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Antidiarrheals And Laxatives Flashcards

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1
Q

What causes diarrhea

A

Drugs
Bacteria
Viruses
Dietary intolerances
Chronic conditions

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2
Q

How does diarrhea effect BMs

A

Increases fluidity and frequency

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3
Q

Acute diahrea lasts for how long

A

Self limiting (resolves on its own)
Usually within 3 days to 2 weeks

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4
Q

How long can chronic diarrhea last for

A

May last 3-4 weeks

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5
Q

When a person has diarrhea what are you treating for

A

Treat the cause of the diarrhea (to prevent weight loss)
Nutritional deficits
Fluid and electrolyte imbalances

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6
Q

Anti-diarrheals are contraindicated in

A

C diff.
E. Coli
(Body wants to flush toxin through)

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7
Q

What is an absorbent anti-diarrheal

A

Bismuth subsasicyate

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8
Q

bismuth subsalicylate

A

Is an absorbent diarrheal so it binds to the bacteria/toxins

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9
Q

Nursing implications for bismuth subsalicylate

A

May cause tongue and stools to darken

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10
Q

bismuth subsalicylate has drug drug interaction with

A

aspirin
warfarin
NSAIDS

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11
Q

Diarrhea is

A

The passage of 3 loose or liquid stools per day
(Could be acute or chronic)

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12
Q

Health care associated diarrhea

A

Diarrhea in a hospitalized patient that was not present on admission and starts 3 days after being hospitalized
(Occurs in 1/3 patients)

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13
Q

Clostridioides difficile
manifestation

A

Watery diarrhea
Fever
Anorexia
Abdominal pain

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14
Q

Clostridioides difficile
source of infection and susceptibility

A

Prolonged use of antibiotics followed by exposure to feces contaminated surfaces
(Spores on hands/environment very hard to kill)

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15
Q

Enterohemorrhagic escherichia coli
Manifestations

A

Severe abdominal cramping, bloody diarrhea, vomiting
Low grade fever
Lasts 5-7 days

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16
Q

Enterohemorrhagic Escherichia coli
Source of infection/susceptibility

A

• Can cause serious illness, especially in older adults
• May progress to life-threatening renal failure
• Transmitted in water or food contaminated with infected feces

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17
Q

Enterotoxigenic E. coli
Manifestations

A

Watery or bloody diarrhea, abdominal cramps
Nausea, vomiting, fever may be present
Lasts 3–4 days

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18
Q

Enterotoxigenic E. coli
Manifestations

A

• Watery or bloody diarrhea, abdominal cramps
• Nausea, vomiting, fever may be present
• Lasts 3–4 days

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19
Q

Enterotoxigenic E. coli
Infection/ susceptibility

A

Most common cause of travelers’ diarrhea
Transmitted in water or food contaminated with infected feces

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20
Q

What influences a pernon’s susceptibility to pathogens

A

Age
Gastric acidity
Intestinal microflora
Immune status
*older adults most likely to have life threatning diarrhea

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21
Q

Proton pump inhibitors

A

Since the stomach acid kills ingested pathogens, taking drugs to decrease stomach acid will increase the chance the pathogens will survive

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22
Q

The normal flora contains? Does?

A

Contains bacteria (ex. E. Coli)
Viruses
Fungi
*aid in fermentation
*provide a microbial barrier against pathogens

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23
Q

Who is susceptible to GI tract infection

A

People who are immunocompromised because of disease, or taking immunosuppressive drugs

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24
Q

Drug and food intolerance diarrhea occurs why

A

Rapid GI transition prevents fluid and electrolyte absorption, bile salts and undigested fats lead to excess fluid secretion into the GI tract
(Osmotic diarrhea)

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25
Severe diarrhea may cause
life-threatening dehydration, electrolyte problems (e.g., hypokalemia), and acid-base imbalances (metabolic acidosis).
26
Major concerns of in self-limiting diarrhea
Preventing transmission Replacing fluid and electrolytes Protecting the skin *if severe may need to give fluids, electrolytes, vitamins, and nutrition through IV
27
Why would an antidiarrheal not be used in treating some infectious diarrheas
they potentially prolong exposure to the organism
28
bismuth subsalicylate Mechanism of action
Decreases secretions and has weak antibacterial activity. Used to prevent travelers’ diarrhea
29
Bismuth subsalicylate Nursing considerations
May cause tinnitus and confusion. Do not use with GI bleeding
30
diphenoxylate/atropine Mechanism of action
Opioid and anticholinergic. Decreases peristalsis and intestinal motility
31
diphenoxylate/atropine Nursing implications
Blurred vision, dry mouth, drowsiness may occur. Take as directed. Overdose may be life-threatening.
32
diphenoxylate/atropine does what?
reduce bowel motility and transit time reduce rectal spam pain ↓ stool frequency and volume
33
diphenoxylate
synthetic opiate agonist slows overactive bowel weak opioid (schedule 5) AE: drowsiness, dizziness
34
atropine
(anti-cholinergic effect with larger doses) discourage recreational use
35
Loperamide
similar to diphenoxylate • inhibits peristalsis and prolongs transit time • direct effect on the nerves in the intestinal muscle wall • ↓ fecal volume and frequency • available OTC
36
loperamide Mechanism of action
Inhibits peristalsis, delays transit, increases absorption of fluid from stools
37
loperamide Nursing considerations
Caution patient to avoid alcohol. Do not use with GI bleeding. May cause drowsiness. Use caution with hazardous activities.
38
What are the opiate antidiarrheals
diphenoxylate/atropine Loperamide
39
Lactobacillus acidophilus
Probiotic Restore normal intestinal flora May be helpful for diarrhea d/t antibiotics Promote “good” bacteria & suppress “bad” bacteria Affect the gut microbiome Found in food (ie., fiber, fermented foods)
40
What is constipation
infrequent passage of abnormally hard and dry stools (two or less per week) feeling of incomplete evacuation stools harden the longer it stays in the colon
41
What do laxatives do
Increase fecal movement facilitates defecation
42
PO laxatives taken
Within 2 hours of other meds
43
Common adverse effects for laxatives
bloating gas abdominal discomfort cramping
44
Why are laxatives only for short term use
Overuse of certain laxatives may lead to dependency and decreased bowel function.
45
risk for contracting CDI is highest in patients
patients receiving antimicrobial, chemotherapy, gastric acid–suppressing, or immunosuppressive drugs
46
How do laxatives work?
They are drugs that promote bowel evacuation by increasing the bulk of feces, softening the stool, or lubricating the intestinal wall
47
What are the causes of acute diarrhea
Drugs Bacteria Viruses Nutritional factors Protozoa
48
What are the causes of chronic diarrhea
Tumors Acquired immunodeficiency syndrome Diabetes mellitus Hyperthyroidism Additions disease IBS
49
Absorbents work by
Coating the walls of GI tract, they bind the causative bacteria or toxin to their absorbent surface for elimination from the body through stool
50
Laxatives are contraindicated in
GI obstruction Bowel perforation
51
psyllium
bulk forming increases fecal mass safest laxative & OTC prevent and long-term management of constipation
52
docusate sodium
emollient (stool softener) promotes H2O & fat absorption ease passage of stool
53
Docusate sodium nursing implication
administer with full glass of water
54
psyllium nursing implications
mixture congeals; drink immediately to prevent obstruction Only administer if they’ll be able to drink 5-8 oz of water
55
mineral oil
lubricates fecal material eases passage of stool Only lubricant laxative in the emollient category
56
Emollient laxatives
Directly lubricate stool and the intestines, which prevent water moving out out of the intestines (Softens and expands the stools)
57
Bulk forming laxatives
Increase water absorption which results in greater total volume (bulk) of the intestinal contents *over the counter, safest, recommended for long term use
58
Probiotics
Suppress the growth of diarrhea causing bacteria and reestablish the flora that normally resides in the intestine
59
polyethylene glycol 3350
Induce bowel cleansing osmotic agent bowel prep for colon procedures reconstituted with water Given the day before procedure NI: drink 8oz. every 10-15mins. Ex. Golytely &Miralax
60
How often should Miralax be used
Daily for up to 7 days, any longer could become laxative dependent
61
What are the hyperosmotic laxatives
polyethylene glycol 3350 (ex. Miralax and golytely)
62
Saline laxatives
increases osmotic pressure and draws water into the colon
63
Saline laxatives consists of
Various magnesium or sodium salts
64
Saline laxatives produce
A watery stool, within 3-6 hours of ingestion
65
What are the types of saline laxatives
Saline enema (fleet enema) magnesium hydroxide (milk of magnesia) Magnesium citrate (citroma)
66
Saline laxatives are to be used cautiously in
renal insufficiency bc they can be absorbed enough to cause hypermagnesemia (high level of magnesium in blood bc can’t be excreted)
67
Saline laxatives are most commonly used to
Evacuate the bowel rapidly in preparation for an endoscopic examination and to remove unabsorbed poisons from the GI tract
68
Milk of magnesia
Contraindicated in renal disease Laxative and antacid Osmotically active
69
Magnesium citrate
Bowel prep Osmotically active
70
Milk of magnesia nursing implications
Shake solution Can lead to F & E imbalance
71
Magnesium citrate nursing implications
Refrigerate Can lead to F & E imbalance
72
What are stimulant laxatives
Induce intestinal peristalsis Stimulate intestinal nerves to do peristalsis and increase water in the colon
73
What are the types of stimulant laxatives
Bisacodyl and senna
74
What class of laxatives are most likely to cause dependence
Stimulant laxatives (Such as bisacodyl and senna)
75
bisacodyl and senna
treatment of constipation stimulates intestinal nerves to do peristalsis and increase H20 in colon F&E depletion may be habit-forming
76
bisacodyl and senna nursing implications
Electrolyte imbalances and increase peristalsis
77
Forms of stimulant laxatives
Could be PO or suppository
78
What can happen with laxative use and abuse
Loss of muscle and nerve response Risk of dependence Laxatives draw water into the lumen Increase risk of dehydration in older individuals Increase risk of F & E imbalances
79
Aging changes that effect GI
Decrease water intake Decrease fiber intake Decrease activity Chronic illness may delay evacuation Increase use of laxatives
80
lifestyle changes that effect GI
Fluid intake Fiber Physical activity
81
Before giving any medications affecting bowel status what should the nurse do
Obtain a through history Preform assesment of : the patients bowel patterns General state of health Any recent illness GI complaints Dietary changes Possible causes of diarrhea
82
When listening to the bowel sounds hypoactive is considered
Less than 6 sounds per minute
83
When listening to the bowel sounds hyperactive is considered
Greater then 32 sounds perfect minute
84
When listening to the bowel sounds hyperactive is considered
Greater then 32 sounds perfect minute
85
Probiotics can be obtained through
Supplements Food such as: fruits and vegetables , whole grain and wheat products, yogurt, cheese, kefir
86
Probiotics have been used to make better symptoms in
Inflammatory bowel disease Crohn disease IBS Travelers diarrhea CDI
87
What health conditions benefit from probiotics
Obesity and gastric cancer
88
Who should not use probiotics
Immunocropromised patients Critically ill patients (Could lead to sepsis in people who lack a normal immune response)
89
What is fiber, what is it found in
Nondigestible material found in whole grains, fruits, vegetables and legumes
90
Fibers are fermented by
The microflora in the GI tract, which provides bulk to the stool (insoluble fibers)
91
What are the health benefits of fiber
Increases fecal mass and promotes laxation ** Promotes growth of beneficial colonic microflora ** Binds bile acids and cholesterol Slows rise in blood glucose and insulin levels Assists in weight managment Protects against colorectal and gastric cancer
92
An 88-year-old patient is undergoing bowel preparation for a colonoscopy. What may be ordered for this patient?
Laxative polyethylene glycol or magnesium citrate to cleanse the bowel
93
What are the nurse’s priorities regarding monitoring the patient during the bowel preparation?
• Fluid and electrolyte imbalances from the bowel preparation • Clear liquid diet to NPO status • Older patients are at greater risk for dehydration and electrolyte disturbances
94
What follow-up is needed after a colonoscopy?
Monitoring vital signs (BP, HR) for signs of dehydration
95
If the patient needs to prevent constipation, what OTC drug is the best choice to help prevent constipation? Why?
Psyllium (Metamucil) is a natural bulk-forming laxative (safest) • Increases the intake of bulk and fiber, contributing to more normal patterns of bowel elimination • Prevents constipation without water and electrolyte loss

201D (4 decks)

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