Sean Whitfield - NURS 3210 Active Learning Guide - Module 9 - GI- Bones and Blood- Revised - Complete.pdf

NURS 3210 Pharmacology and Nursing Active Learning Guide - Module 9 - GI Agents & Bone-building and Blood-forming A...

NURS 3210 Pharmacology and Nursing Active Learning Guide - Module 9 - GI Agents & Bone-building and Blood-forming Agents Purpose/Overview Active learning guides help students to focus their study time. They include knowledge level questions as well as those focusing on the application and analysis of information to provide greater context in relation to the course and career skills. Students should review the active learning guide before beginning to engage with the module content, then work to complete the guide during and after engaging with the content. An active learning guide is not the same as a study guide or a test blueprint. It serves as a guide to help the student navigate course or module content. Instructions Quickly review the active learning guide (ALG) before you begin reading and engaging with other content in the module. Looking at the questions beforehand will provide a preview of the information you should be alert to as your work through your reading or module resources. As you work through the module content, complete the active learning guide, topic-by-topic. You should use the resources provided and linked on the “Prepare” page in Canvas as the primary source for answering the questions in the active learning guide Specific Agents for Module 9 1. Fill in the table with the drug’s classification/s. The drugs in the table are those you will be asked about on quizzes and exams. Keep in mind your assigned reading may include information about individual agents not listed here. You can check your work in the practice activity (flashcards) for each module. Common endings or other clues about the drug’s classification are italicized. Agent Name Classification Agent Name Classification Agent Name Classification Misoprostol Antisecretory, Atropine Anticholinergic Senna Stimulant gastric Laxative protectant. Bismuth Antidiarrheal, Odansetron serotonin 5-HT3 Diphenoxylate Opiate- Subsalicylate Antiulcer receptor related  NURS 3210 Pharmacology and Nursing Agent Name Classification Agent Name Classification Agent Name Classification antagonists Antidiarrheal Belladona Anticholinergics Lactulose Osmotic Sucralfate Antiulcer Alkaloids / Laxative Agent Antispasmodics Prochlorperamid Phenothiazines Docusate Stool Softener Dronabinol Cannabinoid e (Schedule III) Metaclopramide Antiemetics and Meclizine Antihistamine/ Scopolamine Anticholinerg Prokinetics Antiemetic ic Famotidine H2 Receptor Magnesium Saline Laxatives Aluminum Salts Antacid Antagonist Citrate (Mg++ Salts) Mineral Oil Lubricant Omeprazole Proton Pump Loperamide Antidiarrheal Laxative Inhibitor Glycerin Osmotic Psyllium Bulk-Forming Laxative Laxative Cyanocobalamine Vitamin Epoietin Alfa Erythropoiesis- Alendronate Bisphosphon Stimulating ate Agent Calcium Salts Mineral Supplement Reading- Chapter 50, 51, 52 (GI Agents) 1. Compare and contrast adverse effects, contraindications, and cautions of the three antacids below. Antacids Type Adverse Effects Contraindications/Cautions Calcium Salts Constipation, Kidney Stones, Hypercalcemia/Kidney Acid Rebound Disease/Interfere w tetracyclines and iron supplement absorption. Aluminum Salts Constipation/ Renal Impairment/Can reduce Hypophosphatemia/Aluminum absorption of warfarin, digoxin and Toxicity iron supplements Magnesium Salts Diarrhea/Hypermagnesemia Renal Impairment/Dehydration/Can reduce absorption of antibiotics and digoxin. 2. Complete the Proton Pump Inhibitor Case Study Questions #2, #3, and #4 found in Chapter 50, on page 798: 2. What other conditions will the gastroenterologist test for during this diagnostic stage? Peptic Ulcer Disease  NURS 3210 Pharmacology and Nursing Helicobacter Pylori Infection Esophagitis Barrett’s Esophagus Esophageal Strictures Hiatal Hernia Gastric or Esophageal Cancers Motility Disorders 3. What is the rationale for use of the PPIs to treat GERD? Reduction of Acid Production Healing of Erosive Esophagitis Symptom Relief Preventing Complications 4. What patient teaching is important regarding the PPI? Administration Timing→ Take PPI 30 mins before eating. Take in the morning preferably to increase effectiveness. Duration of Therapy→ Used for short term treatment of 4-8 weeks. Potential Side Effects→ Headache, nausea, diarrhea, stomach pain, B12 deficiency, Magnesium deficiency, an increased risk of bone fractures during long term use. Lifestyle Modifications→ Avoiding foods/beverages that cause reflux, caffeine, alcohol and spicy foods. Consume smaller meals and not lying down immediately after meals. Sustain a healthy weight. Drug Interactions→ Clopidogrel, Ketoconazole and particular HIV drugs.  NURS 3210 Pharmacology and Nursing Long Term Use Considerations→ If chronic use is needed inform the patient about the importance of appointment followups to be able to monitor for the potentiality of adverse effects, then evaluate for the need of continued therapy and assess/monitor bone density. 3. Complete the Critical Thinking Questions #1 & #2, found in Chapter 50, on p. 799: 1. A patient with a history of decreased renal function tells the nurse, “I have finally found an antacid that gives me great relief!” The nurse checks the antacid’s content and finds that the antacid is a combination of aluminum hydroxide and magnesium hydroxide. What is the nurse’s priority action at this time? Explain your answer. Priroty→ Inform the patient to stop using the antacid and to call and update the hcp right away. Explanation→ The decreased renal function can cause the patient to be at high risk for aluminum and magnesium toxicity. The decreased renal function will cause the aluminum/magnesium to collect/accumulate due to not being able to excrete resulting in the following: Hypermagnesemia→ hypotension, respiratory depression, bradycardia, and cardiac arrest. Aluminum Toxicity→ encephalopathy, osteomalacia and anemia. 2. A patient tells the nurse, “I like taking antacids because they coat my stomach and protect my ulcer.” What is the nurse’s priority when responding to the patient? The priority is patient education for the actual mechanism of action of antacids and to resolve and correct any misunderstandings. Mechanism of Action→ Antacids work by neutralizing stomach acid, reducing the amount of acid that flows into the esophagus or duodenum, and inhibiting the activity of pepsin, a digestive enzyme that breaks down food. 4. A. What bacteria is frequently present in patients with peptic or duodenal ulcers? Helicobacter pylori.  NURS 3210 Pharmacology and Nursing B. Other than medications to protect against acid, what other pharmacologic therapy is part of routine treatments for patients with this bacteria? PPI combined with Antiobiotics: Clarithromycin Amoxicillin/Metronidazole 5. A. What concerns might a nurse have about a patient who reports taking an over-the-counter H2- blocker and antacids daily for the last year? Concerned about chronic ailments like GERD, PUD and possibly gastric cancer. Chronic use of H2 blockers with antacids are able to mask or hide symptoms of serious conditions. This can delay the diagnosis and treatment of an underlying condition. Chronic use of H2 blockers with antacids can also cause nutrient deficiencies in B12, calcium and renal impairment. B. Do you still have concerns, if the patient’s symptoms are totally relieved? Why? Yes, symptom relief is not a diagnosis and treatment plan for an issue. Also, the long term chronic use of H2 w/antacid can cause the gut environment to become altered, can increase the risk of GI infections and bone fractures. 6. A 55 y/o patient reports a change in his bowel habits. He normally has looser, more frequent stools, but he recently started going several days, and sometimes a week between bowel movements. His stool is positive for occult blood. What advice should the nurse give the patient regarding this sudden change, before recommending OTC laxatives or other dietary modifications? An acute change in bowel habits with occult blood in the bowel movement are signs that need medical attention. These changes in the bowel habits can be an indication of colorectal cancer, inflammatory bowel disease or another GI disorder. The patient should not use any OTC laxatives until being assessed by a HCP. The laxatives can mask symptoms and delay a proper diagnosis and treatment plan.  NURS 3210 Pharmacology and Nursing 7. The nurse assesses a patient and finds the patient to have abdominal tenderness and distention. The nurse decides to withhold the ordered laxative. What concerns might the nurse have about the patient’s situation that would justify holding the medication at this time? 8. A patient is requesting advice about what type of laxative to purchase OTC. In three to five sentences, describe the recommendations should the nurse make to the patient. The nurse should advise starting with a bulk forming laxative (safe and effective. Bulk forming laxatives pull water into the stool, making it easier to pass. The nurse can also advise to slowly increase the intake of fiber and to remain hydrated to prevent gas or bloating. 9. Complete the Critical Thinking Questions #1 & #2, found in Chapter 51, on p. 813: 1. A woman calls the clinic because her 4-month-old daughter has had diarrhea for about 8 hours. What is the nurse’s priority action at this time? Have the mother bring the infant in to be evaluated and assessed for the cause of possible dehydration. During the assessment the nurse can ask about the number of wet diapers the infant has had and if they were vomiting, assess for fever and to find out the possible cause of the diarrhea. 2. An 88-year-old patient is undergoing a bowel preparation for colonoscopy. What are the nurse’s priorities regarding monitoring the patient during the bowel preparation? Hydration Status→ The elderly are susceptible to dehydration during bowel preparation. Assessing/monitoring I’s/O’s and encourage the patient to intake clear fluids. The nurse will also need to assess/monitor for signs/symptoms of electrolyte imbalance. Signs/Symptoms are muscle cramps, confusion and weakness due to the loss of electrolytes and fluids. Make sure the patient has access to the bathroom and to assist them when needed with mobility to prevent falls. Assess/monitor for adverse reactions to bowel prep. 10. Complete the Laxative Case Study, Questions #1, #3, & #4, found in Ch. 51, p. 811:  NURS 3210 Pharmacology and Nursing 1. What are at least five questions the nurse should ask Mrs. M.? Provide reasons for each question. How long have you experienced constipation? ◦ Reason→ To find out duration to determine if acute/chronic. What is your usual bowel movement pattern? Reason→ To find out a baseline. Has there been any changes recently to your diet, intake of fluids and/or physical activity Reason→ These type of changes can be the cause of constipation. These changes can be treated with nonpharmacologic interventions. Have you started any new medications/supplements? Reason→ Opioids, antacids that include aluminum can cause constipation as a side effect. Do you have any signs/symptoms of abdominal pain, weight loss or blood in your stool? Reason→ These signs/symptoms can be an indicator of an underlying issue/condition like colorectal cancer or GI obstruction that may need a quick medical evaluation. 3. What are some nonpharmacologic ways that can help to prevent constipation? Increase fiber intake. Eat vegetables, fruits, legumes and whole grains. Stay hydrated. It helps to soften stools. Consistent physical activity. Stimulates the motility of the intestines and aids in maintaining regular bowel movements. Responding to the urge. Going to the restroom when the urge occurs to have a bowel movement, stools become soft and easier to pass. 4. What over-the-counter drug is the best choice to help prevent constipation? Explain your answer.  NURS 3210 Pharmacology and Nursing Bulk forming laxative is the best choice of an OTC drug to prevent constipation. This type of laxative will absorb water and expand. This will absorption will add a gel substance to increase bulk to stool. The added bulk will stimulate peristalsis to encourage a regular bowel movement. Bulk forming laxatives can also help to lower cholesterol levels and assist in an overall healthier digestive system. Bulk forming laxatives are also able to be used for the long term. They do not lead to a dependency. 11. What adverse effect, associated with dopamine blockade, is associated with both metoclopramide and prochlorperazine (two anti-emetics), but is not associated with other antiemetic therapies? Tardive dyskinesia. 12. Complete the Critical Thinking Question #1 and #2, found in Ch. 52, p. 825: 1. A patient who has received chemotherapy with a highly emetogenic drug has orders for both ondansetron (Zofran) and prochlorperazine (Compazine). Which drug would be the best choice for the nurse to administer for the patient’s nausea and vomiting, and how should it be administered for the best effects? Explain your answer. The best choice is Ondansetron (Zofran) due to it being a serotonin 5-HT3 receptor antagonist. This used to prevent chemo therapy caused nausea/vomiting. The med should be administered 30 minutes before chemo therapy is administered, via IV or PO. 2. The nurse has just given an 83-year-old patient a dose of an antinausea drug. Considering this patient’s age, what is the nurse’s priority action regarding evaluation of the drug’s effects? Priority action is to monitor for adverse side effects to the CNS, sedation, dizziness, and or LOC.  NURS 3210 Pharmacology and Nursing Readings: Chapters 53 & 54, and selected pages from Ch. 34 (Blood-forming and Bone-building Agents) 1. In two to three sentences, explain the pathophysiology of osteoporosis. What lifestyle modifications are helpful in prevention of osteoporosis? Name four. Osteoporosis is the reduced bone mass and the deterioration of the bone tissue, causing an increase in bone fragility and fractures. This is due to bone resorption at a raster rate than bone formation. This is a by product of aging, changes in hormones and deficiencies in hormones, a decrease in estrogen (postmenopausal women) and reduced calcium and vitamin D. Adequate Vitamin D and Calcium intake. Consistent Weight Bearing Exercises. Tobacco cessation. Limiting alcohol intake. Sustaining a healthy body weight. 2. What specialized radiographic exam can help detect osteoporosis and is routinely used for osteoporosis screening? Dual Energy X Ray Absorptiometry Scan→ This diagnostic will measures bone mineral density at the hip and spine. 3. What are some important instructions to provide the patient about how to take alendronate, a bisphosphonate, for osteoporosis? Patient Education: Remain upright for 30 after administration of alendronate to inhibit esophageal irritation/damage. Take Alendronate on an empty stomach first thing in the A.M. with a full glass of water 30 minutes before any food, drink or meds to increase absorption. Do not suck on or chew the tablet to inhibit oropharyngeal irritation.  NURS 3210 Pharmacology and Nursing Medical adherence. Take alendronate once a week as prescribed to maintain it effective therapeutic levels. Additional Specific Agents for Module 9 Complete the chart below with the name of the supplement, associated disease states or symptoms, and dietary sources. See module flashcards. Vitamin or Mineral Corresponding Disease State and/or Dietary Sources Supplement (Agent Symptoms Associated name) with Deficiencies Calcium Calcium carbonate, Osteoporosis, Rickets, Dairy products, leafy calcium citrate Muscle cramps, Tetany greens, fortified foods, orage juice, cereals Iron Ferrous Sulfate, Ferrous Anemia, Fatigue, Red meat, poultry, gluconate Weakness, Pallor seafood, beans, dark leafy greens, fortified grains Vitamin D Cholecalciferol (D3), Rickets, Osteomalacia, Fatty fish, liver, egg Ergocalciferol (D2) Bone pain, Muscle yolks, fortified milk, and weakness sunlight exposure Vitamin A Retinol, Beta-carotene Night blindness, Liver, fish oils, milk, Xerophthalmia, eggs, leafy green and Keratomalacia orange/yellow vegetables Vitamin C Ascorbic acid Scurvy, Bleeding gums, Citrus fruits, tomatoes, Weakness, Anemia potatoes, strawberries, bell peppers Vitamin B2 Riboflavin Ariboflavinosis, Sore Milk, eggs, nuts, green throat, Redness and leafy vegetables, lean swelling of the lining of meats the mouth and throat Vitamin B3 Niacinamide, Nicotinic Pellagra, Dermatitis, Poultry, fish, beef, acid Diarrhea, Dementia peanuts, legumes, whole grains Vitamin B6 Pyridoxine Anemia, Dermatitis, Poultry, fish, potatoes, Depression, Confusion chickpeas, bananas Vitamin B9 (B-Complex) Folic acid, Folate Megaloblastic anemia, Leafy greens, legumes, Neural tube defects in nuts, fortified cereals pregnancy and grains Vitamin B12 Cyanocobalamin Pernicious anemia, Meat, fish, dairy Neuropathy, Cognitive products, fortified disturbances cereals Vitamin B1 Thiamine Beriberi, Wernicke- Whole grains, pork, fish, Korsakoff syndrome, legumes, seeds  NURS 3210 Pharmacology and Nursing Vitamin or Mineral Corresponding Disease State and/or Dietary Sources Supplement (Agent Symptoms Associated name) with Deficiencies Neurological symptoms 4. Define anemia, and list four potential causes of anemia; then give five signs and symptoms associated with anemia. Anemia→ a condition that occurs when the body doesn't have enough healthy red blood cells or hemoglobin to carry oxygen to the body's tissues. Iron deficiency, Vitamin B12 deficiency, Chronic Kidney Disease, Cancer, Rheumatoid Arthritis, Hemolytic anemia. Fatigue, Pallor, Shortness of breath, Dizziness, Rapid/irregular heartbeat. 5. What are the normal ranges for Hemoglobin and Hematocrit? Hemoglobin Men: 13.8-17.2 g/dL Women: 12.1-15.1 g/dL Hematocrit Men: 40.7%-50.3% Women: 36.1%-44.3% What do lab values for MCV and MCHC tell you about the red blood cells and why does it matter? ▪ MCV: The average size of RBCs ↓due to iron deficiency anemia. ↑Vitamin B12 or folate deficiency. ▪ MCHC: The average concentration of hemoglobin in RBCs ↓Iron deficiency  NURS 3210 Pharmacology and Nursing ↑Spherocytosis (changes shape and reduces the life of RBCs) or another hereditary condition. 6. A young woman has been prescribed ferrous sulfate supplementation due to anemia from menorrhagia. What teaching instructions would you want to provide to this patient about taking ferrous sulfate? Take on empty stomach→ Increase absorption Take with Vitamin C→ Increase absorption Adhere to dosage→ Possible Side Effects→ Constipation, dark stools, GI upset. Period of Time→ May take multiple consecutive months to correct iron deficiency. 7. Why is Vitamin B12 typically administered as an injection, rather than in an oral formulation? Many patients with a B12 deficiency have impaired absorption in the GI tract, caused by pernicious anemia due to a reduction in intrinsic factor (required for B12 absorption or a different malabsorption ailment. An injection can ensure that needed levels of B12 are delivered directly into the bloodstream, bypassing the GI tract for absorption. 8. Complete the Vitamin Supplements Case Study Questions #1, #2, #3, and #4 found in Chapter 53, p. 844: 1. Based on S.C.’s history, what vitamin deficiencies are possible? Vitamins B1, B6, B9, B12 and Vitamins A and D. 2. Which vitamin supplement is especially used to treat complications associated with alcoholism? Explain your answer. Thiamine (Vitamin B1): Alcoholism can lead to Wernicke Korsakoff syndrome. Thiamine supplementation is important to preventing/treating this condition.  NURS 3210 Pharmacology and Nursing 3. S.C. is receiving large doses of several vitamins, and the nurse is concerned about vitamin toxicities. Which type of vitamin, water-soluble or fat-soluble, carries the risk for toxicities? Explain your answer. Fat soluble (A,D,E,K): Stored in the body fat and liver. Increased intake can lead to accumulation to toxic levels. 4. Because of S.C.’s long-term malnourished state, the prescriber is concerned about the condition of his bones and starts S.C. on phosphorus and calcium supplementation, along with vitamin D. Explain the rationale behind the addition of vitamin D. Vitamin D is crucial for calcium absorption and bone health. 9. Complete the Case Study-Biphosphonates in Chapter. 34 found on p. 545: 1. After you provide instructions on taking ibandronate, Mrs. S. tells you that she likes to have breakfast, take her morning medicines, and then lie down on the couch to read the morning newspaper. What will you say next? Patient education will include: Ibandronate needs to be taken first thing in the morning on an empty stomach 30 minutes before eating any food and taking any other meds. Need to stay upright after administration for 30 minutes to inhibit esophageal irritation or other damage. 2. The next day, Mrs. S. calls the clinic to ask what to use for headaches. “I have several different types of headache pills, so aren’t they all the same?” How will you respond? It is crucial to not take anything that will interact with the Ibandronate. Request the patient call the clinic to get a recommendation for the proper choice for headache relief.  NURS 3210 Pharmacology and Nursing 3. A few months later, Mrs. S. comes in for a follow-up visit. She tells you that she is due for her next osteoporosis pill next week, but she has been having some jaw pain ever since she went to the dentist 2 weeks earlier to have a tooth pulled. She is worried that her osteoporosis has affected her jaw. What could be the reason for this pain? What do you think will be done about it? Patient education to inform of what is the possible cause of her sign/symptom and to request the president be assessed by her hcp. The jaw pain is a possible sign of osteonecrosis of the jaw, an adverse side effect of bisphosphonates (Ibandronate) particularly after a dental procedure. The patient needs to be assessed by her hcp immediately.