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Why would someone with Cardo Disease benefit from a stool softener?
- Due to Valsalva Maneuver (bearing down to pass stool) blood is pushed to perifery and then returns to core which may trigger:
- Heart attack
- Stroke
- Release of thrombi (clot)
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What are hemeroids and why would pt's with them benefit from a stool softener?
They're retcal vericose veins and it hurts them to poop
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Contraindications for Laxatives
- Unexplained abdominal pain
- Nausea
- Cramps
- Symptoms of appendicitis: Feer, lower rt quadrant pain abd pain
- Regional enteritis:Increasing peristalsys can cause perferation.
- Diverticulitis:Increasing peristalsys can cause perferation.
- Ulcerative colitis: Increasing peristalsys can cause perferation.
- Acute surgical abdomen.
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What are bulk forming laxatives?
- Any laxatives that contains fiber.
- Draws fluid into the bowel and creates viscous volume there--> increase perstal.
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What is a surfactant lax?
It lubricates the bowel to aid passage.
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Stimulant
Irritant to colon--> increase paristal
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Osmotics
- Increases tonicity of contents of bowel.
- Adds fluid to stool, increases volume--> increase peristal.
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Laxtulose
- Not really a laxative.
- Removes amonia in chronic liver disease and draws it into the bowel.-->diarreah.
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Polyetholine glycole electrolyte solution
- Large volumes. (Up to 4 liters.)
- BM starts ~1hr after administration.
- Used as prep for rectal exame
- Also called Go Lightly
- Considered cathartic (feel squeekly clean)
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Polyetholine glycol (miralax)
- Powder, clear, tasteless, mixes with liquid
- No bloating or cramping
- Most pt's prefer to other laxatives.
- 3-4 days until effective
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Relistore (Methylmaltrexone Bromide)
- Opiod antagonist
- Used to treat opiod-induced contipation
- Antagonizes Mu opiod receptors in gut.
- Does not trigger receptors for pain and analgisia.
- Decreases constipation without reducing analgisia.
- Admin subcut, given every other day.
- 33% have bm within 30 min. 60% in 4 hrs
- Reduce dose by half if pt has renal failure.
- Vial is one use. dispose of leftovers with documentation and have witness.
- Discontinue if pt stops taking opiods.
- Side effects: abd pain, nausea, dizziness, diarreah.
- Dose based on weight.
- Do not give to pt with intestinal blockage.
- Must be used within 24 hrs after drawn.
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What to look for when pt has diarreah...
- How frequent and what's the viscosity?
- Formed, semiformed, liquid, etc?
- Is a symptom, so treat cause not just symptom
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Potential causes of diarreah.
- Infxn.
- Maldigestion-->increased acid.
- Functional disorder of intestin.
- Dehydration.
- Impaction: Non-movable fecal obstruction. Diarreah leaks around impaction. (Smeary, continuous diarreah.)
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What are the 2 forms of anti-diarreals?
- Specific: Treats cause, ie antibiotics.
- Non-specific: Rx which will effect bowel in very specific ways. (ie opiods--> decrease peristal).
- Bulk formers can treat both constipation and
- Antisposmotics: Decreases parasympathetic stimulation of bowel.
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