Chapter 40: Drug Therapy for Diarrhea

A nurse is teaching a client who is prescribed diphenoxylate with atropine. Which statement by the client indicates the teaching was effective? A) "I will start working out at the gym before my bowel habits become more normal." B) "I will add this medication to my daily medication schedule." C) "My urine should be dark and cloudy." D) "As my stools decrease, I will discontinue this medication."

"As my stools decrease, I will discontinue this medication." Explanation: Diphenoxylate with atropine is used for diarrhea and not for daily use. Once the stools change to a more normal pattern, the medication should be stopped. Working out can lead to dehydration and fatigue. The medication does not affect urine; however, the urine output be dark and cloudy, which may indicate dehydration.

A caregiver of a 1-year-old asks the nurse if they can give the diphenoxylate that was prescribed for an older sibling to the child. Which is the nurse's best response?

"Children younger than 1 year of age should not be given this medication." Explanation: Children younger than 2 years of age should not take this drug, and those from age 2 to less than 13 years should take the liquid preparation to enhance accuracy of the dosage. Calling the prescriber is not necessary. The nurse should not encourage over-the-counter medications for the child.

A nurse is teaching a client about diarrhea. Which statement by the client regarding diarrhea would indicate a need for additional teaching?

"Diarrhea is a disease that has no cure." Explanation: Diarrhea is an increase in the liquidity of stool or frequency of defecation to more than 3 stools per day. It is a symptom of numerous conditions and not a disease. Diarrhea is a manifestation of basic mechanisms that increase bowel motility, and a variety of toxins and medications can cause the diarrhea. Diarrhea may be acute or chronic and mild or severe.

The nurse is about to administer diphenoxylate (Lomotil) to a client for the first time. Which of the following side effects should be included in the teaching about this medication?

"This medication may make you feel lightheaded or drowsy." Explanation: Diphenoxylate (Lomotil) is chemically related to opioid drugs; therefore, it may have sedative and euphoric effects as well as a list of other side effects. It does not increase energy or cause perianal irritation, although perianal irritation is often a result of diarrhea.

Which of the following are effects that a client might experience while taking diphenoxylate (Lomotil)? Select all that apply: -Analgesic effects -Slowed GI effects -Euphoric effects -Sedative effects -Anti-inflammatory effects

-Analgesic effects -Slowed GI effects -Euphoric effects Explanation: Because diphenoxylate (Lomotil) is opioid-related, it may have sedative, slowed GI, and euphoric effects but no analgesic or anti-inflammatory activity.

The nurse is teaching the client nonpharmacologic means for recovery from acute, nospecific diarrhea. What items would the nurse suggest that the client consume in the first 24 hours of recovery? Select all that apply. -Broth -Gelatin -Decaffeinated tea -Coffee -Carbonated water

-Broth -Gelatin -Decaffeinated tea Explanation: Fluids such as decaffeinated tea, water, broth, clear soup, noncarbonated caffeine-free beverages, and gelatin are usually tolerated and helpful in restoring fluids and electrolytes. Coffee and carbonated liquids would be poorly tolerated.

A client who is homeless is admitted with dehydration and diarrhea. The admission interview indicates that the client regularly collects food from dumpsters behind restaurants. What pathogens could be causing diarrhea? Select all that apply. -Staphylococcus aureus -Shigella -Salmonella -Clostridium difficile -Listeria monocytogenes

-Shigella -Salmonella -Staphylococcus aureus -Listeria monocytogenes

Which adverse effects should the nurse teach a client to possibly expect when prescribed diphenoxylate with atropine? Select all that apply. -nausea and vomiting -urinary retention -elevated blood sugar -dizziness -hypertension

-nausea and vomiting -urinary retention -dizziness Explanation: In teaching adverse effects to a client prescribed diphenoxylate with atropine, the nurse should include a discussion about tachycardia, dizziness, headache, flushing, nausea and vomiting, dry skin and mucous membranes, and urinary retention. Hypotension and respiratory depression have also occurred. Hypertension and elevated blood sugar are not adverse effects of this medication.

The nurse administers metoclopramide orally at 9:00 AM to a patient with GERD. The nurse would expect this drug to exert its maximum effectiveness at which time?

10:00 AM to 10:30 AM

The nurse should counsel a client to discontinue use of over-the-counter antidiarrheals and seek treatment from a health care provider if diarrhea persists for how long?

2 days Explanation: The nurse should counsel a client to discontinue use of over-the-counter antidiarrheals and seek treatment from a health care provider if diarrhea persists for more than 2 days. Diarrhea lasting more than 2 days can indicate infection or a condition that will require more intense treatment with prescription medication. Dehydration can occur if untreated. Diarrhea of 12 hours to 1 day can be viral. Diarrhea for 7 days can be life threatening.

A nurse instructs a client taking an antidiarrheal agent to stop the drug and call the health care provider if the client does not experience relief within which time frame?

48 hours Explanation: If the client experiences no response within 48 hours, the client should notify her health care provider to determine a possible underlying medical cause for the diarrhea.

Diarrhea can be caused by innumerable factors, including drugs. Which of the following medications can cause diarrhea? -SSRIs -Tacrolimus -Misoprostol -All of these

All of these Explanation: Many oral drugs irritate the GI tract and may cause diarrhea, including acarbose, antacids that contain magnesium, antibacterials, antineoplastic agents, colchicine, laxatives, metformin, metoclopramide, misoprostol, selective serotonin reuptake inhibitors, tacrine, and tacrolimus.

A nurse is caring for a client who has developed diarrhea after antibiotic administration. The client has a BUN of 35 and creatinine of 1.8. The provider has ordered diphenoxylate with atropine for the client. What action should the nurse implement?

Call the prescriber about the laboratory tests. Explanation: The nurse knows that the use of diphenoxylate with atropine requires caution with clients that have renal or hepatic compromise. The nurse should call the provider and make sure the provider is aware of the laboratory values before administering the medication. Discussion with other nurses is not warranted. The medication does not need to be held at this time as diphenoxylate with atropine is not contraindicated with renal or hepatic compromise but can be administered with caution.

The nurse is assessing a 68-year-old man with chronic diarrhea. The past medical history does not reveal any current conditions that might be contributing. The patient mentions that he used to have a problem with constipation. The nurse is aware that which of the following might be the cause of his diarrhea?

Chronic use of laxatives

The nurse is caring for a 68-year-old patient with diarrhea. The patient has been prescribed an antidiarrheal. The nurse is aware this patient is at risk for developing which of the following?

Constipation Explanation: Older people may safely take most antidiarrheal drugs, but cautious use is indicated to avoid inducing constipation.

Which of the following nursing diagnoses is a priority for a client who is 89 years old and has frequent liquid stools?

Deficient Fluid Volume related to excessive losses in liquid stools Explanation: Fluid volume deficits may develop rapidly in older adults with diarrhea.

The nurse is caring for a client with diarrhea who has been prescribed diphenoxylate with atropine and is observing the client for which adverse effects of this drug?

Dizziness Explanation: Adverse effect of diphenoxylate include tachycardia, urinary retention, flushing, headache, and dizziness as well as nausea and vomiting.

When describing the drugs used to treat traveler's diarrhea, which would the nurse identify as the most common cause?

E. coli Explanation: The most common cause of traveler's diarrhea is E. coli.

At your general medicine practice, your newest patient is a 2-year-old girl from Nigeria whose mother reports the child has excellent health, except for the diarrhea she has demonstrated. Diarrhea started within days of their arrival in the United States 3 weeks ago. History reveals nothing remarkable, but her mother comments on her love of (and continual consumption of) ice cream, something new to her since coming to this country. What would you expect her treatment to involve?

Eliminate milk products from her diet

Nonspecific therapy of diarrhea includes: A) Bulk laxatives. B) Loperamide. C)Fluid and electrolyte replacement. D) Psyllium.

Fluid and electrolyte replacement. Explanation: A major element of nonspecific therapy is adequate fluid and electrolyte replacement.

A prescriber adds psyllium to the medication administration record for a client experiencing diarrhea. Which is the best rationale for the addition of psyllium?

It absorbs toxins and water, decreasing fluidity of stools. Explanation: Polycarbophil and psyllium are most often used as bulk-forming laxatives as they absorb toxin and water, decreasing the fluidity of the stools. They do not cause bloating and swell the colon or reduce the exchange of proteins and mucus in the stools.

The client has been prescribed diphenoxylate with atropine (Lomotil) for diarrhea. The nurse recognizes that this drug is effective against diarrhea because of which action? A) Decreases GI secretions B) Slows peristalsis by acting on the smooth muscles of the intestine C) Anti-inflammatory effects allowing absorption of fluids D) Antimicrobial effects

Slows peristalsis by acting on the smooth muscles of the intestine Explanation: Diphenoxylate with atropine is chemically related to opioid drugs; therefore, they decrease intestinal peristalsis, which often is increased when the client has diarrhea.

A client has sought care because their diarrhea has not resolved, despite taking over-the-counter loperamide 12 mg/day for the past 2 days. In addition to referring the client to their health care provider, the nurse will provide which instruction? A) Increase the dose to 16 mg/day until seeing the health care provider. B) Stop taking the medication. C) Reduce fluid intake to 1 L/day until the diarrhea resolves. D) Supplement the loperamide with psyllium.

Stop taking the medication. Explanation: In general, it is necessary to discontinue loperamide after 48 hours if clinical improvement has not occurred. Doses above 8 mg/day require supervision by the health care provider. Psyllium would not negate the risks of continued use, and fluid restriction is ineffective and unsafe.

The nurse should question a prescription for bismuth salts for a client with what condition? A) allergy to aspirin B) rheumatoid arthritis C) viral gastroenteritis D) hypertension

allergy to aspirin Explanation: Bismuth salts contain aspirin and should not be given to a client with an allergy to aspirin. There is no contraindication for a client with rheumatoid arthritis, hypertension, or viral gastroenteritis.

The nurse is preparing medications for a client with diarrhea. The nurse will withhold bismuth subsalicylate if the client's record indicates a history of what disorder?

aspirin allergy Explanation: Bismuth subsalicylate has antisecretory and possibly anti-inflammatory effects because of its salicylate component. Clients with an allergy to aspirin and aspirin products should not take bismuth subsalicylate. Bismuth subsalicylate is not contraindicated for hypertension, type 2 diabetes, or lactose intolerance.

A client diagnosed with irritable bowel syndrome has been prescribed alosetron. The nurse should ensure that the client has been made aware of what potentially severe adverse effect? A) blood dyscrasias B) diverticulosis C) anal fissures D) bowel obstruction

bowel obstruction Explanation: Severe constipation, with possible obstruction, perforation, and hemorrhage, is the most common problem resulting from alosetron. None of the other options are associated with this medication.

The parent of an adolescent client reports that the teen has chronic diarrhea and lacks an appetite. Assessment reveals that the client is significantly underweight, has dry hair, and exhibits erosion of tooth enamel. When asked, the client reports occasional laxative use for "constipation." What condition does the nurse consider most likely? A) dehydration and hyperkalemia B) anorexia nervosa C) sodium retention D) bulimia with laxative abuse

bulimia with laxative abuse Explanation: Enamel erosion is a hallmark of bulimia. The report of "occasional" laxative use plus the report of chronic diarrhea raises the strong potential for laxative abuse. None of the other options would account for the tooth enamel erosion.

The health care provider (HCP) has determined that a client diagnosed with bacterial gastroenteritis following an overseas trip is a candidate for antibacterial drug therapy. The nurse knows that the HCP will select the appropriate drug based on which factor?

causative agent Explanation: In bacterial gastroenteritis or diarrhea, the choice of antibacterial drug depends on the causative organism and susceptibility tests. The other information will not influence selection.

A client reports the intention to use an over-the-counter bismuth product. The nurse should inform the client that there is a potential that the medication will cause what side effect? A) hyperglycemia B) dark stool C) hypertension D) photosensitivity

dark stool Explanation: Bismuth subsalicylate causes a temporary and harmless darkening of the tongue or stool. It is not associated with any of the other options.

A male client develops diarrhea secondary to antibiotic therapy. He is to receive two tablets of diphenoxylate HCl with atropine sulfate (Lomotil) orally as needed for each loose stool. The nurse should inform him that he may experience:

dizziness. Explanation: The most common adverse effects of diphenoxylate HCl with atropine sulfate are drowsiness and dizziness related to the drug's chemical similarity to meperidine, an opioid. Tachycardia is an adverse effect, not bradycardia. Muscle aches and an increase in appetite are not adverse effects of the drug.

To maximize the therapeutic effect of diphenoxylate HCl with atropine sulfate, the nurse will instruct the client to take the medication:

four times a day. Explanation: To maximize the therapeutic effect, diphenoxylate HCl with atropine sulfate is usually administered four times daily, which serves to help maintain a therapeutic drug level.

The client states that prior to exams at school, the client has abdominal cramping and diarrhea. What does the nurse suspect is the trigger for these signs and symptoms?

functional diarrhea disorder Explanation: The client is describing functional diarrhea disorder where the diarrhea occurs as a result of stress or anxiety. The client does not have hyperthyroid, intestinal neoplasm, or colitis. While all of these conditions can lead to diarrhea, the client's description does not support any of these diagnoses.

A 2-year-old child from Nigeria is reported to have excellent health, except for the diarrhea that started within days of the family's arrival in the United States 3 weeks ago. History reveals nothing remarkable, but the mother comments on her child's love of (and continual consumption of) ice cream, something not available in their native country. This history supports what possible cause of the child's diarrhea?

lactase deficiency Explanation: Deficiency of lactase, which breaks down lactose to simple sugars (i.e., glucose and galactose) that can be absorbed by the gastrointestinal (GI) mucosa, inhibits digestion of milk and milk products. Lactase deficiency commonly occurs among people of African and Asian descent.

A hospital client has been scheduled for a barium enema the following morning. The nurse should anticipate what prescription for the client's bowel preparation?

polyethylene glycol-electrolyte solution Explanation: Polyethylene glycol-electrolyte solution is often prescribed for bowel preparation before diagnostic tests. Magnesium sulfate is more commonly used for emergency situations. Senna and polycarbophil are most often used for short-term relief of constipation.