ch 39 prepU
The nurse recognizes that a client needs additional instruction if the client makes which comment about treatment for occasional constipation?
"I will make sure that I have a bowel movement every day."
The nurse has just finished client education with a client who is being discharged home on bulk-forming laxatives. The nurse knows the client understands discharge instructructions regarding these medications when which statement is made?
"I will mix the medication with 4 to 8 ounces of liquid and follow it by an additional 4 to 8 ounces." Bulk-forming laxatives need to be taken with at least 8 oz of water or other liquid.
The nurse is preparing to administer medications to a group of clients. For which client is bisacodyl contraindicated?
4-year-old. Bisacodyl is contraindicated in clients younger than 6 years of age.
The nurse is seeing a 69-year-old client who is highly physically active and consumes a balanced diet that includes adequate fluid intake. Despite this, the client states experiencing occasional constipation in recent months. What remedy should be the nurse's first suggestion?
A bulk-forming (fiber) laxative,Bulk-forming (fiber) laxatives are considered the safest and most physiologic of the laxatives. As such, they are normally preferable to stimulant and hyperosmotic laxatives for occasional relief of constipation.
A clent is being sent home with orders for a laxative PRN. What should the nurse inform the client is one of the most common adverse effects of a laxative?
Abdominal cramping, Common adverse effects of laxatives are diarrhea, abdominal cramping, and nausea. CNS effects such as dizziness, headache, and weakness can occur. However, these adverse effects usually relate to the loss of fluid and electrolyte imbalance associated with laxative use.
A female client calls the clinic and reports not feeling good to the nurse. The client tells the nurse that the client was recently prescribed a laxative. The nurse knows that the client takes other medications for congestive heart failure and osteoarthritis. What should the nurse question the client about?
Administration of the laxative in relation to taking the other medications
The nurse is aware that critically ill clients are more at risk for constipation for what reasons? (Select all that apply.)
Decreased activity Use of opioid medications Change in bowel routines
A student asks the physiology instructor what failure to respond to the defecation reflex will cause. What would the instructor answer?
Decreased sensory stimulation of relfex.
A new mother had to have an episiotomy during the birth of her baby. Two days after delivery, the client is in need of a laxative. What will the nurse administer?
Docusate (Colace), A mild laxative may be used after delivery with care that it not enter breast milk and affect the newborn if the mother is nursing. Docusate would be the drug of choice from this list because it is mild and will produce a soft stool and decrease the need to strain.
A client reports to the nurse about needing to strain to defecate. The client adds that defecating is very painful. What laxative will the nurse suggest to the prescriber based on the painful defecation?
Ducosate. A laxative such as a stool softener like ducosate sodium is recommended for clients who are straining or for whom defecation is painful. Sorbitol may be given with activated charcoal to remove toxic substances. Bulk-forming laxatives such as psyllium are used in clients who are debilitated, older, or unable or unwilling to eat an adequate diet. Fluids and fiber are indicated for all clients to encourage a healthy bowel regimen.
You are preparing to administer a saline cathartic when the patient mentions that they have CHF. You know that saline cathartics are contraindicated for clients with congestive heart failure due to what adverse effect?
Hypernatremia, Patients with congestive heart failure are at risk of fluid retention and edema with sodium-containing laxatives.
A group of students are reviewing the actions of laxatives on the GI tract. The students demonstrate understanding when they state what about bulk stimulants?
Increase the fluid in the intestinal contents, Bulk laxatives increase the fluid in the intestinal contents, which enlarges bulk and stimulates local stretch receptor and activates local activity. Chemical stimulant laxatives directly stimulate the nerve plexus in the intestinal wall. Mineral oil, a lubricant, forms a slippery coat on the contents of the intestinal tract. Methylnaltrexone acts as a selective antagonist to opioid binding at the mu receptor.
In pharmacology class the students are learning about the mechanism of action of different laxatives. What would the students learn about the mechanism of action of psyllium hydrophilic mucilloid?
Increasing mass and water content of stool. When water is added, the laxative substance swells and becomes gel-like. The added bulk or size of the fecal mass stimulates peristalsis and defecation.
What is the correct rationale for why the nurse would administer a laxative at a separate time from the client's other medications?
Laxatives may reduce absorption of other drugs present in the GI tract.
A female client has dealt with constipation most of her adult life. She has not had relief of symptoms with most medications used in the treatment of this condition. The nurse is aware that this client will be prescribed which drug?
Lubiprostone, Clients with chronic idiopathic constipation are prescribed lubiprostone
You are caring for four clients. Which client would you know is at highest risk for constipation?
Paraplegic
After teaching a group of students about laxatives, the instructor determines that the teaching has been successful when the students identify which agent as an example of a bulk laxative?
Polycarbophil, Polycarbophil is an example of a bulk laxative. Bisacodyl and senna are examples of chemical stimulant laxatives. Docusate is an example of a lubricant laxative.
A client is scheduled for a colonoscopy. The nurse knows that the preferred drug for bowel cleansing before this procedure is:
Polyethylene glycol-electrolyte solution (NuLYTELY). Polyethylene glycol-electrolyte solution taken orally will rapidly provoke extensive diarrhea with complete emptying of the lower intestine. Polyethylene glycol solution, bisacodyl, and psyllium work much more slowly and are useful in managing constipation.
A nurse is presenting a class to a local women's group on gastrointestinal (GI) problems. How would the nurse tell these women that GI function is best maintained?
Proper diet, fluid intake, and exercise
Which is an important assessment for the nurse to make before administering a laxative?
Question the client regarding the type and intensity of symptoms to provide a baseline evaluation.
The nurse is giving instructions to a client who will be having a colonoscopy in the morning. The client will be taking polyethylene glycol-electrolyte solution for bowel cleaning. What information will help increase the palatability of this medication?
Refrigerate the solution until it is cold.
A client with a history of constipation has been taking over-the-counter laxatives with good success. The client tells the nurse that he is relieved to have found a solution to his constipation. When providing health education, the nurse should prioritize what topic?
Strategies for preventing dependence on laxatives
Which would be most important to include when teaching a patient about using psyllium?
Taking the agent with a large amount of water, A large amount of water is needed to prevent the laxative from swelling into a gelatin-like mass in the esophagus that could lead to obstruction. Psyllium can be taken any time, 1 to 3 times per day. Bulk laxatives, like psyllium, can increase the motility of the GI tract and interfere with the timing or process of absorption. Administration of other drugs with psyllium should be separated by at least 30 minutes. It would be important to encourage the patient to ingest high fiber foods to promote bowel evacuation and reduce the need for psyllium.
A hospitalized client's request for a magnesium citrate "bisacodyl pill" every night to "keep regular" should alert the nurse to what potential health risk for the client?
laxative abuse, Stimulant laxatives such as bisacodyl are generally useful and safe for short-term treatment of constipation, cleansing the bowel prior to endoscopic examinations, and treating fecal impaction. However, they are not safe for frequent or prolonged usage but are often used or overused in older adults.
What type of laxative would be the first choice for a client diagnosed with hemorrhoids experiencing intense pain when straining to pass stools?
stool softener. For clients in whom straining is potentially harmful or painful, stool softeners (e.g., docusate sodium) are the agents of choice.
Which laxative or cathartic is most likely prescribed for a postpartum client who experienced a posterior laceration during birth?
surfactant laxatives, Surfactant laxatives have little if any laxative effect. Their main value is to prevent straining while expelling stool. They usually act within 1 to 3 days and should be taken daily.
What physiological result occurs when an individual regularly fails to take needed bathroom breaks?
weakened defecation reflex
A home health nurse is caring for a 72-year-old male in his home. The client reports diarrhea on an almost-daily basis. What would the nurse explain to this client is a common cause of diarrhea in older adults?
Laxative overuse
The nurse explains that there is no "normal" number of daily stools because of differences in what contributing factor?
diet
The nurse is providing care to a client with hepatic encephalopathy. Which would the nurse anticipate administering to assist in lowering the client's blood ammonia level?
lactulose
A client needing to evacuate the colon for endoscopy would likely be prescribed which medication?
polyethylene glycol electrolyte solution. A client needing to evacuate the colon for endoscopy would likely take polyethylene glycol electrolyte solution as it is a bowel evacuant. Methylcellulose and psyllium are bulk-forming laxatives and will not evacuate the bowel for endoscopy. Mineral oil is an emollient that lubricates the intestinal walls and softens the stool, thereby enhancing passage of fecal material.
A client with constipation is prescribed psyllium. The client asks the nurse how the client should take the medication. What is the nurse's best response?
"Take this medication with 8 ounces of water."
The nurse receives a call from a client who is taking lactulose. The client reports having two to three soft stools every day and the client is afraid of developing diarrhea. What is the nurse's best response to this client?
"That is exactly what the medication is supposed to do."
A client is advised to use a bulk-forming laxative to alleviate constipation. The nurse will recommend:
Psyllium (Metamucil).
The nurse is caring for a client who will need to use a medication to assist in the prevention of constipation for an extended period of time. The nurse is aware that which drug is the most desirable for long-term use?
Psyllium is the best medication for long-term use in the treatment of constipation.
What is an important teaching point regarding intake for anyone using bulk-forming laxatives?
assure adequate fluid intake, It is important to take the drug with at least 8 ounces of water or another liquid. With the psyllium-containing preparation Metamucil, there have been reports of obstruction in the GI tract when the compound was taken with insufficient fluid.
A client who has suffered a myocardial infarction is prescribed a laxative to help prevent straining during defecation. Which medication would the nurse expect to administer?
docusate, Docusate a stool softener, may be prescribed after a myocardial infarction to prevent straining during defecation. Psyllium is a bulk-forming laxative and may require straining to eliminate. Lubiprostone and lactulose are hyperosmotic agents that are used to relieve constipation and the reduction of blood ammonia levels in hepatic encephalopathy which may require straining.
The nurse should prioritize what assessment when providing care for a client who has taken over-the-counter (OTC) bisacodyl daily for several months?
electrolyte levels. People should not use bisacodyl frequently or for longer than 1 week because it may produce serum electrolyte and acid-base imbalances (e.g., hypocalcemia, hypokalemia, metabolic acidosis, or alkalosis). Assessment of electrolytes would thus be warranted in the care of this client. Reflexes, heart rate, and coagulation factors may be affected, but these would be consequent to alterations in electrolyte levels.
