C H A P T E R 5 7
Drugs affecting gastrointestinal secretions
913
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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
KEY POINTS
Care considerations for
people receiving digestive enzymes
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
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).
