GI Flashcards
(41 cards)
GI Function
Digestion food particles Absorption of the digested content - nutrition - electrolyte - minerals and fluids
What are the secreted gastric juice
- chief cells, which secrete the pro enzyme pepsinogen ( pepsin)
- parietal cells, which secrete HCL
- Gastrin-producing cells, which secrete gastric a hormone that regulates enzyme release during digestion
- mucus producing cell that release mucus to protect the stomach lining which extends from the mouth to the duodenum.
*** mucosa extends from the mouth to the anus
Where do must drugs absorb in ? And which drugs absorb in the stomach?
- in the duodenum
- lipid soluble drugs and alcohol
Gastrointestinal disorders
- vomiting ( f/e and nutrition prob)
- diarrhea ( f/e, absorption)
- constipation ( decreased peristalsis )
Primary problem with GI and concern
Primary: fluid and electrolyte and nutrition
Concern: how the food get through the GI tract ( peristalsis )
Drugs to treat GI disorders
- Antiemetics ( stops you from vomiting)
- Emetics ( causes you to vomit)
- Anti-diarrhea ( stops diarrhea)
- laxative ( treats pt with constipation)
Why does vomiting occur ?
Motion sickness, viral and bacterial infection, food tolerance, surgery, pregnancy, pain, shock, effects of selected drugs, radiation, disturbances of the middle ear that affect equilibrium or hit in the back of the head
Cerebral centers affecting vomiting
-Vomiting center
* found inside the medulla
* Causes vomiting to stimulate
* odor, smell, taste and gastric mucosal irritation are transmitted directly to the vomiting center. Causing pt to vomit
* Acetylcholine is a vomiting stimulant
BLOCK ACETYLCHOLINE IS VOMITING IS CAUSED BY SENSORY IMPULSES
- Chemoreceptor trigger center
- found near the medulla
*Drugs and toxins - Dopamine stimulates CTZ, which in turns stimulate the vomiting center and causes vomiting
BLOCK DOPAMINE IF VOMITING IS CAUSED BY A DRUG OR TOXIN
Vestibular center
- found near the medulla
NON- PHARMACOLOGIC measures
- weak tea
- flat soda
- gelatin
- Gatorade
- pedialyte ( for children )
- crackers
- toast
**Ginger and red raspberry tea
Non prescription anti-emetics
-Antihistamines - hydr. - cilzine hydrochloride
- Bismuth subsalicylate ( pepto - bismol) * Acts directly on the gastric mucosa to supress vomiting
◦ Dimenhydrinate (Dramamine)
◦ Cyclizine hydrochloride (Marezine)
◦ Meclizine hydrochloride (Antivert)
◦ Diphenhydramine (Benadryl)
Use/action, S/E, contra, Implication, P/E
Usage: for motion sickness
Cyclizine, Meclizine prevent nausea vomiting and dizziness caused by motion sickness; inhibit vestibular stimulation in the inner ear
Diphenhydramine ( Benadryl) to prevent or alleviate allergic reactions by inhibiting H1 receptor
- side effects ( similar to anticholingerics)
* drowsiness, dry mouth, constipation, NO PEE, NO POO, dizziness, hypotension, tachycardia, blurry vision, palpitation
- Contraindication: Pregnant women in first trimester, hepatic disorder, Glaucoma, hypersensitive=it’s, intolerance to alcohol or tetrazzini
Implication: determine history & factor of vomiting, assess vital signs, bowel sounds, dehydration, I&O, urinalysis before and during therapy
P/E: TAKE 30 MINS BEFORE. No driving ( drowsiness), perform good oral care, avoid alcohol
Prescriptive antihistamines antihistamine anticholingerics dopamine antagonists benodiazepines serotonin antagonists Glucocorticoids Canabinoids (for patients with cancer) Miscellaneous
For cancer Patients: antihistamine anticholingerics dopamine antagonists --------------------------------- -benodiazepines (lams & pams) -serotonin antagonists (PNS similar ) -Glucocorticoids -Canabinoids (for patients with cancer) (act directly on cerebral cortext) -Miscellaneous (act on CTZ) ---------------------------- associated with vomiting antihistamine & anticholingerics ( act directly on V.C & lowers stimulation of the CTZ) serotonin antagonists
Chlorpromazine (Thorazine) -dopamine antagonists & Promethazine HCl (Phenergan) & Hydroxyzine - antihistamine
-end in ZINE
Use/action, S/E, contra, Implication, P/E
- renal PT
NO EPS FOR PROMETHAZINE
other meds: -Butyrophenones (- peridol) - Benzodiazepines (-lams and pams)
-Action: blocks dopamine receptors, (acts primarily on the vomiting center, lowers stimulation of CTZ and vestibular pathway)
-Use: treat PostOp nausea and vomiting resulting from surgery, anesthetics, chemotherapy, and radiation sickness
-SE: drowsiness, dry mouth,blurred vision,tachycardia, anticholinergic symptoms ( dry everything, NO PEE NO POO) moderate sedation, hypotension, EPS, CNS effects (weakness, restlessness)
Conra:GLAUCOMA, hypersensitivity, comatose , prostatic hypertrophy, bladder neck obstruction, severe hypotension, CNS depression, CV, Seziure disorder
Implication: keep patient recumbent for at least 30 minutes following administration to minimize hypotensive effects if given IV, Assess for risk for falls, monitor BP, monitor CBC & liver function & ocular exams periodically( decrease in CBC, increase in liver functions)
P/E: do not skip doses, report symptoms of tardive dyskinesia, change positions slowly, avoid driving or activities requiring alertness before knowing response to medication, use sunscreen and protective clothes when exposed to the sun (may cause temporary pigment change), practice good oral hygiene, do not take within 2 hrs of antacid or antidiarrheal, may turn urine pink to reddish brown color
Serotonin antagonits
ends in -SETRON
-ONDANSETRON (ZOFRAN)
-(granisetron, dolasetron, palonosetron)
Use/action, S/E, contra, Implication, P/E
- DOES NOT BLOCK DOPAMINE & DO NOT HAVE EPS S/E
-Action: Block serotonin receptors in CTZ, Block afferent vagal nerve terminals in upper GI tract -Use: Nausea and vomiting from cancer chemotherapy– induced emesis or emetogenic anticancer drug, pre/postoperative nausea and vomiting
S/E: headaches, diarrhea, dizziness, and fatigue
- Implication: assess for nausea and vomiting as well as abdominal distention, monitor for signs and symptoms of serotonin syndrome. 30 MINS BEFORE CHEMO
- Patient Education: take as directed, immediately report symptoms irregular heartbeat, serotonin syndrome, or involuntary movement of eyes face or limbs
- Contraindications: hypersensitivity, pt with phenylketonuria, congenital QT syndrome, concurrent use of apomorphine
Glucocorticoids ends in -SONE -SOLONE
Dexamethasone & methylprednisolone
ARE NOT ON STUDY GUIDE
use: effective in suppressing emesis associated with cancer chemotherapy
Given IV
Check glucose level
Cannabinoids : dronabinol (Marinol)
*can be used for appetite increase for patients with aids
- Action: inhibition of the vomiting control mechanism in the medulla oblongata
- Use: Nausea and vomiting from chemotherapy
- SE: mood changes, euphoria, drowsiness, dizziness, headaches, depersonalization, nightmares, confusion, incoordination, memory lapse, dry mouth, orthostatic hypotension or hypertension, and tachycardia
- Implication: capsules should be refrigerated, drug may be administered prophylactically 1-3 hours prior to chemo and repeated every 2-4 hrs after chemo
- Patient Education: do not double dose, call for assistance when ambulating (may cause dizziness), change positions slowly to minimize ortho hypotension, do not drink alcohol while taking this drug,
- Contraindications: PT WITH PSYCHIATRIC DISORDER
Miscellaneous diphenidol (vontrol), trimethobenzamide ( Tigan)
NOT ON S.G
- do not act on anti histamine, anti cholinergic, or phenothiazine
use- postop nausea and vomiting, chemotherapy, radiation therapy
Action: suppress impluse to CTZ, block dopamine
S/E: drowsiness, anticholingeric s/s, hypotension, diarrhea, and EPS
Miscellaneous
metoclopramide (Reglan)
- on S.G
- Block DOPAMINE Center
** ‘ya man reglan be making the GI system move along so the tract will be alright”
Action: Suppress impulses to CTZ, Stimulate GI tract
Use: Used in the treatment of postoperative n/v , cancer, chemotherapy, and radiation therapy
- SE: sedation ( drowsiness, restleness, fatigue, lethargy) and diarrhea EPS IN KIDS
- Implication: assess for nausea vomiting and abdominal distention, monitor for tardive dyskinesia, monitor for neuroleptic syndrome(hyperthermia, muscle rigidity, altered consciousness, irregular pulse or BP, tachycardia, and diaphoresis), monitor for signs of depression
- Patient Education: may cause drowsiness, do not drink alcohol while taking this drug,
- Contraindications: GI obstruction, hemorrhage, and perforation,— history of tardive dyskinesia, Parkinson’s, may alter hepatic function , may cause elevated serum prolactin and aldosterone
NURSING PROCESS ANTIEMETICS
Determiine fequency, amount and onset of vomiting
FIND OUT WHY THEY VOMIT NONPHARMALOGIC FIRST
** DONT GIVE TO PT WITH GLAUCOMA
Keep a baseline vitalsigns urinalysis, F/E balance, monitior bowel sounds and provide oral care.
- *Avoid alcohol
- Avoid in first trimester of pregnancy
Emetics
Use of Ipecac vs Activated Charcoal:
-Ipecac is used to induce vomiting whereas Activated Charcoal is used as an absorbent promotes absorption of the poison/ toxic/ overdose substance.
Emetics
–Ipecac
-Use: Induces vomiting after toxic substance
-SE: sedation, diarrhea, aspiration, arrhythmias and MYOCARDITIS
-Nursing implications:
• If vomiting does not occur within 15–30 min, dose may be repeated. If vomiting does not occur after the second dose, give activated charcoal. Also, gastric lavage may be needed if vomiting does not occur.
• PO: Have the patient sit up with their head forward prior to administration. Ipecac syrup may not work on an empty stomach. Administer syrup followed immediately by adequate amounts of water (1 glass [240 mL] for adults, ½–1 glass [120–240 mL] for infants and children).
-Contraindications:
• Unconscious or convulsing patients
• Patients who may not have a gag reflex
• Ingestion of caustic substances ( ammonia, chlorine bleach, lye, toilet cleaners, or battery acid)
• Petroleum distillates are ingested (gasoline, kerosene, paint thinners, and lighter fluid).
• MILK OR CARBONATED
BEVERAGE
—Patient education:
• Use ipecac syrup, not ipecac fluid extract.
• Take with a glass of water, not with milk or carbonated beverage
• Vomiting occurs in 15 to 30 minutes
Emetics
Activated Charcoal
– Action: binds drugs and chemicals in the GI tract
—Use: promotes absorption of the poison/ toxic/ overdose substance.
—SE: Black stools, constipation, diarrhea and vomiting
— Nursing implications:
• Activated charcoal is most effective if administered within 30 min of ingestion of drug or poison.
• Mix dose in 6–8 oz water
• Do not administer with milk products
• Do not administer other oral drugs for 2 hours before or after administering activated charcoal
• Monitor BP, pulse, respiratory and neurologic status, and urine output as indicated by toxicity of agent(s)
—Contraindications: Milk, ice cream, or sherbet will decrease the ability of charcoal to absorb other agents.
—- Patient education:
• Inform the patient that their stools will turn black.
• Poisoning: When counseling, discuss methods of prevention, need to confer with poison control center, physician, or emergency department before administering, and need to bring ingested substance to the emergency department for identification.
Diarrhea
Causes
**priority fluid and electrolyte imbalance
- Spolied foods or excessive spicy food
- Bacteria ( E.coil, Salmonella)
- Viruses
- toxins
- Drug reaction
- fecal impaction, laxative abuse
- Malabsorption disorder
- bowel tumor
- IBD
- stress/ anxiety
Diarrhea
-Nonphrmacologic measures
- Purpose
- Precautions
- clear liquids
- oral solutions ( Gatorade, pedialyte, rehdralyte)
-IV electrolyre solution
( isotonic, hypotonic)
Purpose
-Decrease hypermotility (increased peristalsis)
Precautions
- Do not use for more than 2 days or if fever present
Traveler’ s diarrhea/ Acute diarrhea
- prevention
- Treatment
caused by e.coil
Prevention
-Drinking bottled water, washing fruit, eating cooked vegetables, meat should be well done
Treatment
- Fluoroquinolone antibiotics (if severe)
- Loperamide (slow peristalsis but can also slow excretion of organisms from GI tract)
