Pharm chapter 34 Nursing Considerations for Bowel Health

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Questions and Answers

What is the primary recommendation for someone experiencing diarrhea after travel?

  • Stop taking Imodium and consult a healthcare provider. (correct)
  • Take Kaopectate to relieve symptoms.
  • Ignore the symptoms if no fever is present.
  • Continue as normal and hydrate.

Which type of medication is safest for a patient recovering from a myocardial infarction to prevent straining during defecation?

  • Emollients
  • Stimulants
  • Bulk-forming laxatives
  • Stool softeners (correct)

In assessing an older adult with continuous stooling, what is the nurse's priority assessment?

  • Determine signs of an infection.
  • Evaluate for laxative abuse.
  • Review the history of gastrointestinal disease.
  • Assess for an impaction. (correct)

Why should over-the-counter medications not be used excessively for diarrhea?

<p>They can mask underlying infections. (D)</p> Signup and view all the answers

Which product could potentially exacerbate a patient's straining during defecation after a myocardial infarction?

<p>Bulk-forming laxatives (D)</p> Signup and view all the answers

What symptom is most indicative of a possible fecal impaction in a patient with continuous stooling?

<p>Smearing of stool on undergarments (C)</p> Signup and view all the answers

For a patient with diarrhea and no fever, what is the most appropriate course of action?

<p>Monitor hydration and wait to see if symptoms persist. (D)</p> Signup and view all the answers

What is a nursing consideration regarding the use of stimulants for bowel movement?

<p>They can cause abdominal cramps and straining. (B)</p> Signup and view all the answers

Which symptom is indicative of lactase deficiency?

<p>Diarrhea (B)</p> Signup and view all the answers

What should a patient using morphine for pain control understand to prevent constipation?

<p>Stool softeners should be taken consistently during opioid use. (A)</p> Signup and view all the answers

What is the primary mechanism of action for stimulant laxatives?

<p>They irritate the intestine to promote evacuation. (A)</p> Signup and view all the answers

How does the intake of psyllium impact digoxin absorption?

<p>Increases digoxin absorption. (D)</p> Signup and view all the answers

Which laxative works by increasing bulk and promoting intestinal movement?

<p>Bulk-producing laxative (B)</p> Signup and view all the answers

Why can't hydration alone prevent constipation in patients on opioids?

<p>Individual hydration needs vary, and those on opioids still require other measures. (D)</p> Signup and view all the answers

What should be noted about the effects of laxatives for patients who have opioid prescriptions?

<p>Stool softeners are recommended while using opioids. (D)</p> Signup and view all the answers

What symptom is least likely to be associated with digestive enzyme deficiencies?

<p>Constipation (C)</p> Signup and view all the answers

What instruction should be given when administering psyllium to optimize its effectiveness?

<p>Administer with a full glass of water. (D)</p> Signup and view all the answers

Which of the following describes the action of lactulose, an osmotic laxative?

<p>It draws water into the intestine and stimulates defecation. (B)</p> Signup and view all the answers

Which medication should be prescribed for a patient with opioid-induced constipation when laxatives have failed?

<p>Methylnaltrexone (A)</p> Signup and view all the answers

What adverse effect of lactulose should a nurse report immediately to the healthcare provider?

<p>Abdominal tenderness (A)</p> Signup and view all the answers

When should psyllium be administered in relation to digoxin or nitrofurantoin?

<p>At least 1 hour before or 2 hours after administration. (A)</p> Signup and view all the answers

Which instruction regarding diet should be avoided when a patient is taking psyllium?

<p>Limit high-fiber food consumption. (D)</p> Signup and view all the answers

What common adverse effect should a nurse expect in a patient taking lactulose?

<p>Flatulence (D)</p> Signup and view all the answers

What is a precaution to take when administering bulk-forming laxatives like psyllium?

<p>Ensure the medication is dispersed with enough liquid. (A)</p> Signup and view all the answers

Which dietary factors can lead to constipation?

<p>A diet low in fiber and/or residue (B)</p> Signup and view all the answers

What symptoms are indicative of dehydration?

<p>Increased hemoglobin and hematocrit (C)</p> Signup and view all the answers

Which laxatives are considered safe for infants?

<p>Bulk-forming laxatives (B)</p> Signup and view all the answers

In which scenario is the use of antidiarrheal medication appropriate?

<p>A patient with diarrhea of sudden onset lasting 3 days (D)</p> Signup and view all the answers

Which of the following may lead to constipation in patients?

<p>Use of morphine (C)</p> Signup and view all the answers

What might you observe in a patient experiencing signs of dehydration?

<p>Nonelastic skin turgor and delayed capillary filling (B)</p> Signup and view all the answers

Which recommendation is unsuitable for managing constipation in infants?

<p>Stimulant laxatives (A)</p> Signup and view all the answers

Which condition does not warrant treatment with an antidiarrheal?

<p>Mild diet-induced gastrointestinal upset (C)</p> Signup and view all the answers

Which type of laxative is considered the safest for routine use, particularly for older patients, due to its ability to increase stool bulk and stimulate peristalsis?

<p>Bulk forming (D)</p> Signup and view all the answers

A pregnant patient is experiencing constipation due to her enlarging uterus and prenatal vitamin intake. Which type of laxative would be the most appropriate choice for her?

<p>Lubricant laxative (B)</p> Signup and view all the answers

A patient reports using loperamide (Imodium) for persistent diarrhea for a week after returning from a trip abroad. What is the nurse's best response?

<p>Advise the patient to consult a healthcare provider to determine the cause of the diarrhea. (D)</p> Signup and view all the answers

Which of the following is a characteristic of normal bowel elimination?

<p>Regular bowel elimination pattern of soft stool (C)</p> Signup and view all the answers

Which type of laxative is contraindicated for patients with inflammation of the gastrointestinal tract?

<p>Stimulant (C)</p> Signup and view all the answers

Which of the following conditions would make the use of laxatives contraindicated?

<p>Appendicitis (A)</p> Signup and view all the answers

Which of the following groups of patients can generally use laxatives and stool softeners regularly?

<p>Geriatric patients (B)</p> Signup and view all the answers

Which type of laxative is not considered a laxative?

<p>Fecal softener (A)</p> Signup and view all the answers

Flashcards

Normal bowel elimination

Stools that are soft and occur on a regular schedule for the patient.

Lubricant laxative

Laxative type recommended for pregnant patients with constipation.

Contraindication for laxatives

Condition that prevents safe use of laxatives, e.g. appendicitis.

Bulk-forming laxatives

Safest laxative choice for regular use, increases stool bulk.

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Stimulant laxatives

Laxatives that stimulate bowel contractions but can cause cramping.

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Emollient laxatives

Laxatives that soften stool but may reduce muscle tone over time.

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Signs of normal bowel habits

Daily movements or regular soft stools corresponding to an individual.

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Safety for laxative use

Certain populations like pregnant women should use selected laxatives cautiously.

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Lactase deficiency symptom

Patients with lactase deficiency commonly exhibit diarrhea due to undigested lactose.

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Opioid use and constipation

Constipation is a side effect of opioid medications, requiring stool softeners during use.

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Stimulant laxative mechanism

Stimulant laxatives irritate the intestine to promote peristalsis and bowel evacuation.

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Psyllium effect with digoxin

Psyllium can affect the absorption of digoxin, impacting its effectiveness.

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Hydration and constipation

Adequate hydration may help in preventing constipation but alone is often insufficient during opioid use.

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Role of stool softeners

Stool softeners should be used regularly when taking constipating medications like opioids.

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Laxative types

Different laxatives serve various functions: stimulant, saline, lubricant, and bulk-forming.

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Enemas as intervention

Enemas are used as an intervention rather than a preventative measure for constipation.

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Kaopectate

Over-the-counter medication containing bismuth subsalicylate for diarrhea.

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Myocardial Infarction Care

Patients recovering from a heart attack should avoid straining during bowel movements.

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Stool Softeners

Medications that help prevent straining during defecation, especially post-surgery or heart attack.

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Bowel Impaction

A condition where hardened stool blocks the bowel, often seen in patients with continuous stooling.

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Signs of Infection

Symptoms indicating a possible infection in the intestinal tract, requiring immediate care.

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Laxative Abuse

Excessive use of laxatives leading to dependency and potential complications.

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GI Disease History

Previous gastrointestinal issues that may affect current health assessments.

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Fluid Intake Importance

Staying hydrated is crucial during diarrhea to prevent dehydration.

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Causes of constipation

Factors like low fiber diet, iron supplements, or medications.

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Symptoms of dehydration

Indicators include increased hemoglobin, confusion, and nonelastic skin.

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Fluid intake impact

Inadequate fluids can lead to constipation symptoms.

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Safe laxative for infants

Bulk-forming laxatives and malt soup extract are appropriate.

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Signs of dehydration in older adults

Confusion and nonelastic skin are common signs.

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Antidiarrheal indication

Used for sudden diarrhea lasting more than 3 days.

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Inappropriate laxatives for infants

Saline and stimulant laxatives can be risky.

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Chronic diarrhea in elderly

Antidiarrheal may be needed for chronic or sudden episodes.

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Psyllium Administration

Psyllium should be mixed with a full glass of water before taking.

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Psyllium Interaction

Psyllium can inhibit absorption of certain medications like digoxin.

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Osmotic Laxatives

Lactulose draws water into the intestine, promoting bowel movement.

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Methylnaltrexone Use

Methylnaltrexone is used for opioid-induced constipation in advanced illness.

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Serious Adverse Effect of Lactulose

Abdominal tenderness may signal acute abdomen and is serious.

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Ineffective Laxative Therapy

If laxatives don’t work for constipation, consider using methylnaltrexone.

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Psyllium and Juice

Psyllium can be mixed with juice for easier administration.

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Common Adverse Effects of Lactulose

Nausea, flatulence, and abdominal spasms are commonly reported effects.

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Study Notes

Multiple Choice Questions

  • Normal Bowel Elimination: A regular pattern of soft stools, eliminated on a regular schedule.
  • Constipation in Pregnancy: Lubricant laxatives are often the best choice due to reduced cramping and potential electrolyte issues with other types.
  • Contraindicated Laxatives: Laxatives are contraindicated for patients with GI tract inflammation (e.g., appendicitis, gastritis, colitis).
  • Laxatives for Older Adults: Bulk-forming laxatives are generally safer for older adults, especially those with end-stage Alzheimer's.
  • Loperamide Use: If diarrhea persists for more than a week, consult a healthcare professional as it may indicate an infection.
  • Myocardial Infarction & Defecation: Stool softeners prevent straining during defecation when a patient has a myocardial infarction.
  • Emergency Department Presentation: Abdominal tenderness, continual stooling, and undergarments smeared with stool indicate an impaction as the priority concern rather than infection.

Laxative Types and Mechanisms

  • Stimulant Laxatives: Irritate the intestines directly, promoting peristalsis and evacuation.
  • Bulk-Forming Laxatives: Increase stool bulk, stimulate peristalsis by causing water retention within the stool.
  • Osmotic Laxatives: Draw water into the intestines, facilitating the passage of feces.
  • Lubricating Laxatives: Lubricate the intestinal walls and soften the stool.
  • Combination of Factors: Issues like diet, dehydration and medicine interaction all contribute to constipation.

Medication Interactions

  • Psyllium and Digoxin: Psyllium may decrease the absorption of digoxin, thus separate administration by at least an hour is recommended.
  • Laxatives and Opioids: Stool softeners should be continued for patients taking opioid pain medications to prevent constipation.
  • Opioid-induced Constipation: Methylnaltrexone is the treatment of choice for patients with opioid-induced constipation resistant to other laxatives.

Patient Education

  • Preventing Constipation: Adequate hydration and stool softeners are crucial for patients receiving opioid pain medication.
  • Opioid Use: Stool softeners should be initiated and continued as long as constipating medications are being taken.
  • Diet and Laxatives: A diet lacking in fiber and/or residue can cause constipation.

Patient assessment & Symptoms

  • Constipation: Symptoms may include excessive thirst, decreased urine specific gravity, mental confusion, and decreased elasticity of the skin.
  • Dehydration: Symptoms include mental confusion, excessive thirst, periorbital edema, elevated blood pressure and nonelastic skin turgor.
  • Infectious Diarrhea: Long-term use of antidiarrheal medication is not recommended for this type of diarrhea.
  • Medication-induced Diarrhea: Symptoms such as abdominal spasms and flatulence are common and are generally not a concern for immediate action by the nurse.
  • Abdominal tenderness: Abdominal tenderness is a serious, potentially acute, symptom and should be promptly reported.

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