GI/Tube feeding

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GI/Tube feeding
2010-11-14 18:00:28
GI nursing

GI/Tube feeding cards
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  1. Tranquilizers
    • Librax (Chlordiaepoxide + Clidinium)
    • Combination of anxiolytic and Anticholinergic

    • Robinul (Glycopyrrolate)
    • Reduces vagal stimulation, decreases anxiety
  2. Anticholinergics
    Pro-Banthine (Propantheline)

    Inhibits release of HCL by blocking acetylcholine and histamine

    Take with meals to decrease acid secretion
  3. Mechanism of Action for Antacids:
    • -Neutralize stomach acid by
    • Promoting gastric mucosal defense mechanisms and secretion of:
    • -Mucous (protective barrier against HCL)
    • -Bicarbonate (helps buffer acidic properties of HCL)
    • -Prostaglandins (prevent activation of proton pump)
  4. Raising the gastric pH from 1.3 to 1.6 neutralizes
    _____________% of gastric acid
  5. Raising the gastric pH 1 point (1.3 to 2.3) neutralizes
    __________% of gastric acid
  6. Which Antacid has Constipating effects?
    • Aluminum Salts
    • (Often used with with Magnesium to counteract constipation)
  7. What Antacid is often recommended for patients with renal disease since it is more easily excreted?
    Aluminum Salts
  8. Aluminum Salts (Examples)
    • Basajel (Aluminum carbonate)
    • AlternaGEL (Hydroxide salt)

    • COMBO of AL and Mg =
    • Gaviscon, Maalox, Mylanta, Di-Gel
  9. What Antacid commonly causes diarrhea?
    Magnesium Salts
  10. What Antacids are dangerous to use with patients with Renal Failure?
    Failing Kidney cannot excrete extra magnesium resulting in accumulation

    Calcium Salts can also cause accumulation of Calcium causing kidney stones
  11. Magnesium Salts (Examples)
    • Milk of Magnesia (Hydroxide Salt)
    • Gaviscon (Carbonate salt) - Combo product
    • Maalox, Mylanta (aluminum and magnesium combo)
  12. Calcium Salts (Example)
    • -Carbonate is most common
    • -Long duration of acid action (may cause increased gastric acid secretion) *hyperacidity rebound*
    • -Advertised as an extra source of dietary calcium

    TUMS (calcium carbonate)
  13. Sodium Bicarbonate
    • Buffers the acidic properties of HCL
    • Quick onset, but short duration
    • May cause Metabolic alkalosis
    • Sodium content may cause problems in patients with HF, HTN, or Renal insufficiency
  14. Antiulcer Drugs: Action and SE's
    Action: Neautralize gastric acid by reducing pepsin activity

    Systemic side effects: Sodium excess, water retention, metabolic alkalosis, acid rebound

    • Non systemic side effects: Al: Constipation
    • Mg: diarrhea (Taken in combo = none)
  15. Histamine 2 blockers Action:
    Reduces gastric acid by blocking H2 receptors of parietal cells in stomach

    promotes healing of ulcer by eliminating cause

    SE: HA. dizziness, diarrhea, constimpation, reversible IMPOTENCE, gynecomastia (MAN BOOBS)
  16. Histamine 2 Blockers (Examples)
    • Tagamet (Cimetidine)
    • Zantec (Ranitidine)
    • Pepcid (famotidine)
    • Axid (Nizatidine)
  17. Proton Pump inhibitors Action
    Reduce gastric acid by inhibiting hydrogen/potassium ATPase

    SE: HA, insomnia, dizziness, dry mouth, flatulence, abdominal pain
  18. Proton Pump inhibitors Examples
    • Nexium (Esomeprazole)
    • Protonix (Pantoprazole)
    • Prilosec (Omeprazole)
    • Prevacid (Lansoprazole)
  19. Pepsin inhibitors Action and example
    Combines with protein to form thick paste covering ulcer, protects from acid and pepsin

    • SE: Constipation
    • Example: Carafate (Sucralfate) "saran wrap"

  20. Non prescription Antiemetics

    • Dramamine (Dimenhydrinate)
    • Benadryl (Diphenhydramine)

    • Pepto-Bismol (Bismuth subsalicylate)
    • *acts directly on gastric mucosa to suppress vomiting*

    SE: Similar to anticholinergics: Drowsiness, dry mouth, constipation
  21. Prescriptive antihistimines
    Acts on VC, decreases stimulation of CTZ

    • Vistaril (Hydroxyzine)
    • Phenergan (Promethazine) *Dopamine antagonist*
    • *Phenothiazine*
  22. Anticholinergic Antiemetics
    Trasdermal-Scop (Scopolomine)

    Acts on VC, decreases stimulation of CTZ
  23. Promethazine (Phenergan)
    Action: Inhibit CTZ, blocks H1 receptor sites

    SE: Drowsiness, dry mouth, blurred vision, tachycardia, constipation, urinary retention, photosensitivity, EPS (tardive dyskinesia *involuntary movement of the lower face*, acute dystonia *movements that cause twisting or abnormal postures*, akathisia *restless leg syndrome*)
  24. Antiemetics Cont....

    Dopamine Antagonists

    Action (Blocks Dopamine (D2) receptors in CTZ)

    • Haloperidol (Haldol)
    • Droperidol (Inapsine)
    • Metoclopramide (Reglan)

    SE: Sedation, diarrhea, EPS
  25. Antiemetics Cont....

    Benzodiazepines - uses
    Antivan (Lorazepam)

    • Use - Cancer chemotherapy
    • Used in combination with a glucosteroid and serotonin 5-HT3 receptor antagonist
  26. Antiemetics Cont.....

    Serotonin receptor antagonist
    Action and uses + SE
    Zofran (Ondansetron)

    Action - Blocks serotonin receptors in CTZ and afferent vagal nerve terminals in UGI

    • use - Cancer chemotherapy
    • SE: HA, diarrhea, dizziness, fatigue
  27. Antiemetics cont......

    use and examples
    use: Cancer chemotherapy

    • Decadron (Dexamethasone)
    • Solu-Medrol (Methylprednisolone)
  28. Misc Antiemetics
    • Vontrol (diphenidol)
    • Tigan (Trimethobenzamide)
  29. Suppresses impulses to CTZ
    SE:drowsines, dry mouth, tachycardia, urine retention, constipation, diarrhea, blurred vision, hypotension, EPS
  30. Nursing interventions for Antiemetics
    • Provide mouth care
    • monitor VS, bowel sounds
    • Monitor for dehydration
    • Warn not to take alcohol with Antiemetics
    • Warn pregnant females to avoid Antiemetics
    • Avoid driving motor vehicles
  31. Opiates and Opiate related Antidiarrheals

    Examples and SE
    • Paraegoric (camporated opium tincture)
    • Lomotil (Diphenoxylate with Atropine)
    • Immodium (Loperamide)

    Opiates decrease GI motility, can cause respiratory depression in the children and elderly, may cause physical dependence

    Atropine contraindicated in glaucoma
  32. Somatostatin analog

    use and example
    Use: sever diarrhea from Cancer

    Sandostatin (Octreotide)
  33. Adsorbents

    Examples and Action
    Action: Coats GI tract, absorbs bacteria or toxins
  34. Combination agents (Antidiarrheal)
    Parepectolin (paragoric, Kaolinpectin)
  35. Nursing interventions for Anidiarrheals
    • Monitor BP, R
    • Report more than 10-15 mmHg decrease in BP
    • Monitor frequency of bowel movements and bowel sounds
    • Assess for dehydration
    • Monitor electrolytes
    • Avoid fried foods, milk and sedatives
    • If Diarrhea persists after 48hrs, notify MD
  36. Causes of Constipation
    • Bowel Obstruction, fecal impaction
    • Chronic laxative use, ignoring urge to defecate
    • Neurologic disorders
    • SE of drugs
    • Lack of exercise, fiber and water
  37. Causes of Diarrhea
    • Spicy or spoiled foods
    • Bacteria (E-coli), virus or toxins
    • Drug reactions
    • Fecal impaction, laxative abuse
    • Malabsorption disorders, bowel tumor, inflammatory bowel disease
    • Stress + Anxiety
  38. Laxatives vs Cathartics vs Purgatives
    Laxatives - promote soft stool

    Cathartics - soft to watery stool with cramping

    Purgatives - watery stool with cramping
  39. Osmotic (saline) Laxatives

    Action, SE and examples
    Action - Hyperosmolar salts pull water into colon, increase water in feces to increase bulk, which stimulates peristalsis

    • GoLYTELY - Polyethylene glycol
    • Chronulac - Lactulose

    SE: Fluid and electrolyte imbalances, hypotention, weakness
  40. Stimulant (Irritant) Laxative

    Action and example
    Action: Increase peristalsis by irritating sensory nerve endings in intestinal mucosa

    • Ex-Lax, Correctol (Phenolphthalein)
    • Dulcolax (Biscacodyl)

    SE: Abdominal cramps, weakness, reddish brown urine, diarrhea
  41. Bulk Forming Laxatives

    Action and Examples
    • Metamucil (Psyllium hydrophilic mucilloid)
    • Fiber-Con (Calcium polycarbophil)

    Action: Absorb water into intestines, increase bulk and perstalsis

    Takes 8-12 hours
  42. Admin and Side effects of Bulk forming laxatives
    Mix in glass of water or juice,stir, drink immediately, follow with 1 glass of water

    • SE: Abdominal cramps
    • Excess Laxative = N/V, gas, diarrhea
  43. Emollients (Stool Softners)

    Action and example
    • Action: Lowers surface tension
    • Promotes water accumulation in intestine
    • Emulsifies and lubricates feces for easier passage

    Colace (Docusate)
  44. Uses for Emollients (Stool Softners)
    • Prevents constipation
    • Reduces straining post surgery or myocardial infarction

    SE: ABD cramping, N/V, Diarrhea