Antinausea, Antiemetic & Nutrition Supplementation Nursing Slides PDF

Anti-nausea, Anti-emetic, Nutrition Supplementation NUR 2403 – Week 5 Housekeeping Questions from last week Review of quiz Kaplan reminder Ontario College Student Experience Survey Nausea and Vomiting Chemoreceptor trigger zone send signal to Vomiting Centre Signal a noxious stimuli A...

Anti-nausea, Anti-emetic, Nutrition Supplementation NUR 2403 – Week 5 Housekeeping Questions from last week Review of quiz Kaplan reminder Ontario College Student Experience Survey Nausea and Vomiting Chemoreceptor trigger zone send signal to Vomiting Centre Signal a noxious stimuli Ach, D2, H1, PG, S (5-HT3) Sites of Action of Selected Antinausea Drugs Antiemetics and Antinausea Drugs Anticholinergic drugs Antihistamines (H1 receptor blockers) Antidopaminergic drugs Prokinetic drugs Serotonin blockers Tetrahydrocannabinoids Antiemetics and Antinausea Drugs: MOA Many different mechanisms of action Most work by blocking one of the vomiting pathways Antihistamine drugs (H1 receptor blockers) Inhibit acetylcholine by binding to H1 receptors Prevent cholinergic stimulation in vestibular and reticular areas Motion sickness, nonproductive cough, allergy symptoms, sedation dimenhydrinate (Gravol®), diphenhydramine (Benadryl®) Hydroxyzine never IV – tissue damage, thrombosis, gamgrene Antidopaminergic drugs Block dopamine receptors in the chemoreceptor trigger zone Also used for psychotic disorders, intractable hiccups prochlorperazine (Proclorazine®), promethazine hydrochloride (Histanil®) promethazine given po or IM (IV can enter intra-arterial and cause amputation) Anticholinergic drugs (Ach blockers) Bind to and block acetylcholine receptors in the inner ear labyrinth Block transmission of nauseating stimuli to CTZ scopolamine Contraindicated in glaucoma Prokinetic drugs Block dopamine receptors in the CTZ Cause CTZ to be desensitized to impulses it receives from the GI tract Stimulate peristalsis in GI tract, enhancing emptying of stomach contents Also used for gastroesophageal reflux disease, delayed gastric emptying metoclopramide Serotonin Blockers Block serotonin receptors in the GI tract, CTZ, and vomiting centre Chemotherapy and postoperative nausea and vomiting ondansetron (Zofran®), palonosetron (Aloxi®) Risk of dysrhythmia increases with IV ondansetron up to 8mg can be given IV push over 5 minutes Tetrahydrocannabinoids MOA Major psychoactive substance in cannabis Inhibitory effects on reticular formation, thalamus, cerebral cortex Alter mood and body’s perception of its surroundings, which may help relieve nausea and vomiting Chemotherapy and for anorexia associated with weight loss in acquired immune deficiency syndrome (AIDS) patients Miscellaneous Antinausea Drugs aprepitant doxylamine succinate and pyridoxine hydrochloride Antihistamine + vitamin B6 Used for morning sickness Herbal Products: Ginger Adverse effects Anorexia, nausea and vomiting, skin reactions Drug interactions May increase absorption of oral medications Increase bleeding risk with anticoagulants Nursing Implications Many of these drugs cause severe drowsiness; warn patients about driving or performing any hazardous tasks. Taking antiemetics with alcohol may cause severe central nervous system depression. Teach patients to change positions slowly to avoid hypotensive effects. For chemotherapy, antiemetics are often given 30 to 60 minutes before chemotherapy begins. Question A patient tells the nurse that he takes ginger almost every day for nausea. It is most important for the nurse to determine if the patient is taking which medication? A. furosemide (Lasix®) B. acetaminophen (Tylenol®) C. warfarin (Coumadin®) D. calcium supplements Tube Feeding Routes Enteral Nutrition Feeding tubes are used for those with: Abnormal esophageal or stomach peristalsis Altered anatomy secondary to surgery Depressed consciousness Impaired digestive capacity Elemental Polymeric Modular (carbohydrate, fat or protein formulations) Altered amino acid formulations Impaired glucose tolerance Elemental Peptamen®, Vital HN®, Vivonex Plus®, Vivonex® T.E.N. Minimal digestion needed; residual is minimal. Used for malabsorption, partial bowel obstruction, irritable bowel disease, other conditions Hyperosmolarity of formulas may cause gastrointestinal problems. Polymeric Complete®, Ensure®, Ensure Plus®, Isocal®, Osmolite®, Portagen®, Jevity®, Sustacal® Preferred over elemental formulations for patients with fully functional GI tracts and few specialized nutrient requirements; cause fewer gastrointestinal problems Most closely resemble normal dietary intake. Modular Three types Carbohydrate: Moducal®, Polycose® Fat: MCT Oil®, Microlipid® Protein: Beneprotein®, ProMod® Single-nutrient formulas Intended for use with monomeric or polymeric formulations Altered Amino Acid Amin-Aid®, Primene®, TwoCal®, TwoCal HN®, Travasol® Contain varying amounts of specific amino acids Used for patients with diseases associated with altered metabolism capacities Impaired Glucose Tolerance Glucerna Contains proteins, carbohydrates, fat, sodium, potassium Used in patients with impaired glucose tolerance (e.g., diabetes) Enteral Nutrition: Adverse Effects Gastrointestinal intolerance: diarrhea Dumping syndrome nausea, weakness, sweating, palpitations, syncope, sensations of warmth, and diarrhea Aspiration pneumonia Nursing Implications If administering enteral nutrition by tube feedings, follow facility policy for ensuring proper tube placement and for checking residual volumes before administering a feeding. Follow procedures for flushing tubing to prevent clogging the feeding tube with formula. Carefully monitor how the patient is tolerating enteral feedings. Keep in mind that most enteral feedings are started slowly, and the rate is increased gradually. Monitor for signs of lactose intolerance. Parenteral Nutrition Totally digested nutrients are given intravenously The entire GI system is bypassed, eliminating the need for absorption, metabolism, and excretion. ‘Hyperalimentation’ or total parenteral nutrition (TPN) Formulations vary according to individual patient nutritional needs. Calories, Amino acids, Carbohydrates, Fats, Trace Elements, Vitamins, Minerals TPN Parenteral Nutrition: Peripheral vs. Central Peripheral TPN Temporary, short term (less than 2 weeks) Dextrose concentration less than 10% Central TPN Long-term use (longer than 7 to 10 days) Dextrose concentrations may be 10 to 50% but are commonly 25 to 35%. Peripheral Total Parenteral Nutrition Used to provide nutrients than present oral intake can provide Indicated for: Procedures that restrict oral feedings Anorexia caused by chemotherapy or radiation treatments Gastrointestinal illnesses that prevent oral food intake Postsurgical patients When nutrition deficits are minimal but oral nutrition will not be started for more than 5 days Phlebitis risk high Central Total Parenteral Nutrition Delivered through a large central vein Subclavian Internal jugular Long-term use (more than 7 to 10 days) Risks associated with central line insertion, use, and maintenance. Catheter-induced trauma, metabolic alterations Infection Greater chance for hyperglycemia because of the larger and more concentrated volumes given Nursing Implications: TPN Follow facility policies and procedures for care and maintenance of TPN IV lines, including tubing and dressing changes. Monitor patient’s temperature; report any increase immediately. Monitor blood glucose levels with a glucometer. Watch for and monitor for hyperglycemia. Headache, dehydration, weakness Watch for and monitor for hypoglycemia. Cold, clammy skin; dizziness; tachycardia; tingling of the extremities Nursing Implications: Glucose While on TPN, the pancreas provides increased amounts of insulin to cover the increased glucose levels If TPN is discontinued abruptly, rebound hypoglycemia may occur until the pancreas has time to adjust to changing glucose levels If TPN must be discontinued abruptly, then infuse 5 to 10% glucose to prevent hypoglycemia, according to facility policy Nursing Implications Watch for and monitor for fluid overload while patient is on TPN. Weak pulse Hypertension Tachycardia Confusion Decreased urine output Pitting edema Monitor daily weights and intake and output volumes. TPN Policies and Procedures Agency specific HSN TPN order set HSN Procedure Daily labs, lipid profile, INR Glucose Q6H Weights Q Mondays and Thursdays TPN can be held for blood admin, rate may need changed Long Term Progressive fibrosis and cirrhosis of the liver Short bowel-syndrome Sepsis Wrap-up Questions? Week 6: Anemia meds Meds for eyes, ears, skin Quiz on GI meds (both weeks)