McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 5 7 Drugs affecting gastrointestinal secretions

Care considerations for people receiving digestive enzymes

measures to minimise or prevent them; danger signs that need to be reported to the healthcare provider immediately; the need for periodic monitoring of pancreatic enzyme levels to evaluate the effectiveness of therapy; and the importance of complying with therapy and follow-up to enhance knowledge about drug therapy and to promote compliance. Evaluation ■ ■ Monitor the response to the drug (e.g. relief of dry mouth and throat; digestion of fats, proteins and carbohydrates). ■ ■ Monitor for adverse effects (e.g. electrolyte imbalance, GI effects). ■ ■ Monitor the effectiveness of comfort and safety measures and compliance with the regimen. ■ ■ Evaluate the effectiveness of the teaching plan (person can name the drug and dosage and describe adverse effects to watch for, specific measures to avoid them and measures to take to increase the effectiveness of the drug).

Assessment: History and examination

■ ■ Assess for possible contraindications or cautions : any history of allergy to any of the drugs or to pork products to prevent hypersensitivity reactions because there may be an abnormal absorption of electrolytes, including sodium, leading to increased cardiovascular load ; and current status of pregnancy or breastfeeding because of the potential for adverse effects on the fetus or breastfeeding infant. ■ ■ Perform a physical examination to establish baseline data before beginning therapy and during therapy to evaluate the effectiveness of the drug and determine the occurrence of any adverse effects associated with drug therapy. ■ ■ Perform an abdominal examination to rule out underlying medical conditions and assess for adverse effects of the drug ; auscultate bowel sounds to evaluate GI motility. ■ ■ Assess cardiopulmonary status, including blood pressure and cardiac rate and rhythm, to identify changes that may indicate electrolyte imbalances. ■ ■ Monitor the results of laboratory tests, including renal function tests, to determine the need for possible dose adjustment and identify toxic effects , and pancreatic enzyme levels to assure correct dose and to monitor response. Implementation with rationale ■ ■ Administer pancreatic enzymes with meals and snacks so that the enzyme is available when it is needed. Avoid spilling powder on the skin because it may be irritating. Do not crush the capsule or allow the person to chew it; it must be swallowed whole to ensure full therapeutic effect. ■ ■ Assess nutritional status if there are GI effects to arrange for appropriate measures to relieve discomfort and ensure nutrition, such as frequent small meals. ■ ■ Obtain laboratory specimens as indicated to evaluate electrolyte levels and pancreatic enzyme levels. ■ ■ Offer support and encouragement to help the person cope with the disease and the drug regimen. ■ ■ Provide thorough teaching, including the drug name and prescribed dosage; schedule for administration; the importance of taking pancreatic enzymes with meals and snacks; the need to take the pancreatic enzyme whole and not to crush or chew the capsule; dietary measures to follow; signs and symptoms of adverse effects and

KEY POINTS

■■ Digestive enzymes such as pancreatic enzymes may be needed if normal enzyme levels are very low and proper digestion cannot take place. ■■ People receiving replacement enzymes will need to be monitored to ensure that the dose is correct for their particular situation to avoid adverse effects.

CHAPTER SUMMARY

■■ GI complaints are some of the most common symptoms seen in clinical practice. ■■ Peptic ulcers may result from increased acid production, decrease in the protective mucus lining of the stomach, infection with Helicobacter pylori bacteria, or a combination of these. ■■ Agents used to decrease the acid content of the stomach include H 2 antagonists, which block the release of acid in response to gastrin or parasympathetic release; antacids, which chemically react with the acid to neutralise it; proton pump inhibitors, which block the last step of acid production to prevent release; and prostaglandins, which block gastric acid secretion and increase bicarbonate production. ■■ Acid rebound occurs when the stomach produces more gastrin and more acid in response to lowered acid levels in the stomach, which commonly occurs with the use of antacids. Balancing the reduction of