severe diarrhea is
present
• Describe nursing assessments needed to
evaluate the patient’s state of hydration when
suffering from either constipation or
dehydration
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 3
Constipation
• Definition
 Symptom-based disorder of unsatisfactory
defecation characterized by infrequent stools,
difficult stool passage, or both
• Chronic constipation
 Symptoms present for at least 3 months
• “Normal” bowel habits vary
 Daily bowel movement not necessary
 As long as patient’s health is good and stool
not hardened or impacted, this is acceptable
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 4
Causes of Constipation
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Improper diet
Too little fluid intake
Lack of exercise—sedentary habits
Failure to respond to normal defecation
impulses
Muscular weakness of the colon
Diseases such as anemia and
hypothyroidism
Frequent use of constipating medicines
Tumors of the bowel or pressure from tumors
Diseases of the rectum
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Slide 5
Diarrhea
• Definition
 Increase in the frequency or fluid content of
bowel movements
• Considered a symptom, not a disease
• Chronic diarrhea may indicate disease of the
stomach or intestine
• Complications from severe or prolonged
diarrhea
 Dehydration, electrolyte depletion, exhaustion
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 6
Causes of Diarrhea
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Intestinal infections
Spicy or fatty foods
Enzyme deficiencies
Excessive use of laxatives
Drug therapy
Emotional stress
Hyperthyroidism
Inflammatory bowel disease
Surgical bypass of the intestine
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 7
Treatment of Altered Elimination
• Constipation
 High-fiber diet, adequate hydration, exercise
 Avoid use of laxatives
• Avoid laxatives in patients with:
 Severe pain or discomfort
 Fever, nausea and vomiting
 Pre-existing conditions – DM, abdominal
surgery
 Taking medications that cause constipation
 Laxative abusers
 Previous use of laxative without success
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 8
Treatment of Altered Elimination
(cont’d)
• Diarrhea
 Treatment depends on specific cause of
diarrhea
 Indication of disease of stomach, small or
large intestine
 Psychogenic
 Symptom of cancer of the colon or rectum
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 9
Nursing Assessment
and Health Promotion
• Assessment
 Obtain history, medications, activity and
exercise, elimination patterns, nutritional
history, basic assessment, bowel sounds, vital
signs; review laboratory reports
 Monitor electrolytes in prolonged diarrhea
 Monitor hydration
• Promote health
 Teach proper handwashing
 Teach drug adverse effects
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 10
Chapter 35
Lesson 35.2
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Slide 11
Objectives
• Identify the indications for use, method of
action, and onset of action for stimulant
laxatives, saline laxatives, lubricant or
emollient laxatives, bulk-forming laxatives,
and fecal softeners.
• State the differences between locally acting
and systemically acting antidiarrheal agents.
• Cite conditions that generally respond
favorably to antidiarrheal agents.
• Review medications studied to date and
prepare a list of those that may cause
diarrhea.
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 12
Drug Class: Laxatives
• Actions
 Subclassified according to action
• Stimulant and osmotic laxatives
 Action: directly on intestines; cause irritation
that promotes peristalsis and evacuation
• Osmotic laxatives
 Action: hypertonic compounds draw water into
the intestines from surrounding tissues,
distending bowel and causing peristalsis
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 13
Stimulant and Osmotic Laxatives
• Drugs
 Stimulants: bisacodyl (Correctol, Dulcolax,
Modane), sennosides A&B (Ex-Lax), senna
concentrate (X-Prep)
 Osmotics: polyethylene glycol (Colyte, Go-LYTELY,
MiraLax), lactulose (Cephulac), glycerin
• Actions
 Stimulants: cause irritation, promoting peristalsis
and evacuation of the bowel
 Osmotics: draw water into intestine from
surrounding tissues
• Uses
 Relieve acute constipation
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 14
Saline Laxatives
• Drugs
 Lubiprostone (Amitiza)
 Magnesium citrate (Citrate of Magnesia)
 Magnesium hydroxide (Dulcolax Liquid,
Phillip’s Milk of Magnesia)
 Sodium phosphates (Fleet Phospho-Soda)
• Actions: draw water into the intestine from
surrounding tissues, distending the bowel,
causing peristalsis
• Uses: relieve acute constipation
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Stool Softeners
and Bulk-Forming Laxatives
• Stool softeners
 Action: draw water into bowel to soften stools;
do not cause peristalsis
 Used routinely for prophylactic purposes
• Bulk-forming laxatives
 Action: cause water to be retained within the
stool
 Drug of choice for those who use laxatives
routinely; they absorb irritating substances and
soften stools
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 16
Lubricant Laxatives
and Opioid Antagonist
• Lubricant laxatives
 Action: lubricate intestinal wall, allowing for
smooth passage of fecal contents
 Used as prophylactic for patients who should
not strain during defecation
• Opioid antagonist
 Action: binds to opioid receptors in the GI
tract, inhibiting constipation
 Used in treatment of opioid-induced
constipation
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 17
Drug Class:
Antidiarrheal Agents
• Actions
 Locally acting agents: absorb excess water to
cause a formed stool and adsorb irritants or
bacteria causing diarrhea
 Systemic agents: act through autonomic
nervous system to reduce peristalsis and
motility of the GI tract, allowing the mucosal
lining to absorb nutrients, water, and
electrolytes, leaving a formed stool
• Uses
 Treat sudden-onset diarrhea, inflammatory
bowel disease, post-GI surgery
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 18
Drug Class:
Antidiarrheal Agents (cont’d)
• Therapeutic outcomes
 Relief of incapacitation and discomfort of
diarrhea
• Common adverse effects
 Abdominal distension, nausea, constipation
• Serious adverse effects
 Prolonged or worsened diarrhea
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 19