Laxatives and Antidiarrheals Chapter 26 Laxatives and Antidiarrheals

Constipation p596 Condition in which passage of feces through the lower GI tract is slow or nonexistent. This results in a reduction in frequency and an increase in difficulty of fecal evacuation.

Causes of constipation p596 Ignoring the urge to defecate Environmental changes Ingestion of low residue diet Immobility Emotional stress Ingestion of constipating foods (dairy) Use of constipating drugs: opiates, anticholinergics, calcium or aluminum antacids Chronic misuse of laxatives Decreased fluid intake

Laxatives p596 Facilitate elimination of feces Most laxatives are used to prevent or treat constipation Laxatives are also used to prepare pt for lower GI studies or surgery

Stimulant Laxatives Table 26-1 p597 Action: chemical irritation of intestinal mucosa Examples: bisacodyl, senna For short term use Contraindicated: pt with abdominal pain, N&V, rectal fissures Most likely to cause laxative dependence

Saline Laxatives Table 26-2 p598 Draw water through the intestinal wall to increase fluidity of stool and stimulate peristalsis Result: Bowel distention increased peristalsis evacuation of stool Unpleasant taste Systemically absorbed

Saline Laxatives p598-599 Result in: Poor client compliance Risk for dehydration Examples: magnesium citrate, magnesium hydroxide (MOM), magnesium sulfate (epsom salts) Contraindicated in pt with renal failure

Bulk-Forming Laxatives Table 26-3 p600 Safest laxative form Absorbs water to increase bulk Distends bowel to initiate reflex bowel activity Natural or semisynthetic Examples: psyllium hydrophilic muciloid (Metamucil) methylcellulose (Citrucel) polycarbophil (Fibercon)

Bulk-Forming Laxatives cont Must be followed with a large amount of fluid to prevent GI obstruction Effects might not be evident for up to 3 days

Lubricant Laxatives p599 Oils lubricate the fecal material and intestinal walls, thereby promoting fecal passage: Prevent absorption of fat soluble vitamins Example Mineral oil (liquid petroleum) Not digested or absorbed

Stool Softeners p600 Fecal wetting agents Mix fats and fluids with the fecal mass Stool becomes softer Takes several days to work Example: docusate salts (Colace and Surfak) Not used to treat existing constipation Useful to decrease strain of defecation in cardiac patients

Suppositories p601 Available containing stimulant drugs Glycerin Absorbs water from tissues, creating more mass Bisacodyl Induces peristaltic contraction by direct stimulation of sensory nerves

Lactulose p601 Lactulose: hyperosmotic laxative causes water to be drawn into the colon Useful in treating hepatic encephalopathy

GoLYTELY p602 Polyethylene glycol Bowel prep prior to procedures Acts within one hour Produces a diarrheal state

Enemas p602 Solution contain salts (Fleet enema) Administered rectally and cause a laxative effect by osmotically drawing fluid into the colon to initiate defecation Pt in left side lying position, enema bad hung 12-18 inches above anus, lubricate 4-5 inches of catheter tip

Chronic Laxative Use Long-term use of laxatives often results in decreased bowel tone and may lead to laxative dependency Encourage A healthy, high-fiber diet Increased fluid intake Mobility Laxative use of no longer than 1 week

Diarrhea p602 Abnormally frequent passage of watery stools Symptom of an underlying disorder Treatment: reduce GI motility

Antidiarrheals that reduce GI motility Table 26-5 p603 Example: Paregoric Decreases peristalsis Depresses the CNS Decreases transit time through the bowel; more time for water and electrolytes to be absorbed .

Antidiarrheals that reduce GI motility cont p603 Loperarmide HCl (Imodium) Made from chemicals related to meperidine, a narcotic Diphenoxylate HCl and atropine sulfate (Lomotil) Narcotic and anticholinergic drug

Nursing Implications Monitor for therapeutic effect of laxatives or antidiarrheals Pt taking laxatives should be instructed to increase fluid intake to avoid dehydration Laxatives or enemas should not be used to treat acute abdominal pain