McKenna's Pharmacology for Nursing, 2e

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

Care considerations for people receiving antidiarrhoeals

stool; recommended daily maximum dose and the need not to exceed it; signs and symptoms of adverse effects, including measures to minimise or prevent them; safety measures, such as avoiding driving and obtaining assistance with ambulation as needed to reduce the risk of injury due to weakness or dizziness ; danger signs and symptoms that need to be reported immediately; the importance of notifying healthcare provider if diarrhoea is not controlled within 48 hours; and the need for follow-up to enhance knowledge about drug therapy and to promote compliance. Evaluation ■ ■ Monitor the response to the drug (relief of diarrhoea). ■ ■ Monitor for adverse effects (GI effects, CNS changes, dermatological effects). ■ ■ Monitor the effectiveness of comfort and safety measures and compliance with the regimen. ■ ■ Evaluate the effectiveness of the teaching plan (person can name the drug and dosage, as well as describe adverse effects to watch for, specific measures to use to avoid them and measures to take to increase the effectiveness of the drug).

Assessment: History and examination

■ ■ Assess for possible contraindications or cautions : any history of allergy to these drugs to prevent hypersensitivity reactions ; acute abdominal conditions, which could be exacerbated by these drugs ; poisoning, which is a contraindication to slowing GI activity ; hepatic impairment, which could alter the metabolism of the drug ; and current status of pregnancy or breastfeeding, which require cautious use. ■ ■ Perform a physical examination to establish baseline data before beginning therapy and during therapy to determine the effectiveness of the drug and to evaluate for the occurrence of any adverse effects associated with drug therapy. ■ ■ Inspect the skin for colour and evidence of lesions or rash to monitor for potential hypersensitivity reactions. ■ ■ Perform an abdominal examination, including inspecting for distension, palpating for masses and auscultating bowel sounds, to evaluate GI function and to rule out potential underlying medical conditions. ■ ■ Assess bowel elimination pattern, including frequency and characteristics of stool, to assist in determining appropriateness for drug therapy. ■ ■ Assess the person’s neurological status, including level of orientation and affect, to monitor for CNS effects of the drug. Implementation with rationale ■ ■ Administer the drug after each unformed stool to ensure therapeutic effectiveness. Keep track of the exact amount given to ensure that the dose does not exceed the recommended daily maximum dose. ■ ■ Monitor the response carefully; note the frequency and characteristics of the stool. If no response is seen within 48 hours, the diarrhoea could be related to an underlying medical condition. Arrange to discontinue the drug, and arrange for medical evaluation to allow for the diagnosis of underlying medical conditions. ■ ■ Provide appropriate safety and comfort measures if CNS effects occur to prevent injury. ■ ■ Offer support and encouragement to help the person deal with the diagnosis and the drug regimen. ■ ■ Provide thorough teaching, including the drug

KEY POINTS

■■ Antidiarrhoeal drugs are used to soothe irritation to the intestinal wall; block GI muscle activity to decrease movement; or affect CNS activity to cause GI spasm and stop movement. ■■ Antidiarrhoeal drugs can cause GI discomfort and constipation.

IRRITABLE BOWEL SYNDROME DRUGS Irritable bowel syndrome (IBS) is a very common disorder. It is experienced by three times as many women as men and reportedly accounts for a large number of all referrals to GI specialists. The disorder is characterised by abdominal distress, bouts of diarrhoea or constipation, bloating, nausea, flatulence, headache, fatigue, depression and anxiety. No anatomical cause has been found for this disorder. Underlying causes might be stress-related. People with this disorder have often suffered for years, not enjoying meals or activities because of their GI pain and discomfort. Mebever- ine ( Colese , Colofac ) is the most common drug used to treat this condition. Other drugs are discussed in Box 58.5.

name and prescribed dosage; schedule for administration; use of drug after each loose