PHRD5975 Self-Care - Constipation

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  1. sx of constipation
    • <3 BM's per week (LOL)
    • strainingĀ 
    • difficult passage of hard, dry stools
  2. causes of constipation (3)
    • 1) med conditions/medsĀ 
    • 2) psychological/physiological conditions (menopause)
    • 3) lifestyle characteristics (inadequate fiber, sedentary lifestyle)
  3. how does exercise help constipation?
    • increases muscle tone
    • promotes BM's
  4. 2 vitamins that can cause constipation
    • iron
    • calcium
  5. how ignoring the urge to empty the bowel causes rectal muscles to become less effective in elimination
    nerve pathways degenerate & stop sending the signal to defecate
  6. list some drugs that may induce constipation:
    • analgesics
    • antacids
    • antihistamines
    • Ca channel blockers
    • diuretics
    • opiates
    • hypotensives
  7. initial management of constipation (3)
    • 1) adjust diet to include foods high in *insoluble* fiber
    • 2) increase fluid intake
    • 3) exercise
  8. duration of laxative tx before medical referral
    7 days
  9. exclusions for self-treatment of constipation
    • abdominal pain (obstruction)
    • N/V (infection)
    • sudden change in bowel habits that persists for 2 weeks (IBD, colorectal cancer)
    • use of laxative >7days
    • rectal bleeding (hemorrhoids)
    • weight loss (severe dehydration, cancer, CF)
    • para/quadriplegic
    • change in stool character (cancer, obstruction)
  10. recommended adult daily fiber intake
    • 25mg - women
    • 35mg - men
  11. negative effects of significantly increasing dietary fiber
    • 1) erratic bowel habits
    • 2) flatulence
    • 3) abdominal discomfort
  12. when are gastrococlic reflexes the strongest?
    • first thing in the morning
    • 30min after a meal
  13. 2 examples of enemas
    • 1) sodium phosphate
    • 2) mineral oil
  14. onset of action for enemas
  15. why are sodium phosphate enemas cautioned in those w/ heart failure, uncontrolled HTN, renal impairment, or edema?
    increase BP and fluid retention by sodium (exacerbates conditions in which fluid retention is already an issue)
  16. onset of action for suppositories
  17. recommended as first-line pharmacological treatment for most instances of constipation
    bulk-forming agents
  18. MOA of bulk-forming agents
    swells in intestinal fluid of small & large intestines, forming emollient gels that facilitate passage of intestinal contents & stimulate peristalsis (works like a sponge)
  19. onset of action for bulk-forming agents
  20. special populations for bulk-forming agents
    dextrose content should be evaluated before use by diabetic pts or those w/ restricted caloric intake
  21. name 2 hyperosmotic laxatives
    • PEG (polyethylene glycol) 3350
    • glycerin
  22. MOA of hyperosmotic agents
    large, poorly absorbed molecules that draw water into the colon/rectum to stimulate a BM
  23. normal onset of action for PEG3350
    12-72 hrs
  24. youngest age PEG3350 can be used
    2yo (1g/kg)
  25. only laxative safe for all age groups
    glycerin suppository
  26. MOA of emollient agents (stool softeners)
    anionic surfactants that act in the small & large intestines to increase wetting efficiency of intestinal fluid, as was as mixture of aqueous & fatty substances to soften fecal mass
  27. docusate onset of action
    1-3 days
  28. precaution for emollients
    can increase systemic absorption of mineral oil
  29. name a lubricant agent laxative
    mineral oil
  30. MOA of lubricant agents
    acts in the colon to soften fecal contents by coating the stool & preventing colonic absorption of water
  31. onset of action of oral lubricant agent
    6-8 hrs
  32. onset of action of rectally administered lubricant agent
  33. most significant safety concern w/ lubricant agents
    lipid pneumonia from aspiration into lungs after an oral dose
  34. DDI's w/ lubricant agents?
    may impair absorption of fat-soluble vitamins & many oral meds (eg: OC's)
  35. name 2 saline laxative agents
    • magnesium citrate
    • dibasic sodium phosphate
  36. MOA of saline laxative agents
    ions are retained in the small & large intestinal walls & draw water in, increasing intraluminal pressure & intestinal motility
  37. onset of action for orally administered saline laxative
    30min - 3 hrs
  38. name 2 stimulant agents
    • senna
    • bisacodyl
  39. MOA of stimulant agents
    • increases large intestinal motility by local irritation of the mucosa
    • also increases secretion of water & electrolytes into the intestine
  40. onset of action of stimulant agents
    ~6-10 hrs after oral administration
  41. pt counseling regarding senna
    may color urine pink to red, red to violet, or red to brown
  42. pt counseling for bisacodyl (2 main points)
    • 1) administration of tablets within 1 hour of antacids, H2RAs, PPIs, or milk results in erosion of bisacodyl's enteric coating, resulting in gastric/duodenal irritation
    • 2) don't break, crush, or chew tablet
  43. age at which magnesium hydroxide (saline lax) can be used in children
  44. age at which PEG3350 can be used in children
  45. age at which bulk-forming agents and docusate can be used in children
Card Set
PHRD5975 Self-Care - Constipation
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