McKenna's Pharmacology for Nursing, 2e

922

P A R T 1 1  Drugs acting on the gastrointestinal system

■ ■ Investigate the person’s nutritional intake, including fluid intake and ingestion of fibre-containing foods, to evaluate for possible contributing factors related to the need for the drug. ■ ■ Assess the person’s level of activity to determine possible contributing factors for decreased bowel motility. ■ ■ Perform an abdominal examination, including inspecting abdomen for distension, palpating for masses and auscultating for bowel sounds, to establish adequate bowel function, rule out underlying medical conditions and assess the effectiveness of the drug. ■ ■ Monitor results of laboratory tests, including serum electrolyte levels, to detect any changes ■ ■ Administer a laxative only as a temporary measure to prevent the development of cathartic dependence. ■ ■ Arrange for appropriate dietary measures, exercise and environmental controls to encourage the return of normal bowel function. ■ ■ Administer the oral form with a full glass of water, and caution the person not to chew tablets, to ensure that the laxative reaches the GI tract to allow for therapeutic effects. Encourage fluid intake throughout the day as appropriate to maintain fluid balance and improve GI movement. ■ ■ Administer bulk laxatives with plenty of water. If only a little water is used, it may absorb enough fluid in the oesophagus to swell into a gelatine-like mass that can obstruct the oesophagus and cause severe problems. ■ ■ Insert rectal suppositories high into the rectum; encourage people to retain enemas or rectal solution as long as possible to improve effectiveness . abdominal pain, nausea or vomiting, which might indicate a serious underlying medical problem that could be exacerbated by laxative use due to potential risk of bowel perforation. effectiveness. If diarrhoea or cramping occurs, discontinue the drug to relieve discomfort and to prevent serious fluid and electrolyte imbalance. ■ ■ Provide comfort and safety measures to improve compliance and to ensure safety , including ready access to bathroom facilities, assistance with ambulation and periodic orientation if CNS effects occur. ■ ■ Offer support and encouragement to help the person deal with the discomfort of the condition and drug therapy. ■ ■ Do not administer in the presence of acute ■ ■ Monitor bowel function to evaluate drug related to altered absorption. Implementation with rationale

■■ Laxative drugs stimulate GI motility and assist in bowel elimination. ■■ Laxatives can be chemical or bulk stimulants or lubricants. ■■ In many cases, implementing diet and exercise strategies and promoting natural intestinal reflexes have decreased the need to use laxatives. ■■ Chronic use of laxatives can lead to dependence on them and on external stimuli for normal GI function. ■ ■ Offer support and encouragement to help the person deal with the diagnosis and the drug regimen. ■ ■ Provide thorough teaching, including the drug name, dosage and schedule for administration; method of administration, such as taking the oral form with a full glass of water, thoroughly mixing the powdered or granular form with water or juice to ensure complete dissolution , inserting the suppository form or using and retaining an enema; approximate time for achievement of results and importance of having bathroom facilities readily available; safety measures, such as changing positions slowly and using assistance with ambulation if dizziness or weakness occurs; signs and symptoms of possible adverse effects and measures to minimise or prevent them ; possible leakage and staining when liquid paraffin is used and the stool cannot be retained by the external sphincter; danger signs and symptoms to be reported to a healthcare provider immediately ; the importance of daily activity to promote bowel function ; the need for the ingestion of high-fibre foods and adequate fluids to stimulate GI motility ; the importance of avoiding the overuse of laxatives to prevent chronic or long-term problems with elimination ; a bowel training program if indicated to prevent dependence on laxatives ; and importance of periodic monitoring and evaluation to evaluate the effectiveness of therapy, enhance knowledge about drug therapy and promote compliance. Evaluation ■ ■ Monitor response to the drug (relief of GI symptoms, absence of straining, evacuation of GI tract). ■ ■ Monitor for adverse effects (dizziness, confusion, GI alterations, sweating, electrolyte imbalance, cathartic dependence). ■ ■ Monitor the effectiveness of comfort measures and compliance with the regimen. ■ ■ Evaluate the effectiveness of the teaching plan (person can name the drug and dosage, describe adverse effects to watch for and specific measures to use to avoid them).

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