McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 5 8 Drugs affecting gastrointestinal motility

Implementation Administer an antidiarrhoeal agent only as a temporary measure. Provide comfort and safety measures, including assistance, access to bathroom and safety precautions if necessary. Monitor bowel function. Provide support and reassurance for coping with drug effects and discomfort. Provide teaching regarding drug name and dosage, adverse effects and precautions, and warning signs of serious adverse effects to report. Evaluation Evaluate drug effects: relief of GI symptoms. Monitor for adverse effects: GI alterations, dizziness, confusion, salicylate toxicity. Monitor for drug–drug interactions as indicated. Evaluate the effectiveness of teaching program and comfort and safety measures. TEACHING FOR P.F. • The drug you are taking is called bovine colostrum ( Travelan ). This drug is called an antidiarrhoeal agent. It forms a protective coating over the inner lining of the intestine and soothes the irritated areas. • Take this drug exactly as indicated. Shake the bottle well before using the liquid preparation. If you are using tablets, make sure that you chew them thoroughly; do not swallow them whole. • Common effects of this drug include: • Darkening of the stools : Do not become concerned; this is a normal effect that will go away when you stop taking the drug. • Report any of the following conditions to your healthcare provider: diarrhoea that does not stop within 2 days, ringing in the ears, rapid respirations, fever and/or intense abdominal pain. • Stay away from any food or beverage that may be contaminated with bacteria. Use bottled water for drinking, as well as for brushing your teeth. Do not wash fruit or vegetables with water from the local supply. • Tell any doctor, nurse or other healthcare provider involved in your care that you are taking this drug. • Keep this drug and all medications out of the reach of children.

nausea and in some cases vomiting) and an increase in activity below the point of irritation. The body is trying to flush the invader from the body. A low-grade fever may occur as a reaction to the toxins released by the bacteria. Muscle aches and pains, malaise and fatigue are often common symptoms. It is important at this stage of the disease to maintain fluid intake to prevent dehydration from occurring. P.F. may want to return home, but with intense cramping and diarrhoea it might not be a good idea. Bovine colostrum ( Travelan ) has been effective in preventing traveller’s diarrhoea and associated problems. It is available OTC and is readily accessible for travellers. Taken during a course of traveller’s diarrhoea, it may relieve the stomach upset and nausea, and some of the discomfort of the diarrhoea. It should not be used if the person has bloody diarrhoea or diarrhoea that worsens or persists for more than 48 hours. The best course of action, however, is prevention. Several measures can be taken to avoid ingestion of the local bacteria: drinking only bottled or mineral water; avoiding fresh fruits and vegetables that may have been washed in the local water, unless they are peeled; avoiding ice cubes in drinks because the ice cubes are made from the local water; avoiding any food that might be undercooked or rare, including shellfish; and even being cautious about using water to brush teeth or gargle. People who have suffered a bout of traveller’s diarrhoea are very cautious about exposure to local bacteria when they travel again, often combining prophylactic drug therapy with careful avoidance of local pathogens. P.F. can be reassured that in a few days the diarrhoea and associated signs and symptoms should pass and he will regain his strength and energy. CARE GUIDE FOR P.F.: ANTIDIARRHOEALS Assessment: History and examination Assess the person’s health history for allergies to any of these drugs, acute abdominal pain, concurrent use of aspirin products, methotrexate, sodium valproate, corticosteroids, oral tetracyclines, oral hypoglycaemic agents or sulfinpyrazone. Focus the physical examination on the following: Neurological: orientation, reflexes

GI: abdominal evaluation, bowel sounds Respiratory: respiratory rate and depth Laboratory tests: serum electrolyte levels Genitourinary: renal function Other: temperature