t12. Gi & Nutrition
PPIs Suffix
"-prazole"
Clients with cirrhosis typically have
hypokalemia due to hyperaldosteronism (as aldosterone is not metabolized by the damaged liver)
if TD symptoms develop after administration of Metoclopramide (reglan) ?
immediately call Care Provider
Long-term use of PPIs (Prazoles - omeprazole, lansoprazole, pantoprazole, rebeprazole) has been associated with increased risk for
C difficile-associated diarrhea and pneumonia.
commonly seen with phenytoin toxicity ?
Ataxia gait disturbance
pt's on PPI and an ABX are at increased risk for
C Diff infection
after taking bisphosphonates ?
Drinking extra water and being upright for 30 minutes
who did you work with that was on Metoclopramide
Gastroparesis Pt's
Pancrelipase is
medication containing lipase, protease, and amylase.
Improved mental status implies
reduction of ammonia levels.
extrapyramidal adverse effects
tardive dyskinesia (TD)
*** A diabetic client is prescribed metoclopramide. Which of the following side effects must the nurse teach the client to report immediately to the health care provider? Select all
- excess blinking of eyes - lip smacking - puffing of cheeks
+ Normal urine specific gravity is
1.003-1.030.
normal hemoglobin
13.2-17.3 g/dL males 11.7-15.5 g/dL females
for unresolved diarrhea in PPI users, consider
CDAD clostridium difficile-associated diarrhea
cup feeding may be a method used to feed infants in specific cases, but
A syringe can provide an accurate measurement and decrease the risk of waste due to the infant's spitting or drooling.
what kinds of meds can increase the adverse effects of misoprostol (eg, diarrhea, dehydration)
Antacids, especially those that contain magnesium (eg, Gaviscon)
its unknown why, but long term use of PPI's can cause
Clostridium Difficile-Associated Diarrhea (CDAD)
*** nurse reinforces teaching to a female client about taking misoprostol to prevent stomach ulcers. Which statement by the client would prompt further instruction?
I will take this med with antacid to decrease stomach upset
PPIs such as omeprazole are often prescribed to hospitalized clients without
GERD or ulcers to prevent stress ulcers from developing during surgery or a major illness.
*** caring for a client with cirrhosis who has hepatic encephalopathy. The client is prescribed lactulose. Which assessment by the nurse will most likely indicate that the medication has achieved the desired therapeutic effect?
Improved mental status
so the pt has cirrhosis, which develops into higher levels of ammonia being retained, so how does this get fixed ?
Lactulose is a laxative which allows the ammonia to be expelled by diarrhea
*** The nurse is caring for a client who had surgery yesterday. When administering omeprazole, the client asks "What is that for? I don't take it at home." Which reply by the nurse is most appropriate?
Omeprazole helps prevent you from developing an ulcer due to stress of surgery
_______________ is given to reduce the ammonia by trapping it in the gut and then expelling it with a laxative effect
Oral lactulose
tardive dyskinesia (TD) symptoms include
Protruding and twisting of the tongue Lip smacking Puffing of cheeks Chewing movements Frowning or blinking of eyes Twisting fingers Twisted or rotated neck (torticollis)
Lactulose is a laxative used to trap and expel
ammonia in clients with cirrhosis who have hepatic encephalopathy
why ?
This technique decreases the risk for choking and ensures that all the medication is consumed.
seen with lithium toxicity and albuterol (short-acting beta agonist) use ?
Tremor
*** nurse is caring for a client with an inflammatory bowel disease exacerbation. The client is prescribed sulfasalazine. Which finding would require a priority follow-up
Urine Specific Gravity of 1.035
Elevated specific gravity can indicate
concentrated urine and be a sign of dehydration
*** nurse teaches a parent how to administer an oral liquid medication to a 2-month-old client. The nurse knows that the parent understands the teaching when the parent does which of the following?
Using a syringe, administers the med in small amounts into the back of the cheek
sulfasalazine expected side effect
Yellow-orange discoloration of the client's skin and urine
Medication should never be mixed in
a bottle of formula as the infant may not consume the entire amount.
Misoprostol is classified as
a pregnancy category X drug.
Omeprazole is
a proton pump inhibitor (PPI) that suppresses the production of gastric acid by inhibiting the proton pump in the parietal cells of the stomach
what else increases the risk for CDIF ?
abx use
PPIs cause
acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract
PPIs cause suppression of
acid that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract.
The client usually does not feel thirsty until
after there is a fluid volume deficit.
Misoprostol should not be taken with
antacids but can be taken with food to reduce gastrointestinal upset
why ?
as the body cannot use the available iron in bone marrow with active inflammation
why?
bisphosphonates (eg, risedronate, alendronate) can cause esophagitis
IBD exacerbation usually includes
bloody stools, resulting in blood loss iron deficiency anemia
Long-term use of PPIs (Prazoles - omeprazole, lansoprazole, pantoprazole, rebeprazole) has been associated with decreased
bone density (calcium malabsorption)
how to assess if the client already has osteoporosis.
bone density test
Long-term therapy with a proton pump inhibitor (PPI) (eg, omeprazole, pantoprazole, esomeprazole) may decrease the absorption of
calcium and promote osteoporosis
Without these enzymes,
client is unable to absorb fats, starches, and some proteins from the diet.
In cystic fibrosis
client's pancreas does not excrete these necessary enzyme
*** has been on long-term omeprazole therapy for gastroesophageal reflux disease is admitted to the hospital for a urinary tract infection. The nurse recognizes that this client is at highest risk for which complication due to omeprazole use?
clostridium difficile infection
In cirrhosis the pt can get
constipation (which allows more ammonia to be absorbed) and hard stool (which irritates hemorrhoids)
Sulfa can
crystallize in the kidney if the client is dehydrated
Taking misoprostol with food can help
decrease gastrointestinal side effects (eg, abdominal pain, cramping, diarrhea).
Lactulose is a syruplike liquid that
decreases intestinal ammonia absorption in clients with liver disease and hepatic encephalopathy
Metoclopramide (Reglan)
decreases postoperative nausea by promoting gastric emptying.
______________ is a concern wi Sulfasalazine and most other Sulfa meds due to risk of crystal formation in the kidney
dehydration
__________________ is also a potential complication of inflammatory bowel disease
dehydration
Metoclopramide (Reglan) is prescribed for the treatment of
delayed gastric emptying, gastroesophageal reflux (GERD), and as an antiemetic
Hospitalized clients also have an increased risk of
diarrhea caused by Clostridium difficile.
Abdominal distension (ascites) in cirrhosis is treated with
diuretics (eg, furosemide, spironolactone) and paracentesis
Hypokalemia can also result from
diuretics used to treat the fluid retention and ascites. Lactulose is not intended to treat this pathology.
that two-thirds of clients who receive PPIs
do not need them
When the 5-ASA is combined with the sulfa preparation, the drug
does not become absorbed until it reaches the colon.
if a pt is on Misoprostol and they also want to take an antacid, they should choose one that
does not contain magnesium (eg, calcium carbonate [Tums]) and contact the health care provider if adverse effects occur
To prevent malabsorption syndrome
enzymes must be taken with every snack and every meal.
Due to the inflammatory nature of IBD,
erythrocyte sedimentation rate, C-reactive protein, and white blood cells can be elevated
Similar to antipsychotic drugs, metoclopramide use is associated with
extrapyramidal adverse effects,
so ... long term use of PPI's increases the possibility of
fractures of the spine hip wrist
Infants have a decreased
gag reflex
*** A client has been on long-term therapy with esomeprazole. What is essential for the nurse to ask the client?
have you had a bone density test recently ?
Pancrelipase provides
hese enzymes to the client and must be given with every snack and meal so that the client can digest and absorb the nutrients eaten
Hepatic encephalopathy in cirrhosis results from
higher serum ammonia levels that cause neurotoxic effects, including mental confusion
*** child with cystic fibrosis is to receive a dose of pancrelipase at 12:00 PM. The client states that he is not hungry and will eat his lunch in an hour. Which action is appropriate
hold the pancrelipase until the pt eats
pt's on PPI's should be encouraged to
increase intake of Calcium Vitamin D (to prevent osteoporosis )
Dispensing medication onto the back of the tongue would
increase the risk for aspiration of the medication.
PPIs impair
intestinal calcium absorption and therefore are associated with decreased bone density
Mild to moderate anemia
is common with most chronic inflammatory conditions (eg, rheumatoid arthritis, IBD)
*** client with a history of cirrhosis has a new prescription for lactulose 30 mL four times a day. What does the nurse explain to the client about this medication?
it will decrease intestinal absorption of ammonia
associated with long-term bisphosphonate (eg, alendronate, risedronate) therapy ?
jaw necrosis
Misoprostol is also used for
labor induction
Misoprostol prevents gastric ulcers in clients receiving
long-term nonsteroidal anti-inflammatory drug therapy.
Elevated ammonia levels cause
mental confusion.
do PPI's affect blood pressure
no
Long-term use of PPIs (eg, omeprazole, pantoprazole, esomeprazole) is associated with
osteoporosis, C difficile infection, and pneumonias.
Cystic fibrosis affects
pancreatic excretion of digestive enzymes.
Example of PPI's
pantoprazole, lansoprazole, esomeprazole
so, long term use of PPI's is assoc with
pneumonia
PPIs lead to increased risk of
pneumonias.
Misoprostol (Cytotec) is often prescribed to
prevent gastric ulcers in clients receiving long-term nonsteroidal anti-inflammatory drug (NSAID) therapy.
hospitalized pt's wi/out a hx of GERD or Ulcers, PPI's are prescribed to
prevent stress ulcers from developing during surgery or a major illness.
Women of childbearing age who are taking Misoprostol ?
should be educated on using reliable birth control methods as misoprostol can induce labor.
taking PPI's in relation to meals?
should be taken prior to meals
Sulfasalazine (Azulfidine) contains
sulfapyridine and aspirin (5-ASA) and is used as a topical gastrointestinal anti-inflammatory and immunomodulatory agent in inflammatory bowel disease (IBD)
Misoprostol (Cytotec) is
synthetic prostaglandin that protects against gastric ulcers by reducing stomach acid and promoting mucus production and cell regeneration
important for the infant to receive
the entire dose of the medication.
If the client is not eating when the medication is scheduled,
there are no nutrients to digest.
Long-term use of proton pump inhibitors (PPIs) is common as
these medications are available over the counter.
correct procedure for administering oral medication to an infant is
to place small amounts of the medication at the back of the cheek,
Dehydration is a risk with IBD as the client can have
up to 20 diarrheal stools a day.
the most accurate technique to ensure that the proper amount of medication is being administered ?
using a Syringe to measure the medication
how do you remember "-prazole"
you take prazoles and you "pray" that they reduce the acid in your stomach and stop burning up your "a-z/h-ole"
