GI system, Vitamins, Minerals, Men's health

GI disorders?

* Peptic Ulcer Disease
* Nausea/vomiting
* Motion sickness
* Diarrhea
* Constipation
* GERD
* Hyper-secretory condition: Zollinger-Ellison syndrome

With PUD, there is an imbalance between…

gastric mucosal defenses (**mucus and bicarbonate**)

Most common causes of PUD?

* H. Pylori
* NSAIDs

Additional causes of PUD?

* gastric acid
* pepsin
* smoking

Antibiotics for H. Pylori

* **metronidazole (Flagyl)**
* **most used and responds well to diarrheal disease in general**
* amoxicillin
* clarithromycin
* tetracycline

We want to educate our patients not to consume -- with metronidazole because patients can experience --

alcohol

severe alcohol withdrawal like symptoms

Two most important considerations for Tetracycline?

* can **stain the teeth** thus contraindicated in children

Educate patient to take amoxicillin, clarithromycin, and metrondiazole with…

FOOD

If N/D occur while taking antibiotics for H. Pylori, patient should have…

probiotics to help

For any medication, take the…

full course of treatment

Histamine2 receptors are cells that produce…

gastric acid in the stoma

H2 receptor antagonists block…

==CELLS== -- reduces amount of gastric acid in the stomach

H2 receptor antagonist medications?

**-TIDINE**

* cimetidine
* famotidine

If H. Pylori is present, patient can take H2 receptor antagonists along with…

antibiotics

Nursing considerations for H2 receptor antagonists?

* IV for acute situations
* Eat meals regularly – constant neutralization of acids
* Avoid foods that promote gastric acid secretion
* Adequate rest/reduce stress
* Avoid smoking
* Avoid aspirin, NSAIDs
* Avoid alcohol
* Start with BID dosage/ then QD

Proton Pump Inhibitors (PPIs) block acid production and reduces gastric acid secretion by…

inhibiting the ==ENZYME== that produces gastric acid

Main difference between H2 receptor antagonists and PPIs is that they each block two different things…

H2 receptor antagonists block ==CELLS==

PPIs block ==ENZYMES==

PPI medications?

**-PRAZOLE**

* omeprazole
* lansoprazole
* pantoprazole

PPIs may be given in conjunction with…

H2 receptor antagonists

PPIs can be used for…

* Ulcers
* GERD
* Erosive esophagitis
* Hiatal hernia
* hole in the diaphragm; indigestion in thoracic cavity

Take PPIs before…

meals (breakfast)

Which PPI may be given IV?

Pantoprazole

How does Mucosal Protectants work?

They become a protective barrier that adheres to an ulcer. Protects the ulcer from further injury due to acid and pepsin

Mucosal Protectant medications?

* Sucralfate
* Misoprostol

Sucralfate is not -- so it does not cause any -- effects

absorbed into the whole system; systemic effects

***they work for up to 6 hours**

Sucralfate can be used for -- and -- term therapy for -- ulcers

acute and long term; duodenal ulcers

Antacids -- gastric acid because they are --

neutralize; alkaline based

Antacids are used for…

* PUD
* GERD
* Hiatal hernias

Antacids promote -- and relieve --

healing; pain

Antacid medications?

* aluminum hydroxide
* magnesium hydroxide
* calcium carbonate -- may be used for osteoporosis

Aluminum hydroxide can cause…

constipation

Magnesium hydroxide can cause…

* hypermagnesemia
* diarrhea

calcium carbonate can cause…

* **metabolic acidosis**
* hypercalcemia
* stones
* constipation

Give antacids -- meals

AFTER

PPIs are given -- meals and Antacids are given -- meals

BEFORE; AFTER

When administering Antacids be sure to give them…

WITHOUT any other medications -- space them out 4-6 hours

* ==“give medication with antacids” is usually the wrong answer==

Antiemetics -- serotonin antagonist medication?

Ondansetron -- Zofran

==\*most common antiemetic==

Ondansetron blocks…

serotonin receptors on vagal nerves that travel from the upper GI tract to the chemoreceptor trigger zone (CTZ)

Ondansetron can be administered…

PO -- not a good idea if patient is vomiting

IM

IV -- preferred method

Ondansetron can be used for…

* chemo therapy
* radiation therapy
* post op nausea
* PRN along with opioids to decrease nausea

Antiemetics -- dopamine antagonists medications?

* promethazine
* prochlorperazine
* metoclopramide

Promethazine can be administered as -- and it is used for --

* PO, IV, suppository -- PRN
* chemo and post op nausea

Promethazine is very -- when given IV

**irritating on the veins**

* make sure IV access is working; dilute medication with NS

Promethazine can cause -- and can mask symptoms of --

drowsiness; altered LOC

Metoclopramide can be given…

AC & HS

Metoclopramide uses?

* Helps with gastroparesis with clients who have diabetes
* Prevents nausea
* Short term for GERD

Miscellaneous Antiemetics?

* **dexamethasone**
* glucocorticoid
* intra-operatively
* **dronabinol**
* can be used for cancer patients (or anyone) who is not eating well/ FTT
* **scopolamine**
* ==Primarily used as a patch - behind ear==
* anticholinergic
* Used preoperatively
* Motion sickness


* **dymenhydrinate**
* motion sickness

Which laxatives PREVENT constipation?

* Pysllium
* Docusate sodium

Which laxatives TREAT constipation?

* biscodyl
* magnesium hydroxide

Psyllium -- fecal mass and -- bulk

softens; increases

Docusate sodium -- surface tension of the stool to allow -- to penetrate

lowers; water

What kind of patients do we definitely NOT want straining or constipated?

Cardiac (MI) and Neuro patients

* can increase ICP and IOP

How does biscodyl work?

it stimulates intestinal peristalsis

Magnesium hydroxide draws -- into the intestine to increase mass of stool, stretching --, resulting in --

water; musculature; peristalsis

\*also used for bowel prep

Senna, Lactulose, and Magnesium Citrate are also…

laxatives

Senna induces -- and is often used in combo with --

peristalsis; docusate

\*promotes BM

Lactulose is used primarily for…

==hepatic encephalopathy==

* flushes blood and bacteria out of the system to help get rid of excess **ammonia** in the body

Magnesium citrate is used prior to --

colonoscopies to clean out the bowel

Complications from laxatives?

* Toxic magnesium levels
* Sodium absorption and fluid retention
* Fleet’s Enema (sodium phosphate)
* Dehydration
* GI irritation
* Chronic use: **bad** – can lead to fluid and electrolyte imbalances
* Rebound constipation d/t chronic use– body cannot go without having the med

Laxatives are contraindicated if patients have…

* Fecal impaction
* can cause further damage; want to know what the underlying cause is; watery stool can be a sign
* Bowel obstruction
* Acute surgical abdomen
* Ulcerative colitis
* Diverticulitis

Fiber requirements for Men and Women for good bowel function?

MEN: 38 g/day

WOMEN: 25 g/day

What else can help with good bowel function?

* drink lots of WATER
* MOVE
* whole wheat bread
* choose cereal high in fiber
* eat fresh FRUITS and VEGGIES
* legumes

Anti-dirrheal medications -- opioid agonists?

* diphenoxylate/atropine
* loperamide

diphenoxylate/atropine SE?

* dry mouth/secretion
* urinary retention
* constipation

What do we want to educate patients on when taking loperamide?

READ INSTRUCTIONS CAREFULLY -- dosing is weird

Nursing considerations for patients with diarrhea?

* While GI tract is upset: stop solid foods and keep hydrated with clear liquids
* **Gatorade**
* **Broth**
* **Other electrolyte drinks**
* Avoid water
* Avoid caffeine - diuretic
* Monitor weight, I&O, VS
* Know amount of BM patients has during shift because too many can cause **hypotension and hypokalemia**

IBS consists of both…

diarrhea and constipation

Medications for IBS?

==Diarrhea:==

* alosetron
* increases firmness of stool and decreases urgency/frequency of defecation
* **COMPLICATION** is constipation

==Constipation:==

* lubiprostone
* increases fluid secretion in the intestine to promote peristalsis
* sulfasalazine
* **very specific antibiotic for GI**
* decreases inflammation
* can be used for IBS, Crohns, and Ulcerative colitis
* **COMPLICATION** is diarrhea

What do Probiotics do?

* Metabolize foods
* promote nutrient absorption
* reduce bad bacteria
* increase immunity response

Make sure that probiotics are kept in the…

fridge

* if they are kept at room temp. it can cause overgrowth of the bacteria

Probiotics can help treat…

* IBS
* ulcerative colitis
* C. Diff
* rotavirus diarrhea in kids

Medications for Men’s health?

* 5-Alpha reductase inhibitors
* Alpha1-adrenergic antagonists
* PDE-5 inhibitors

5-Alpha reductase inhibitors medications

**-TERIDE**

* finasteride
* dutasteride

Finasteride and Dutasteride decrease usable -- causing a reduced -- size

testosterone; prostate

\*may take up to 6 months before becoming effective

Finasteride and Dutasteride are used for…

* BPH
* Male pattern baldness
* receding line

Complication and Cautions of Finasteride and Dustasteride?

* Can cause decreased libido and gynecomastia
* Caution clients not to donate blood unless meds have been discontinued for a month

Alpha1-adrenergic antagonists medications

**-OSIN**

* tamsulosin
* alfuzosin
* doxazosin

Tamsulosin, Alfuzosin, and Doxazosin decrease mechanical obstruction of the -- by -- smooth muscles of the bladder neck and prostate

urethra; relaxing

Tamsulosin, Alfuzosin, and Doxazosin are used for…

* BPH
* HTN d/t vasodilation properties

Complications of Tamsulosin, Alfuzosin, and Doxazosin

* Hypotension
* Problems with ejaculation
* can cause retrograde ejaculation which is wear the semen goes back up into the bladder so patient may have cloudy pee which is actually the semen

PDE-5 inhibitor medications

* sildenafil
* tadalafil
* can be taken daily

Sildenafil and Tadalafil enhance…

blood flow to the penis

Sildenafil and Tadalafil are contraindicated for…

cardiac patients who are taking **nitrates such as isosorbide or a nitroglycerin**

Iron is used for…

iron deficiency anemia

Complications of iron?

* GI distress
* Don’t want to give iron with food because it is poorly absorbed in the GI – will decrease further if given with food; vitamin C enhances absorption of iron
* Teeth staining (liquid form with straw)
* Staining of skin (IM: Z track)
* Anaphylaxis (IV): test dose
* Black stool
* Constipation

Cyancobalamin is used for -- and works by converting -- from an inactive to active form

Vitamin b12 deficiency; folic acid

Loss of -- in the stomach causes an ability to absorb vitamin b12

Intrinsic Factor (IF)

Vitamin b12 deficiency causes…

We want to administer IF -- for those with insufficiency

* beefy red tongue, pallor, neuropathy
* parenteral or intranasal

\-- determines Vitamin B12 absorption in the GI tract

Schilling test

B12 shows up in urine?

You do not have anemia

B12 in stool?

You do have anemia

Foods high in Vitamin b12?

* poultry
* red meat
* eggs
* cheese
* salmon
* lobster
* milk

Folic acid (Vitamin b9) - folate

* Essential in production of DNA and erythropoiesis
* Treats anemia
* Very important for pregnant women to prevent neural tube defects in the fetus
* Treatment of malabsorption syndrome, like celiac disease
* Supplement for alcoholics
* Alcoholics and malnourished patients are risk for this deficiency
* Also used for high cholesterol

Vitamin b9 deficiency - we want to increase foods high in folic acid

* liver
* green leafy veggies
* citrus fruits
* beans

Potassium Supplement actions

conducts nerve impulses, maintains electrical excitability of muscle, regulation of acid/base balance

**normal level is 3.5-5.1 mmol/L**

* IV administration: slow!
* Irritates the veins
* Always diluted
* Never give IV push!
* Potassium Protocol

If the body is acidotic it can cause --

If the body is alkalotic it can cause --

* hyperkalemia
* hypokalemia

Causes of Hypokalemia and symptoms?

==Causes:==

* vomiting
* diarrhea
* excessive use of laxatives
* intestinal drainage

==Symptoms:==

* weakness
* fatigue
* muscle cramps/spasms
* tingling
* numbness
* **cardiac dysrhythmias**

What can we give to control Hyperkalemia?

* calcium gluconate
* sodium polystyrene sulfonate
* acts faster but can cause diarrhea

Before administering IV potassium check…

I&O

* don’t give if output is

Magnesium Supplement actions?

Activates many intracellular enzymes, regulates skeletal muscle contractility and blood coagulation

**normal level is 1.5-2.5 mEq/L**

**low levels of Magnesium can lead to life threatening cardiac dysrhythmias**

\
* Magnesium sulfate (IV); stops labor, hypomagnesemia
* Magnesium oxide (cardiac)
* Magnesium hydroxide (GI)
* Magnesium citrate (cleans the bowel)