1. Laxatives and Antidiarrheals
Chapter 26
Laxatives and Antidiarrheals

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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)

9. 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

10. 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

11. 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

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

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

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

15. 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 inches above anus, lubricate 4-5 inches of catheter tip

16. 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

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

18. 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 .

19. 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

20. 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