NURS 20025 GI

What is required in your body to promote health, prevent illness, and promote recovery

Water

Carbohydrates

Energy

Fats

Proteins

Minerals

Vitamins

Fat Soluble Vitamins

vitamins that are accumulated and stored in the body when taken in excess: vitamins A,E,K

Water soluble vitamins

vitamins that are not stored in the body and are rapidly eliminated: vitamins B and C

Vitamin A: retinol

fat soluble

toxicity include: hair loss, double vision, headaches, vomiting, bone abnormalities, and liver damage

Vitamin E: alpha-tocopherol

can interfere with vitamin K action (blood clotting) by decreasing platelet aggregation and producing a risk of bleeding

Vitamin K: phytonadione

-to correct hypoprothrombinemia caused by inadequate levels of vitamin K and

-to reverse the effects of warfarin (Coumadin) overdose

-Adverse Effect: BLACK BOX WARNING: IV administration may result in an anaphylactic type of reaction with risks of shock, cardiorespiratory arrest, and death, even with drug dilution and slow administration

vitamin B1 (thiamine), vitamin B3 (niacin), and vitamin B6 (pyridoxine)

-adverse effects: niacin: hepatic impairment, active peptic ulcer disease; pyridoxine: cardiac disease

-many of the vitamin B deficiencies occur together

Vitamin B12 (cyanocobalamin) and folic acid

Use: Megaloblastic anemia, pernicious anemia, vitamin B12 deficiency

Adverse Effect: Vit B12: hypokalemia; Folic Acid: bronchospasms

Vitamin C (ascorbic acid)

Adverse Effect: abdominal cramps, nausea, vomiting, and diarrhea

Caution in patients who have a history of kidney stones

Iron (ferrous sulfate)

Adverse Effect: GI discomfort, nausea, constipation, diarrhea, and black stools.

Administration: in general food decreases iron absorption, except vitamin C will increase the absorption of iron

Potassium chloride or KCL

Adverse Effect:

-Oral route: nausea, vomiting, abdominal pain, and diarrhea

-IV route: phlebitis

Administration: people should take oral preparations with or after meals; this decreases gastric irritation

Medications used to treat hyperkalemia

-Sodium bicarb

-Calcium gluconate

-Glucose and insulin

-Sodium Polystyrene Sulfonate

Noradrenergic Sympathomimetic Anorexiants (phentermine)

used to help speed up weight loss

Contraindications: severe hypertension, cardiovascular disease, hyperthyroidism, glaucoma

Lipase Inhibitors (Orlistat)

Action: binds to gastric and pancreatic lipases in the GI tract, and it can prevent the absorption of 30% of ingested fat

Bupropion

used for the prevention of weight gain during smoking cessation, as well as for the treatment of depression

Peptic Ulcer Disease

-Ulcerations can happen in any area of gastrointestinal tract

-Risk factors: Family Hx, Blood type O, Smoking, caffeine, ETOH, Chronic pulmonary or kidney disease, Stress (Cortisol), Drugs, H. pylori*

GERD

Causes: Incompetent LES, Pyloric stenosis, Hiatal hernia, Motility disorder, Obesity, Age-related changes

Long Term Risks: Esophagitis, Barrett's Esophagus, Strictures, Esophageal cancers

PUD/GERD Treatment

Lifestyle changes: ETOH, Tobacco, Weight management, Reducing stress, Eliminate causative foods

Eliminate/change drugs (if feasible): NSAIDS, Corticosteroids, Platelet inhibitors

H2 Receptor Antagonists (H2 Blockers): famotidine, ranitidine

-Reduction of gastric acid secretion, gastric volume, & hydrogen ion concentration

-Uses: Short term duodenal or gastric ulcers, Prophylaxis for stress induced ulcers or hypersecretory conditions,Treatment for erosive GERD, Heartburn (OTC preparations)

-Drug-Drug Interactions: Warfarin, phenytoin, beta adrenergic blockers

Antacids: Sodium bicarbonate, Calcium salts, Magnesium salts, Aluminum hydroxide

Uses: Symptomatic relief of upset stomach from hyperacidity, Peptic ulcer, peptic esophagitis, gastric hyperacidity, hiatal hernia

-available OTC

-simethicone may also be added

-can affect the absorption of many drugs

Proton Pump Inhibitors (PPI's): omeprazole, pantoprazole

Suppress the secretion of hydrochloric acid

-take in the morning on an empty stomach

Used: Short term treatment of active duodenal ulcers, GERD, erosive esophagitis, gastric ulcers

GI Protectant (Sucralfate)

Uses: Coat any injured area in the stomach to prevent further injury from acid

-caution needs to be used if your patient is also taking phenytoin

Prostaglandin (Misoprostol)

Used to protect the stomach lining

Prevent NSAID induced gastric ulcers in high risk patients: elderly, history of ulcers, debilitating disease

-Do not use in pregnant women, women of child bearing age should not use

H Pylori

-need to use a full 10-14 day therapy

-triple and quadruple therapy

Digestive Enzyme: pancrelipase or saliva substitute

A chemical that helps break down food or can be used to treat dry mouth

Nausea and Vomiting

Helps body rid itself of toxins

Causes: Infection, Food poisoning, Motion sickness, Extreme pain, Stress/emotional states, Drugs, Migraine, Pregnancy, Trauma

Complications: Dehydration, F/E imbalances, Wt loss, Metabolic alkalosis, Vascular collapse

treat the underlying cause

Nonpharmacological treatment for Nausea/Vomiting

Antacids

diphenhydramine

Peppermint

Ginger

Phenothiazines (Prochlorperazine (Compazine), Promethazine (Phenergan)

For N/v and hiccups

Works by: Change the responsiveness or the stimulation of the CTZ in the medulla

do not take with CNS depressants and/or alcohol

Nonphenothiazines (Metoclopramide (Reglan)

Works by: Decrease the responsiveness of the nerve cells in the CTZ to the chemicals circulating the cause vomiting

Anticholinergics/Antihistamines (Meclizine (Antivert)

Hydroxyzine (Vistaril)

Works by: Block the transmission of impulses to the CTZ

Used for: Nausea and vomiting from motion sickness and vestibular problems

Don't use in: Narrow angle glaucoma, BPH, PUD, bronchial asthma

Do not mix with CNS depressants or alcohol

Substance P/Neurokinin 1 Receptor Antagonist: Aprepitant (Emend)

Works by: Blocks the receptors linked to nausea and vomiting without affecting the neurotransmitters serotonin, dopamine, or coticosteroids

Used for: Nausea and vomiting linked to highly emetogenic antineoplastic chemotherapy

5-HT3 (serotonin) Receptor Blockers: Ondansetron (Zofran)

Palonosetron (Aloxi)

Works by: Block the receptors associated with nausea and vomiting in the CTZ

Used for: Antineoplastic chemotherapy, Postoperative nausea and vomiting, Emetogenic chemotherapy

Constipation Causes

-Insufficient food/fiber/fluid/exercise

-Medications: Opioids, Anticholinergics, Antihistamines, Antacids, Iron supplements

-Foods: Refined flour, Dairy, Chocolate, ETOH

-Diseases: Hypothyroidism, DM, IBS

Constipation Complications

Hypertension

Fecal impaction

Hemorrhoids

Fissures

Megacolon

Bowel Perforation

Constipation Treatment

Bulk Stimulant

Lubricants

Chemical Stimulant

Gastrointestinal Stimulant

Bulk Stimulant/Mechanical Stimulant (Magnesium citrate,

Lactulose)

Used to treat and prevent chronic constipation

Work because: Contain fiber, Increase the size of fecal mass, Pulls H2O into GI tract

Watch for electrolyte imbalance

Make sure you take with enough water

Chemical Stimulant/Cathartics (Bisacodyl (Dulcolax), Castor oil, senna)

-Directly stimulate the nerve plexus in the intestinal wall

-Promote peristalsis, rapid acting

-More likely to cause cramping

-Increased risk of dependence

Lubricants (Mineral oil, docusate (colace)

To make defecation easier without stimulating the GI tract

Given for: hemorrhoids, recent surgery, if you do not want patient to strain when they have a bowel movement

Not absorbed systemically

Do not give if patient has: Appendicitis, diverticulitis, ulcerative colitis

Diarrhea Causes

Medications: ATB's

Infections

Lactose

Inflammatory disorders: UC, Crohn's, IBS

Diarrhea Complications

Cardiac dysrhythmias

Dehydration, F/E imbalances

Metabolic acidosis

Decreased UOP

Muscle weakness

Paresthesia

HypoTn

Anorexia

Drowsiness

Altered skin integrity

Diarrhea Treatment

Treat underlying Cause

Antidiarrheals

Opium Derivatives

Antidiarrheals: Opium (diphenoxylate with atropine (Lomotil)

Works by: Slow peristalsis, Allow time for additional H2O reabsorption

Side effects to watch for: Respiratory or CNS depression

Antidiarrheals: Bismuth subsalicylate (Pepto-Bismol)

uLoperamide (Imodium)

Block stimulation of the GI tract for symptomatic relief from diarrhea

Always figure out the cause of diarrhea before treating it or stopping it

Uses: Acute and chronic diarrhea, Decrease the output from ileostomies, Prevent and treat travelers diarrhea

Monitor for constipation

Irritable Bowel Syndrome

An intestinal disorder causing abdominal pain, gas, diarrhea, and constipation

Affects women 3 times as much as men

Medications: Alosetron (Lotronex), Hyoscyamine (Anaspaz)