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"