drugs that act by coating the wall of the GI tract and absorbing bacteria or toxins that cause diarrhea (EX: kaolin, pectin, Pepto-Bismol)
Adsorbents
the active ingredients in marijuana approved for clinical use to alleviate nausea & vomiting resulting from cancer treatment
Cannabinoids
drugs used to eliminate fecal matter; “laxative”
Carthartics
cerebral center lying near the medulla that causes vomiting when stimulated
Chemoreceptor Trigger Zone (CTZ)
drugs that act as lubricants and stool softeners used to prevent constipation
Emollients
“hyperolmolar laxatives” including salts or saline products, lactulose, and glycerin
Osmotics
“harsh” carthartics that cause water stool with abdominal cramping
Purgatives
drugs that promote ulcer healing by neutralizing hydrochloric acid and reducing pepsin activity; do not coat the ulcer; two types: systemic & nonsystemic
Antacids
thick, viscous, mucous material that provides a barrier between the mucosal lining and acidic gastric secretions; maintains the integrity of the gastric lining and is a defense against corrosive substances
Gastric Mucosal Barrier (GMB)
ulcer frequently occurring because of breakdown of the GMB
Gastric Ulcer
ulcer caused by hypersecretion of acid from the stomach passing into the duodenum because of (1) insufficient buffers to neutralize gastric acid in the stomach (2) defective pyloric sphincter or (3) hypermotility of the stomach
Duodenal Ulcer
inflammation or erosion of the esophageal mucosa caused by a reflux of gastric acid content from the stomach into the esophagus
Gastroesophogeal Reflux Disease (GERD)
popular drugs used in the treatment of gastric and duodenal ulcers that block the H2 receptors of the parietal cells in the stomach, thus reducing gastric acid secretion and concentration (EX: ranitidine, cimetidine, axid)
Histamine2 Receptor Antagonists (H2 Blockers)
acid released by the parietal cells of the stomach influenced by histamine, gastrin & acetylcholine
Hydrochloric Acid
broad term used for an ulcer occurring in the esophagus, stomach or duodenum within the upper GI tract
Peptic Ulcer
ulcer resulting from the reflux of acidic gastric secretions into the esophagus as a result of a defective or incompetent cardiac sphincter
Esophageal Ulcer
digestive enzyme activated at a pH of 2
Pepsin
ulcer following a critical situation such as extensive trauma or major surgery (burns, cardiac surgery)
Stress Ulcer
Nonpharmacological Management Techniques for Upper GI Disorders
Lifestyle changes!!!, low-fat food, increased exercise, eliminate alcohol, avoid chocolate, avoid caffeine, elevate HOB on blocks
vitamin required for development & maintenance of healthy eyes, gums, teeth, skin, hair & selected glands…needed for fat metabolism…in fortified milk, butter, eggs, leafy green & yellow veggies & fruits…naturally only in cod, halibut, shark & tuna…deficiency= dry skin, poor tooth development, night blindness
Vitamin A (Retinol)
vitamin that promotes use of sugars (energy) & required for good function of nervous system & heart…in enriched breads/cereals, yeast, liver, pork, fish, milk, lentils, blackstrap molasses…deficiency= sensory disturbances, retarded growth, fatique, anorexia, Wernicke encephalopathy (alcohol abuse)
Vitamin B1 (Thiamine)
vitamin that promotes body’s use of carbs, proteins & fats by releasing energy to cells & required for tissue integrity…in milk, enriched breads/cereals, liver, lean meat, eggs, almonds, wheat germ, soy, leafy green veggies…deficiency= visual defects (blurred vision & photophobia), cheilosis, rash on nose, extremity numbness
Vitamin B2 (Riboflavin)
vitamin important in metabolism, protein synthesis, & formation of RBC…in lean meat, leafy green veggies, whole-grain cereals, yeast, bananas, salmon, soybeans, seeds, nuts, avacados, carrots…deficiency= neuritis, convulsions, dermatitis, anemia, lymphopenia
Vitamin B6 (Pyroxidine)
vitamin that functions as a building block of nucleic acids, forms RBC & facilitates functioning of nervous system…in liver, kidney, fish, milk, eggs, chicken, turkey…deficiency= GI disorders, poor growth, anemias (pernicious anemia) vegetarians
Vitamin B12 (Cobalamin)
vitamin that helps in formation of genetic materials & proteins for the cell nucleus, assists in intestinal functioning & prevents selected anemias…in leafy green veggies, yellow fruits/veggies, yeast, organ meats, black-eyed peas, lentils…deficiency= decreased WBC & clotting factors, anemias, intestinal disturbances, depression (400 mcg/day in pregnancy)
Folic Acid (Folvite)
vitamine that promotes body’s use of carbs, fats & proteins for the cell nucleus and is essential in formation of specific hormones & nerve-regulating substances…in eggs, leafy green veggies, nuts, liver, kidney, skim milk, seeds, nuts, wheat germ, salmon…deficiency= unknown in humans
Pantothenic Acid
vitamin in all body tissues necessary for energy-producing reactions and assists in nervous system…in eggs, meat, liver, beans, peas, enriched bread/cereals…deficiency= retarded growth, pellagra, HA, memory loss, anorexia, insomnia
Niacin
vitamin that synthesizes fatty acids & glucose for energy production and required by body chemical systems…in eggs, milk, leafy green veggies, liver, kidney…deficiency= unknown in humans
Biotin
vitamin that helps tissue repair & growth and required in formation of collagen…in citrus fruits, cantaloupe, tomatoes, leafy green veggies, sweet red peppers, potatoes, strawberries, kiwi…deficiency= poor wound healing, bleeding gums, scurvy, predisposition to infection
Vitamin C (Ascorbic Acid)
vitamin that promotes the use of phosphorus & calcium and important for strong teeth & bones…in fortified milk, egg yolk, tuna, salmon, liver…deficiency= Rickets in children, osteomalacia in adults
Vitamin D (Calciferol)
vitamin that protects fatty acids & promotes formation and functioning of RBC, muscle, other tissues…in whole grain cereals, wheat germ, veggie oils, lettuce, sunflower seeds, milk, eggs, meat, avocados, asparagus…deficiency= breakdown of RBC
Vitamin E (Alpha-Tocopherol)
vitamin essential for blood clotting…in leafy green veggies, liver, cheese, egg yolk, veggie oil, tomatoes…deficiency= increased clotting time, leading to increased bleeding & hemorrhage
Vitamin K
Categories for Justification of Vitamin Supplements
malabsorption, diarrhea, infectious dx, chronic dx (Chron’s, celiac), inability to use vitamins (liver dx, renal dx, hereditary deficiencies), increased vitamin loss (fever from infection, hyperthyroidism, dialysis, cancer, starvation, crash diets), increased vitamin requirements (pregnancy, early childhood, cancer, alcoholism, GI surgery, special diets)
Fat-Soluble Vitamins
K.A.D.E…slowly metabolized, stored in fatty tissue, liver & muscle
mineral that is vital for hemoglobin formation (60% is found in hemoglobin)…in meat, fish, poultry, grains, veggies…increased doses needed during pregnancy…deficiency= fatigue, intolerance to cold, pale skin, anemia
Iron
Non-Heme Iron Absorption is Impaired By?
taking with coffee, tea, calcium, dried peas, rice, spinach, berries & cholocate
Non-Heme Iron Absorption is Enhanced By?
taking with vitamin C rich foods (OJ or tomato products)
Ususal Dose of Ferrous Sulfate (Iron)
325 mg daily…PO, IM or IV
mineral that is a component of hemoglobin synthesis, wound healing, excess amounts = Wilson’s dx
Copper
mineral that helps with common cold, excess= copper deficiency
Zinc
mineral that enhances the action of insulin…helps with diabetes & weight loss
Chromium
mineral that is an antioxidant…excess= garlic odor
Selenium
the most plentiful mineral in the body responsible for bone & teeth formation, blood clotting & nerve transmission…RDA 1000-1500 mg/day…in milk, cheese, yogurt, fortified OJ, almonds
Calcium
calcium supplement that is least expensive & is better absorbed when taken with food
Calcium Carbonate
calcium supplement that contains citric acid which is better absorbed in elderly people, less likely to cause constipation & better absorbed in empty stomach
Calcium Citrate
Nursing Interventions for IV Calcium
(1) assess renal fxn prior to administration (2) SLOW IV infusion (3) close pt. monitoring (4) monitor IV site
the most common intracellular cation that is poorly stored in the body but is necessary for the transmission of nerve impulses & contract of the heart, skeletal & smooth muscles…RDA 40-60 mEq/day
Potassium
Reasons Patients Need Potassium Supplements
(1) on antibiotics (PCN) (2) taking K+ wasting diuretics (thiazides, loop diuretics)
Treatment for Hypokalemia
PO: liquid, powder or tablet that is irritating to stomach so give with full glass of fluid…IV: NEVER GIVE PUSH, ALWAYS DILUTE
Treatment for Hyperkalemia
K+ restriction, IV sodium bicarbonate, 10% calcium gluconate, insulin/glucose, kayexelate (PO or rectal enema)
Treatment for Hyponatremia
H2O restriction, 0.9% normal saline for mild case, 3% saline for levels of <115 mEq/L
Symptoms of Hypernatremia
FIRED! = Fever, Flushed Skin, Restless, Increased fluid retention, Increased BP, Edema, Decreased urinary output, Dry mouth
Treatment of Hypernatremia
dietary restrictions (2 of 4 gm/day)
electrolyte that promotes transmission of neuromuscular activity & contraction of myocardium
Magnesium
Treatment of Hypermagnesemia
calcium gluconate
Treatment of Hypomagnesemia
IV Mg sulfate
enteral feeding that is lactose free
Isocal
enteral feeding that is high in protein
Ultracal
enteral feeding that is high in fiber
Jevity
enteral feeding that is for diabetics
Glucerna
enteral feeding that is for respiratory patients
Pulmocare
Advantages of Continuous Enteral Feeding
improve tolerance, reduce risk of aspiration, increased time for nutrient absorption
Disadvantages of Continuous Enteral Feeding
restricts ambulation, more expensive
enteral feeding administered at specified times throughout the day generally in smaller volumes & at slower rate thatn bolus feedings but in larger/faster volumes than continuous drip feedings
Intermittent Enteral Feeding
enteral feeding administered via continuous drip over a period of 8-16 hrs usually nocturnally
Cyclic Enteral Feeding
ALERT Campaign for Enteral Safety
Aseptic technique, Label enteral equipment, Elevate HOB 30 deg, Right patient/formula/tube, Trace all lines/tubing back to patient
least desirable method of supplying nutrients to the body via IV for severe GI disturbances & patients unable to meet nutritional requirements…must be given over 24 hours & patient must be weaned off
Total Parenteral Nutrition (TPN)
line used to give isotonic or mildly hypertonic solutions during administration of TPN
PICC Line
line used when large amount of carbs are given through subclavian or internal jugular veins
Central Venous Catheter
Potential Complications of TPN
Pneumothorax, Air embolism, Hyper/Hypoglycemia, Hypervolemia, Infection
herb used for external pain relief & burn relief, constipation…S/E= arrythmias neuropathies, edema
Aloe Vera
herb used for digestive complaints, sedative effects…S/E= urticaria, bronchoconstriction if allergic to daisy or ragweed
Chamomile
herb used as all-purpose woman’s tonic frequently mixed with fillers (vit B12)
Don Quai
herb that stimulates immune system used for colds, flu, recurrent URI & UTI…hepatoxic
Echinacea
herb that detoxifies & increased immune fxn, decreases platelet aggregation used for hypercholesterolemia & mild HTN
Garlic
herb used to stimluate digestion, as antispasmodic, to decrease platelet aggregation
Ginger
herb used as antioxidant, peripheral vasodilator & increased blood flow to CNS, helps with memory, decreased platelet aggregation
Ginkgo Biloba
herb used as antidepressant, antiviral, for anxiety, sleep disorders…drug interactions with transplant meds & antidepressants, not for HIV patients
St. John’s Wort
herb that increases liver cell regeneration, slows cirrhotic disease, increases quality of life
Milk Thistle
herb used at mild sedative and sleep-inducing agent, “herbal valium” for anxiety…has dirty sock odor
Valerian
herb that decreases size of prostate, “plant catheter”
Saw Palmetto
act that classified herbs as “dietary supplements”, made premarket testing not required, clarified marketing regulations…made no claims about prevention or curing of specific diseases
Dietary Supplement Health & Education Act of 1994
group of harmful chemicals
free radicals
used as a measurement of the concentration of IV solutions compared with the osmolality of body fluids
Tonicity
another name of total parenteral nutrition (TPN)
Hyperalimentation (HA)