Chapter 9: Gastrointestinal Medications Answer Key

9.5 Anti-Ulcer Medications

Learning Activity 1

1. Plan to do a complete GI assessment. Let’s review the options.

• She reports occasional constipation. Magnesium antacid can be used as a laxative, so this may be a good choice. Magnesium is the only antacid that can cause loose stools.  Calcium-based and aluminum-based antacids will cause constipation, so not ideal.
• She has hypertension, so she needs to avoid sodium-based antacids.
• Magnesium hydroxide will be an effective choice.

2. Client teaching: She takes several medications, so she needs to take her other meds two hours before or one hour after her antacid. If she does not get relief, she should see her health care provider for further assessment.

Learning Activity 2

Postoperative clients often require a proton pump inhibitor due to the stress response that occurs during surgery and hospitalization. Pantoprazole suppresses the secretion of hydrochloric acid and prevents the formation of a stress ulcer.

9.6 Anti-diarrheals

1. The client may be experiencing increased heart rate as a symptom of dehydration associated with water loss from diarrhea. Additionally, a Black Box Warning for loperamide is abnormal heart rhythm. The nurse should assess the client’s heart rate and rhythm and notify the provider.
2. The nurse can recommend providing over-the-counter probiotics, which are also found in yogurt, for the prevention of diarrhea associated with antibiotic use or to assist in decreasing the symptoms of diarrhea.

9.7 Laxatives

1. A postoperative client has many risk factors for constipation, including side effects of anesthesia and opiates, sedentary levels of activity, and decreased fluid and food intake after surgery.   In addition to administering docusate or other laxatives as needed, the nurse should educate the client about nonpharmacological interventions to relieve constipation, such as increased fluid and fiber intake and walking.
2. PEG 3350 has a mild laxative effect. It causes water to be pulled into the intestine, and then the stool, increasing osmotic pressure in bowel.
3. PEG 3350, taken daily, works within 1-3 days. It is also important to continue to increase fluid and fiber intake.
4. Preventative measures for constipation include increasing fluid and fiber intake, ambulating, and using the least amount of opiates needed to effectively treat the pain.
5. Bowel protocols usually include a step-wise approach to constipation.  Polyethylene glycol 3350 are often used preventively, but if a bowel movement does not occur within the expected timeframe, additional laxatives can be added. Most bowel protocols have a step-up process with progressive increase in laxative choices. Some options include stimulants such as senna, bisacodyl or if no results after a few days, an enema may be added.  A bisacodyl suppository generally produces a bowel movement within one hour whereas a mineral oil enema usually works within 15 minutes of administration.

9.8 Anti-emetics

1. This med is an effective choice for pediatric clients. The dosage should be based on the child’s weight. The child must be over 2 years of age due to risk of respiratory depression with the younger age. Do a thorough assessment including vital signs, nausea level and ability to take fluids. If the client can’t manage swallowing, rectal route is an option if necessary.  Always do an independent double check with another nurse.
2. Aprepitant is usually administered concurrently with dexamethasone (a corticosteroid) and ondansetron.

9.9 Critical Thinking and Decision Making Activities

1. a. The nurse assesses for dehydration by monitoring blood pressure for hypotension, heart rate for tachycardia, urine output for decreased level, skin for tenting, and mucus membranes for dryness.

1. b. The dissolving tablets eliminate the risk of vomiting the medication before it is absorbed. If the client can’t tolerate the dissolving tablets, the nurse can request the provider to change the route of ondansetron to the intravenous route.

1. c. The nurse should plan to proactively administer medications before meals to prevent nausea.

The client can also be instructed to follow a bland diet to prevent feelings of nausea that can be stimulated by spicy food or strong flavors.  Fluids should be encouraged to prevent dehydration, but if fluids increase the client’s feelings of nausea, the client can be instructed to take frequent sips of fluid or suck on ice chips.

2. 2. Metoclopramide is an effective antiemetic that works on the D2 receptors. It also causes GI motility and increases peristalsis.  In this client’s case, increasing peristalsis with a bowel obstruction is contraindicated. It is also not good for older adults due to the risk of adverse effects of tardive dyskinesia.

Ondansetron is a highly effective anti-emetic that is good for many causes of nausea.  It can cause headache and fatigue but typically mild.  There is a slight risk of prolonging QT interval but this can be monitored if the client will be on it long term.