CHAPTER 25

Laxatives and Antidiarrheals

CONSTIPATIONPassage of feces through the lower

GI tract is slow or nonexistentMay be caused by - ignoring the defecation urge - environmental changes - low residue diet - decreased physical activity - emotional stress - eating constipating foods - constipating drugs - misuse of laxatives - low fluid intake

2

LAXATIVES

Facilitate the passing of fecal material from the colon and rectum

Reasons for use - test preparation - reduce strain of defecation - parasitic infections - poison removal - constipation 3

LAXATIVES

Use is widespreadOveruse can be an issue

especially in the elderlyOccasional constipation may be

normalLaxative dependence can occurProlonged use can lead to - fluid and electrolyte loss - malnutrition - liver disease

4

LAXATIVE CLASSIFICATIONS

StimulantSalineBulk-formingLubricant

Stool softenersSuppositories

LactuloseEnemas 5

STIMULANT LAXATIVES

ActionChemical irritation

Increase motility of the GI tract

Increase secretion of water into large and small intestineExample: bisacodyl

6

SALINE LAXATIVES

Increase osmotic pressure within the intestinal tractCause more water to enter the intestines

Result in: Bowel distention, increased peristalsis, and evacuation

7

SALINE LAXATIVES

Contain saltUnpleasant tasteSystemically absorbedResult in:

Poor client complianceRisk for dehydration Risk for congestive heart failure 8

BULK-FORMING LAXATIVES

Safest formAbsorbs water to increase bulk

Distends bowel to initiate reflex bowel activityNot systemically absorbed

High fiber 9

BULK-FORMING LAXATIVES

Natural or semisyntheticExamples: psyllium hydrophilic muciloid (Metamucil), methylcellulose (Citrucel), and polycarbophil (Fibercon)

10

BULK-FORMING LAXATIVES

Must be followed with a large amount of fluidIf chewed or taken in dry powder form, these agents can cause esophageal obstruction and/or fecal impaction.

11

LUBRICANT LAXATIVES

Oils lubricate the fecal material and intestinal walls, thereby promoting fecal passage:Prevent fat-soluble vitamins from

being absorbedPopular lubricant

Mineral oilOften made from petroleum products

Not digested or absorbed12

STOOL SOFTENERS

Detergent-like drugs:Permit mixing of fats and fluids with the fecal mass

Stool becomes softer and is passed much easier

Takes several days to workExample: docusate salts (Colace and Surfak) 13

SUPPOSITORIES

Usually in a wax base

Administered rectally

Absorbed systemically

14

SUPPOSITORIES Available containing stimulant drugsGlycerin

Absorbs water from tissues, creating more mass

Bisacodyl Induces peristaltic contraction by direct stimulation of sensory nerves

15

LACTULOSE LAXATIVES

Two monosaccharides that are not digested or absorbed

Digested in the colon by bacteria to form acids substancesAcid substances cause water to be drawn into the colon 16

GOLYTELY

Polyethylene glycol (electrolyte solution and salt)Must consume 4 liters within 3 hours

Causes a large volume of water to be retained in the colon

Acts within one hourProduces a diarrheal state

17

ENEMAS

HyperosmoticsSolution contain salts (e.g., Fleet enema) Administered rectally and cause a laxative effect by osmotically drawing fluid into the colon to initiate defecation 18

LONG-TERM USE

Long-term use of laxatives often results in decreased bowel tone and may lead to dependency.

EncourageA healthy, high-fiber dietIncreased fluid intake

19

NURSING CONSIDERATIONS

Assess bowel patternsEncourage fluids for patients taking laxatives

The elderly, children, and patients with electrolyte imbalances should not take saline laxatives

Bulk laxatives can take days to be effective

20

NURSING CONSIDERATIONS

Educate patients that laxatives can be habit-forming

Teach patients proper technique for self-administration of suppositories and enemas

Some laxatives should not be used for longer than 1 week

Use in infants and debilitated patients should be directed by their provider 21

DIARRHEA

Abnormally frequent passage of watery stools

Failure of the small and large colon to adequately absorb fluid from the intestinal contents

A symptom of an underlying disorder

22

DIARRHEA

Patients with chronic or severe acute diarrhea must be diagnosed before treatment

Untreated diarrhea can lead to dehydration and malnutrition

Therapy is aimed at reducing GI motility, remove irritants, or replace normal bacterial flora

23

ADSORBENTS

24

Most commonly used Claylike materials administered in a

tablet or liquid suspension form after each loose bowel movement

Bind to the causative bacteria or toxin, and are eliminated through the stool

Little scientific proof that they work– Examples: kaolin-pectin, attapulgite

(Kaopectate)

DRUGS THAT REDUCE GI MOTILITY

Opiate derivatives - reduce propulsive movement of the small

intestine and colon - dependence with prolonged use - depression of the CNS

25

DRUGS THAT REDUCE GI MOTILITY

Anticholinergic drugs - reduce intestinal motility - potential dangerous side effects – limits

usefulness

26

ANTIDIARRHEALS

Loperamide HCl (Imodium)Made from chemicals related to meperidine, a narcotic

Diphenoxylate HCl and atropine sulfate (Lomotil)Narcotic and anticholinergic drugReduces GI motility 27

ANTICHOLINERGICS

Decrease intestinal muscle tone and peristalsis of GI tract

Result: slows the movement of fecal matter through the GI tractExample: belladonna alkaloids (Donnatal)

28

NURSING CONSIDERATIONS

Monitor fluid intake and outputMonitor body weight in infantsMonitor for CNS depressionAdsorbents should not be administered with other drugs

Lactobacillus must be refrigerated

29

NURSING CONSIDERATIONS

Adults with fever, dehydration, or persistent diarrhea should contact provider

Infants and young children need sooner evaluation

30

NURSING CONSIDERATIONS

Patients with glaucoma or enlarged prostates should not take anticholinergic antidiarrheals

Do not use antidiarrheals with patients with acute abdominal pain

Antidiarrheals can cause constipation

31