PRIORITY SETTING: who do you see 1st?
[give med] for pt. on call for surgery.
pt. c/o indigestion.
pt. who needs routine med for GERD.
pt. who needs pepto for ulcer.
[give med] for pt. on call for sugery.
MATH: physician orders: cimetidine (Tagamet)--[H2-blocker]--for pt. w/ ulcers. med comes in 400 mg/tablet. how many tablets do you give?
what type of med is diphenoxylate/atropine (Lomotil)?
lactulose (Cephulac, Chronulac) [hepatobiliary; constipation] is given for what?
to relieve constipation.
as tx for hepatic encephalopathy to decrease ammonia levels.
whom would you not give diphenoxylate/atropine (Lomotil)--[Diarrhea]--to & why?
78 yr. old w/ diarrhea
68 yr. old w/ glaucoma
50 yr. old w/ CAD
pt. recieving aminoglycoside antibiotics
pt. w/ glaucoma b/c anti-diarrheals causes retention of fluid causing increased pressure.
which physician's orders would you question?
*omeprazole (Prilosec)--[PPIs; H. pylori]--for duodenal ulcer
*metronidazole (Flagyl)--[Antiparasitics; other antibacterials]--for h. pylori.
*psyllium (Metamucil)--[Constipation/(Vitamins/Nutritionals)]--for chronic constipation
*misoprostol (Cytotec)--[Constipation; other GI/gynecologics]--for pt. w/ NSIAD induced ulcer
what type of drug is simethicone (Mylicon)?
pt. teaching for taking calcium carbonate (Tums):
chew thoroughly then drink full 8 oz. glass of water.
pt. is taking omeprazole (Prilosec)--[PPIs; H. pylori]--for GERD. how do you med is effective?
if pt. doesn't have heartburn (decreased production of acid).
if pt. has hypertension. what don't you want to increase?
BP (don't give docusate sodium (Colace)--[Constipation]--b/c it has sodium in it).
**can't give any med that contains sodium.
almost all antacids (if chewable) should be?
chewed thoroughly followed by drinking an 8 oz. glass of water.
dr. ordered pancrelipase (Cotazym)--[Digestive Enzyme]. why would drug be prescribed?
to supplement pancreatic enzymes.
breakdown fats, starches, & proteins.
necessary for breakdown & digestion of food.
replacement therapy for those w/ pancreatic enzyme insufficiency.
what type of drug is ranitidine (Zantac)?
H2 [antagonist] blocker med.
where does antacid mainly work?
place pt. in left-lateral position w/ knees slightly flexed.
get suppository out of fridge.
lubricate med w/ KY-jelly.
squeeze cheeks to hold in place for 2-3 min.
aluminum carbonate (Basaljel)--[Antacid]--is given for what?
to treat hyperacidity caused by:
acid indigestion [dyspepsia].
to prevent formation of phosphate based urinary stones.
aluminum containing antacids may cause?
pt. who has cirrhosis has high serum ammonial level. what med would be prescribed?
lactulose (Cephula, Chronulac).
how do you know if lactulose (Cephulac, Chronulac)--[Laxative]--is effective?
level of consciousness has increased.
what type of drug is loperamide (Imodium)?
pt. has CHF & dr. prescribed sodium bicarbonate (Baking Soda)--[Antacid]--for GI upset. would you question order?
yes b/c of sodium--given to pt. w/ metabolic acidosis.
**may cause systemic alkalosis & rebound hyperacidity.
**contraindicated w/ cardiovascular probs. & those on sodium restricted diets.
what type of drug is loperamide (Imodium)?
how does loperamide (Imodium)--[Antidiarrheal]--work?
acts directly on muscle of bowel to slow motility.
take after ea. loose stool.
what type of med is magnesium hydroxide (MOM) & can cause what?
severe diarrhea, dehydration, & hypermagnesemia.
nursing/teaching interventions for pt. who has hiatal hernia [defect in diaphragm permits portion of stomach to pass through diaphragmatic opening into the chest] to decrease heartburn?
provide sm. frequent meals.
do not recline for 1 hr. after eating.
elevate HOB on 4-8 in. blocks.
pt. who has inflammatory bowel disease was prescribed sulfasalazine (Azulfidine)--[Aminosalicylate]. what are the instructions for taking med?
3-4 g/day PO in divided doses.
then 2 g PO QID.
push fluids to prevent crystalluria from sulfa.
**monitor BUN & serum creatinine for kidney damage.
where should suppositories be stored?
MATH: pt. prescribed 100 mL to be given over 20 min.
60 gtts per min.
**re-check IV every hr.
what does an H. pylori infection cause?
peptic/duodenal ulcers--H. pylori produces toxin that destroys mucus.
nursing considerations for H. pylori infections?
all ulcers at risk for hemorrhage & hypovolemic shock from perforation & obstruction--assess for melena & hematemesis.
s/s of bleeding include increase in pulse & drop in BP.
**monitor CBC & FOBT.
what type of drug is sennosides (Senokot)?
[irritant/stimulant laxative] constipation.
pt. taking sennosides (Senokot)--[Irritant/Stimulant Laxative]--is c/o brown urine & yellow-green stool. what should you tell pt.?
normal side effect of drug.
dronabinol (Marinol)--[Antiemetic]--is used for what?
for chemotherapy induced nausea & vomiting.
appetite stimulant for pt. w/ HIV.
what type of med is dronabinol (Marinol)?
**may cause drowsiness, somnolence,
euphoria, dizziness, & vomiting.
prolonged us of loperamide (Imodium)--[Antidiarrheal]--may cause?
dry skin & mucous membranes.
prolonged use of laxatives may cause?
diarrhea & loss of water/electrolytes.
which meds are used to treat ulcerative colitis?
corticotropin & adrenal corticosteroids.
iron/liquid (IV) supplements.
best time to administer mineral oil--[Emollient]--for constipation?
take at HS [at night] on empty stomach.
what is 1 advantage of giving an H2 [antagonist] blocker rather than an antacid?
dosing is less frequent.
**antacids may be taken hourly for 1st 2 wks.
**H2-blockers usually given BID/at HS for maintenance.
H2 [antagonist] blockers are used cautiously?
in pts. w/ renal/hepatic impairment.
in severely ill, elderly/debilitated pts.
during pregnancy & lactation.
other meds taken w/ an antacid should be take when?
2 hrs before/after.
metoclopramide (Reglan)--[Gastrointestinal Stimulant]--is used to treat? how?
used to treat GERD & gastric distress.
increases motility of upper GI tract w/o increasing production of secretions.
laxatives are also used for what besides constipation?
for pt. w/ [IBS] irritable bowel syndrome & severe watery diarrhea.
for pt. going for sigmoidoscopy/colonoscopy.
what type of med is cimetidine (Tagamet)?
H2 [antagonist] blocker med.
cimetidine (Tagamet)--[H2 [antagonist] blocker]--can cause what for men?
if pt. has trouble taking laxative [tablet], can they chew it?
no--can be split in half, but not crushed.
**suggest liquid form/suppository.
before administering sulfasalazine (Azulfidine)--[Aminosalicylate]--what should you ask pt. & what is it given for?
any allergies to sulfa.
used to treat inflammatory bowel disease: Chron's disease & ulcerative colitis.
if pt. is given combination drugs for H. pylori, how long do they have to take them?
2 wks (14 days).
what consistency & color of stool be for pt. taking Colace?
soft & brown (means Colace is working).
pt. prescribed bulk laxative [methylcellulose (Citrucel)psyllium (Metamucil), polycarbophil (FiberCon)] how do those meds work?
pt. scheduled for colonoscopy. what drug is prescribed for stool evacuation?
laxatives [MOM] (turns stool clear-yellow).
**assess skin turgor before administering med.
what is the generic name for Colace?
docusate sodium (Colace)--[Laxative]--is contraindicated for pts. who have?
lactulose (Cephulac) can be given for?
**check neurological status (level of consciousness).
prochlorperazine (Compazine) is an antidopaminergic antiemetic drug that prevents?
pt. is being prescribed promethazine (Phenergan), what type of drug is it & how does it work?