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Drugs Affecting The Gastrointestinal System: NURS263 Laxatives

Here are 3 potential responses to the critical thinking questions: 1. Hillary's constipation is likely caused by her poor diet, lack of exercise, and use of antacids. The low-fiber "disaster" diet, sedentary lifestyle, and antacid use can all cause or contribute to constipation. 2. Psyllium would be a good choice for Ira's chronic constipation as a bulk-forming laxative. Instruct him to take it with plenty of water and not with meals to ensure proper hydration and effect. 3. For Drake's constipation, glycerin suppositories are suitable due to their local action on the rectum without systemic absorption. Monitor for pain,

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32 views26 pages

Drugs Affecting The Gastrointestinal System: NURS263 Laxatives

Here are 3 potential responses to the critical thinking questions: 1. Hillary's constipation is likely caused by her poor diet, lack of exercise, and use of antacids. The low-fiber "disaster" diet, sedentary lifestyle, and antacid use can all cause or contribute to constipation. 2. Psyllium would be a good choice for Ira's chronic constipation as a bulk-forming laxative. Instruct him to take it with plenty of water and not with meals to ensure proper hydration and effect. 3. For Drake's constipation, glycerin suppositories are suitable due to their local action on the rectum without systemic absorption. Monitor for pain,

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drinhumb
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Drugs Affecting the Gastrointestinal System

NURS263 Laxatives
2011 SA/DS

Constipation
Is a condition of abnormally infrequent and difficult passage of feces through the lower GI tract Symptom, not a disease Disorder of movement through the colon and/or rectum Can be caused by a variety of diseases or drugs

Causes of Constipation
Metabolic and endocrine disorders
Diabetes, hypothyroidism, pregnancy, hypercalcemia, hypokalemia

Neurogenic disorders
Autonomic neuropathy, multiple sclerosis, spinal cord lesions, Parkinsons disease, CVA (stroke)

Adverse drug effects


Analgesics, anticholinergics, iron supplements, opiates, aluminum antacids, calcium antacids

Causes of Constipation
Lifestyle
Poor bowel movement habits: voluntary refusal to defecate resulting in constipation Diet: poor fluid intake and/or low-residue (roughage) diet, or excessive consumption of dairy products Physical inactivity Psychological factors: stress, anxiety, hypochondria

Laxatives:
Five Main Groups:
Bulk-forming Emollients- Fecal Softners and Lubricants Hyperosmotic Saline Stimulant/Contact

Laxatives: Mechanism of Action


Bulk-Forming
High fiber Absorbs water into the intestine to increase bulk Distends bowel to initiate reflex bowel activity (defecation)

Examples:

psyllium (Metamucil)

*MUST BE TAKEN WITH LOTS OF WATER*

Laxatives: Mechanism of Action


Emollients
Stool softeners and lubricants Prevents the absorption of water Promotes more water and fat to be absorbed into the stools Lubricates the fecal material and intestinal walls

Examples:
Stool softeners: docusate salts (Colace, Surfak) Lubricants: mineral oil (Agarol Plain)

Laxatives: Mechanism of Action


Hyperosmotic
Increase fecal water content Result: bowel distention, increased peristalsis, and evacuation

Examples:
polyethylene glycol (GoLYTELY), glycerin, lactulose (Cephulac)

*SITE OF ACTION IS ONLY THE LARGE INTESTINE*

Laxatives: Mechanism of Action


Saline
Increases osmotic pressure on the small intestinal walls by inhibiting absorption of water, causing more water to enter the intestines Increases water and electrolyte secretions Result: bowel distention, increased peristalsis, and evacuation (watery stools)

Examples:
magnesium hydroxide , Milk of Magnesia (MOM), magnesium citrate, Fleet Enema

Laxatives: Mechanism of Action


Stimulant/Contact
Increases peristalsis via intestinal nerve stimulation Results in increased peristalsis Increased fluid into colon increases bulk and softens stool
Examples: bisacodyl (Dulcolax), senna, cascara sagrada

*CAUSES DEPENDENCE*

Laxatives: Therapeutic Uses


Group
Bulk-forming Emollients

Use
Acute and chronic constipation Irritable bowel syndrome (IBS) Diverticulosis Acute and chronic constipation Softening of fecal impaction Facilitation of BMs in anorectal conditions (hemorrhoids)

Laxatives: Therapeutic Uses


Group
Hyperosmotic

Use
Chronic constipation Diagnostic and surgical preps Constipation Diagnostic and surgical preps Removal of helminths/parasites Acute constipation Diagnostic & surgical bowel preps

Saline

Stimulant/Contact

Laxatives: Side Effects


Group
Bulk-forming Emollient

Side Effects
Impaction and fluid overload, esophageal blockages, gas Skin rashes, decreased absorption of vitamins (A, D, E, K) Abdominal bloating, rectal irritation, diarrhea (dose related)

Hyperosmotic

Laxatives: Side Effects


Group
Saline Stimulant

Side Effects
Magnesium toxicity (with renal insufficiency), cramping, diarrhea, increased thirst Nutrient malabsorption, skin rashes, gastric irritation, rectal irritation, discolored urine

Laxatives: Side Effects

All laxatives can cause electrolyte imbalances!!!

Laxatives: Nursing Implications


Obtain a thorough history of presenting symptoms, elimination patterns, and allergies. Assess fluid and electrolytes before initiating therapy. Patients should not take a laxative or cathartic if they are experiencing nausea, vomiting, and/or abdominal pain.

Laxatives: Nursing Implications


* Long-term use of laxatives often results in decreased bowel tone and may lead to dependency. * A normal bowel pattern does not necessarily mean a daily movement. All laxative tablets should be swallowed whole, not crushed or chewed, especially if enteric-coated.

Laxatives: Nursing Implications


Patients should take all laxative tablets with AT LEAST 6 to 8 ounces of water. Patients should take bulk-forming laxatives as directed by the manufacturer with at least 240 mL (8 ounces) of water. Taken with NO food and taken immediately after mixing.

Laxatives: Nursing Implications


Bisacodyl and cascara sagrada should be given with water due to interactions with milk, antacids, and H2 blockers. Patients should contact their physician if they experience severe abdominal pain, muscle weakness, cramps, and/or dizziness, which may indicate possible fluid or electrolyte loss.

Laxatives: Nursing Implications


Can be many interactions due to the altered intestinal function. Monitor for therapeutic effect.

Laxatives: Nursing Implications


Encourage lifestyle changes to combat acute/chronic constipation:
High fiber diet Increase fluid intake Healthy diet Exercise and activity

Critical Thinking Question


Hillary has come to the clinic complaining of constipation. During your assessment she mentions that she recently started Humber College and hasnt had time lately to keep up her usual exercise regimen--and her diet is a disaster. She says that on some days, all she has time to do is grab a milkshake at Java Jazz. She also tells you she has been taking antacids for heartburn. What might be causing Hillarys constipation?

Critical Thinking Question


Ira, a 45-year-old accountant, has chronic constipation. A) What are the advantages of the bulk-forming laxatives in treating Ira? B) He has been prescribed psyllium. What instructions will you give him regarding its administration?

Critical Thinking Question


Mr. Granger has been given a polyethylene glycol agent as part of his preparation for bowel surgery. He asks you how long it will take for the medication to work. A) What is your response? B) Two hours later Mr. Granger is concerned because he still has diarrhea. What should you do?

Critical Thinking Question


Jennifer is a 20-year-old student who has come to the clinic complaining of a rash. During your assessment you discover that she has been using ExLax this semester to lose weight. What do you tell Jennifer?

Critical Thinking Question


Drake is a 5-year-old boy with constipation. The physician has ordered treatment with glycerin suppositories. A) Why is glycerin a good choice for Drake? B) What adverse effects will you monitor for?

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