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pathopharm exam 4
CHAPTER 79
| Question | Answer |
|---|---|
| Laxatives P.973 | Used to ease or stimulate defecation Soften the stool Increase stool volume Hasten fecal passage through the intestine Facilitate evacuation from the rectum Misuse comes from misconceptions of what constitutes normal bowel function |
| Laxative Effect Versus Catharsis | Laxative effect Production of soft, formed stool over 1 or more days Relatively mild HAVE FIBER-WALK AROUND-DRINK LOTS OF H2O ASK HOW THEY RELIEVE CONSTIPATION=PRUNE JUICE, HOT COFFE CatharsisPrompt, fluid evacuation of the bowelFast and intense |
| Function of the Colon UNDERSTAND PT BOWEL PATTERNS | Absorbs water and electrolytes( nutrients is minimal) 1500 mL of fluid enters colon each day, BUT 90% is absorbed Delayed transport through colon = excessive fluid absorption and hard stool Frequency of bowel elimination varies 2 to 3/day to 2 t/wk |
| Dietary Fiber- Proper bowel function is highly dependent on dietary fiber | Part of fruits and vegetables that escapes digestion 20-60 gm/day Benefits of fiber Absorbs H2O: Oftens feces and increases size digested by colonic bacteria, whose growth increases fecal mass Low-fiber diet: Frequent cause of constipation |
| Constipation? One of the most common GI disorders People seek medical help for constipation in the United States at least 2.5 million times a year | 100millions of dollars a year are spent on laxatives Constipation may be defined as: Hard stools, infrequent stools, excessive straining, prolonged effort, sense of incomplete evacuation, unsuccessful defecation |
| Indications for Laxative Use PROMOTE DEFECATION Obtain fresh stool sample Empty bowel before treatment or procedure | Expel dead parasites after treatment Modify effluent from ileostomy or colostomy Constipation (multiple causes, including pregnancy and opioid use)Prevent fecal impaction in bedridden patientsRemove poisons |
| Contraindications to Laxative Use | Abdominal pain, nausea, cramps, or other symptoms of appendicitis, regional enteritis, diverticulitis, or ulcerative colitis Acute surgical abdomenFecal impaction or bowel obstruction Habitual use Use with caution in pregnancy and lactation |
| Classification of Laxatives | Bulk-forming laxatives Psyllium [Metamucil] Surfactant laxatives Docusate sodium [Colace] Stimulant laxatives Bisacodyl [Dulcolax] Osmotic laxatives Milk of magnesia (MOM) |
| Classification of Laxatives: Therapeutic EffecTS | Group I: Act rapidly (within 2 to 6 hours) and give stool a watery consistency; useful for preparing bowel for diagnostic procedures or surgery Group II: Intermediate latency (6 to 12 hours); produce a semifluid stool |
| Classification of Laxatives: Therapeutic EffecTS USED WHEN HAVE ABDOMINAL SURGERY, FROM LABOR OR ON OPIOIDS | Group III: Most frequently abused by the general public; act slowly (1 to 3 days) to produce a soft, formed stool; uses include treating chronic constipation and preventing straining at stool |
| Bulk-Forming Laxatives -Methylcellulose (Citrucel) | AS to dietary fiber: Swell with water to form a gel that softens and increases fecal mass Preferred temporary treatment of constipation for diverticulosis and irritable bowel syndromE ADR=Esophageal obstruction if swallowed without adequate fluid |
| Surfactant Laxatives-Docusate sodium (Colace) Alter stool consistency by lowering surface tension, which facilitates penetration of water into feces | Produce soft stool FEW days after onset of treatment May also act on intestinal wall to (1) inhibit fluid absorption and (2) stimulate secretion of water and electrolytes into intestinal lumen; in this respect, surfactants resemble stimulant laxatives |
| Stimulant Laxatives - Bisacodyl (Dulcolax) acts within 6 to 12 hour | Two effects on bowel: Stimulate intestinal motility Increase amounts of water and electrolytes in intestinal lumen Widely used and abused Legitimately used for opioid-induced constipation and for constipation from slow intestinal transit |
| Osmotic Laxatives - Magnesium hydroxide (Milk of Magnesia) | Laxative salts (sodium phosphate, magnesium hydroxide) Poorly absorbed salts that draw water into intestinal lumen; fecal mass softens and swells, wall stretches, and peristalsis is stimulated Low doses: in 6 to 12 hours High doses: in 2 to 6 hours |
| ADVERSE EFFETCS? | Dehydration: Substantial water loss Acute renal failure Sodium retention: Exacerbated heart failure, hypertension, edema |
| Other Laxatives -ENEMA | Mineral oil: Mixture of indigestible and poorly absorbed hydrocarbons. Laxative action is produced by lubrication. Mineral oil is especially useful when administered by enema to treat fecal impaction. |
| ADVERSE EFFECTS | Lipid pneumonia, anal leakage, and deposition of mineral oil in the liver |
| Other Laxatives-Glycerin suppository Osmotic agent that softens and lubricates hardened, impacted feces HOLD IT INSIDE FOR ATLEAST 30MINS ACT FAST -in 15 to 60 minutes) | May also stimulate rectal contraction Evacuation occurs about 30 minutes after suppository insertion Useful for reestablishing normal bowel function after termination of chronic laxative use |
| Bowel-Cleansing Products for Colonoscopy-Allow for good visualization of the bowel Combination of sodium picosulfate, magnesium oxide, and citric acid •Requires ingestion of large volume of bad-tasting liquid PT HATE TAKING MED 2 EMPTY BOWEL, & PREP | Sodium phosphate •Hypertonic with body fluids •Can cause dehydration and electrolyte disturbance •Possibility of renal damage Polyethylene glycol (PEG) plus electrolytes (ELS) •Isotonic with body fluids |
| Laxative AbusE-CAUSES | Misconception that bowel movements must occur daily Can perpetuate their own use-REBOND LAXATIVE BODY DEPENDS ON LAXATIVE Bowel replenishment after evacuation can take 2 to 5 days; often mistaken for constipation |
| Laxative Abuse-CONSEQUENCES | Diminished defecatory reflexes, leading to further reliance on laxativesElectrolyte imbalance, dehydration, colitis |
| The nurse identifies which of the following as the most common type of laxative abused by the general public? | Stimulant laxatives (bisacodyl, senna, castor oil) are most commonly abused by the general public. The nurse should discourage use of these drugs for occasional relief of constipation. |
| A patient who has been taking a long-acting morphine to treat severe pain for a few months complains of constipation. The nurse anticipates which of the following will be prescribed for the patient? | Stimulant laxatives are commonly used to treat opioid-induced constipation. Senna [Senokot] - can cause the patient’s urine to turn a harmless yellow-brown or pink. |
| A patient is prescribed bisacodyl. Which of the following should the nurse include in patient teaching? | Do not take the bisacodyl w/an antacid. Instruct patients to : take oral bisacodyl 1 hour after ingesting milk or antacids. to swallow the tablets intact, w/O crushing or chewing. bisacodyl suppositories = burning sensation, prolonged USE =proctiTIS |
| The nurse identifies which of the following laxatives as having the added response of ridding the body of ammonia? | Lactulose-can enhance intestinal excretion of ammonia to lower blood ammonia content in patients with portal hypertension and hepatic encephalopathy (damage or disease that affects the brain) secondary to chronic liver disease. |
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