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PRIORITY SETTING: who do you see 1st?
[give med] for pt. on call for surgery.
pt. c/o indigestion.
pt. who needs routine med for GERD.
pt. who needs pepto for ulcer.
[give med] for pt. on call for sugery.
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MATH: physician orders: cimetidine (Tagamet)--[H2-blocker]--for pt. w/ ulcers. med comes in 400 mg/tablet. how many tablets do you give?
4 tablets.
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what type of med is diphenoxylate/atropine (Lomotil)?
anti-diarrheal med.
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lactulose (Cephulac, Chronulac) [hepatobiliary; constipation] is given for what?
- to relieve constipation.
- as tx for hepatic encephalopathy to decrease ammonia levels.
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whom would you not give diphenoxylate/atropine (Lomotil)--[Diarrhea]--to & why?
78 yr. old w/ diarrhea
68 yr. old w/ glaucoma
50 yr. old w/ CAD
pt. recieving aminoglycoside antibiotics
pt. w/ glaucoma b/c anti-diarrheals causes retention of fluid causing increased pressure.
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which physician's orders would you question?
*omeprazole (Prilosec)--[PPIs; H. pylori]--for duodenal ulcer
*metronidazole (Flagyl)--[Antiparasitics; other antibacterials]--for h. pylori.
*psyllium (Metamucil)--[Constipation/(Vitamins/Nutritionals)]--for chronic constipation
*misoprostol (Cytotec)--[Constipation; other GI/gynecologics]--for pt. w/ NSIAD induced ulcer
?
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what type of drug is simethicone (Mylicon)?
anti-flatulence med.
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pt. teaching for taking calcium carbonate (Tums):
chew thoroughly then drink full 8 oz. glass of water.
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pt. is taking omeprazole (Prilosec)--[PPIs; H. pylori]--for GERD. how do you med is effective?
if pt. doesn't have heartburn (decreased production of acid).
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if pt. has hypertension. what don't you want to increase?
- BP (don't give docusate sodium (Colace)--[Constipation]--b/c it has sodium in it).
- **can't give any med that contains sodium.
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almost all antacids (if chewable) should be?
chewed thoroughly followed by drinking an 8 oz. glass of water.
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dr. ordered pancrelipase (Cotazym)--[Digestive Enzyme]. why would drug be prescribed?
- to supplement pancreatic enzymes.
- breakdown fats, starches, & proteins.
- necessary for breakdown & digestion of food.
- replacement therapy for those w/ pancreatic enzyme insufficiency.
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what type of drug is ranitidine (Zantac)?
H2 [antagonist] blocker med.
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where does antacid mainly work?
stomach.
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suppository procedure:
- place pt. in left-lateral position w/ knees slightly flexed.
- get suppository out of fridge.
- get gloves.
- lubricate med w/ KY-jelly.
- squeeze cheeks to hold in place for 2-3 min.
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aluminum carbonate (Basaljel)--[Antacid]--is given for what?
- to treat hyperacidity caused by:
- heartburn.
- acid indigestion [dyspepsia].
- sour stomach.
- GERD.
- peptic ulcer.
- to prevent formation of phosphate based urinary stones.
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aluminum containing antacids may cause?
- constipation.
- intestinal impaction.
- anorexia.
- weakness.
- tremors.
- bone pain.
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pt. who has cirrhosis has high serum ammonial level. what med would be prescribed?
lactulose (Cephula, Chronulac).
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how do you know if lactulose (Cephulac, Chronulac)--[Laxative]--is effective?
level of consciousness has increased.
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what type of drug is loperamide (Imodium)?
anti-diarrheal med.
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pt. has CHF & dr. prescribed sodium bicarbonate (Baking Soda)--[Antacid]--for GI upset. would you question order?
- yes b/c of sodium--given to pt. w/ metabolic acidosis.
- **may cause systemic alkalosis & rebound hyperacidity.
- **contraindicated w/ cardiovascular probs. & those on sodium restricted diets.
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what type of drug is loperamide (Imodium)?
anti-diarrheal med.
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how does loperamide (Imodium)--[Antidiarrheal]--work?
- acts directly on muscle of bowel to slow motility.
- take after ea. loose stool.
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what type of med is magnesium hydroxide (MOM) & can cause what?
- antacid.
- severe diarrhea, dehydration, & hypermagnesemia.
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nursing/teaching interventions for pt. who has hiatal hernia [defect in diaphragm permits portion of stomach to pass through diaphragmatic opening into the chest] to decrease heartburn?
- provide sm. frequent meals.
- do not recline for 1 hr. after eating.
- elevate HOB on 4-8 in. blocks.
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pt. who has inflammatory bowel disease was prescribed sulfasalazine (Azulfidine)--[Aminosalicylate]. what are the instructions for taking med?
- 3-4 g/day PO in divided doses.
- then 2 g PO QID.
- push fluids to prevent crystalluria from sulfa.
- **monitor BUN & serum creatinine for kidney damage.
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where should suppositories be stored?
in fridge.
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MATH: pt. prescribed 100 mL to be given over 20 min.
- 60 gtts per min.
- **re-check IV every hr.
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what does an H. pylori infection cause?
peptic/duodenal ulcers--H. pylori produces toxin that destroys mucus.
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nursing considerations for H. pylori infections?
- all ulcers at risk for hemorrhage & hypovolemic shock from perforation & obstruction--assess for melena & hematemesis.
- s/s of bleeding include increase in pulse & drop in BP.
- **monitor CBC & FOBT.
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what type of drug is sennosides (Senokot)?
[irritant/stimulant laxative] constipation.
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pt. taking sennosides (Senokot)--[Irritant/Stimulant Laxative]--is c/o brown urine & yellow-green stool. what should you tell pt.?
normal side effect of drug.
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dronabinol (Marinol)--[Antiemetic]--is used for what?
- for chemotherapy induced nausea & vomiting.
- appetite stimulant for pt. w/ HIV.
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what type of med is dronabinol (Marinol)?
- antiemetic.
- **may cause drowsiness, somnolence,
euphoria, dizziness, & vomiting.
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prolonged us of loperamide (Imodium)--[Antidiarrheal]--may cause?
- dry skin & mucous membranes.
- nausea.
- constipation.
- lightheadedness.
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prolonged use of laxatives may cause?
- diarrhea & loss of water/electrolytes.
- abd pain/discomfort.
- nausea.
- vomiting.
- perianal irritation.
- fainting.
- bloating.
- flatulence.
- cramps.
- weakness.
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which meds are used to treat ulcerative colitis?
- corticotropin & adrenal corticosteroids.
- sulfasalazine (Azulfidine).
- olsalazine (Dipentum).
- mesalamine (Asacol).
- anti-diarrheals.
- iron/liquid (IV) supplements.
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best time to administer mineral oil--[Emollient]--for constipation?
take at HS [at night] on empty stomach.
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what is 1 advantage of giving an H2 [antagonist] blocker rather than an antacid?
- dosing is less frequent.
- **antacids may be taken hourly for 1st 2 wks.
- **H2-blockers usually given BID/at HS for maintenance.
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H2 [antagonist] blockers are used cautiously?
- in pts. w/ renal/hepatic impairment.
- in severely ill, elderly/debilitated pts.
- during pregnancy & lactation.
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other meds taken w/ an antacid should be take when?
2 hrs before/after.
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metoclopramide (Reglan)--[Gastrointestinal Stimulant]--is used to treat? how?
- used to treat GERD & gastric distress.
- increases motility of upper GI tract w/o increasing production of secretions.
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laxatives are also used for what besides constipation?
- for pt. w/ [IBS] irritable bowel syndrome & severe watery diarrhea.
- for pt. going for sigmoidoscopy/colonoscopy.
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what type of med is cimetidine (Tagamet)?
H2 [antagonist] blocker med.
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cimetidine (Tagamet)--[H2 [antagonist] blocker]--can cause what for men?
reversible impotency.
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if pt. has trouble taking laxative [tablet], can they chew it?
- no--can be split in half, but not crushed.
- **suggest liquid form/suppository.
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before administering sulfasalazine (Azulfidine)--[Aminosalicylate]--what should you ask pt. & what is it given for?
- any allergies to sulfa.
- used to treat inflammatory bowel disease: Chron's disease & ulcerative colitis.
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if pt. is given combination drugs for H. pylori, how long do they have to take them?
2 wks (14 days).
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what consistency & color of stool be for pt. taking Colace?
soft & brown (means Colace is working).
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pt. prescribed bulk laxative [methylcellulose (Citrucel)psyllium (Metamucil), polycarbophil (FiberCon)] how do those meds work?
provides fiber.
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pt. scheduled for colonoscopy. what drug is prescribed for stool evacuation?
- laxatives [MOM] (turns stool clear-yellow).
- **assess skin turgor before administering med.
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what is the generic name for Colace?
docusate sodium.
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docusate sodium (Colace)--[Laxative]--is contraindicated for pts. who have?
HTN (hypertension).
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lactulose (Cephulac) can be given for?
- cerebralencephalopathy.
- **check neurological status (level of consciousness).
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prochlorperazine (Compazine) is an antidopaminergic antiemetic drug that prevents?
nausea/vomiting.
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pt. is being prescribed promethazine (Phenergan), what type of drug is it & how does it work?
- antidopaminergic antiemetic.
- inhibits [CTZ--chemoreceptor trigger zone] & brain's primary neurotransmitters dopamine & acetylcholine.
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what should be avoided when taking promethazine (Phenergan)--[Antidopaminergic Antiemetic]?
alcohol.
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dicyclomine (Bentyl) is an anticholinergic [reduces gastric motility & decreases amt. of hydrochloric acid produced by stomach], how do you know if drug is effective?
pt. will have decrease in pain & # of stool (formed-soft stool).
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propantheline (Probanthine)--[Anticholinergic]--may cause?
- drowsiness.
- dizziness & photophobia.
- confusion in elderly.
- diarrhea.
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dicyclomine (Bentyl)--[Anticholinergic]--is contraindicated in?
- clients w/ [BPH--benign prostatic hypertrophy] (enlarged prostate).
- anyone w/ urinary retention.
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