922
P A R T 1 1
Drugs acting on the gastrointestinal system
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Laxative drugs stimulate GI motility and assist in
bowel elimination.
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Laxatives can be chemical or bulk stimulants or
lubricants.
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In many cases, implementing diet and exercise
strategies and promoting natural intestinal reflexes
have decreased the need to use laxatives.
■■
Chronic use of laxatives can lead to dependence on
them and on external stimuli for normal GI function.
KEY POINTS
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■
Investigate the person’s nutritional intake, including
fluid intake and ingestion of fibre-containing foods,
to evaluate for possible contributing factors related
to the need for the drug.
■
■
Assess the person’s level of activity
to determine
possible contributing factors for decreased bowel
motility.
■
■
Perform an abdominal examination, including
inspecting abdomen for distension, palpating
for masses and auscultating for bowel sounds,
to establish adequate bowel function, rule out
underlying medical conditions and assess the
effectiveness of the drug.
■
■
Monitor results of laboratory tests, including
serum electrolyte levels,
to detect any changes
related to altered absorption.
Implementation with rationale
■
■
Administer a laxative only as a temporary
measure
to prevent the development of cathartic
dependence.
■
■
Arrange for appropriate dietary measures, exercise
and environmental controls
to encourage the
return of normal bowel function.
■
■
Administer the oral form with a full glass of
water, and caution the person not to chew tablets,
to ensure that the laxative reaches the GI tract
to allow for therapeutic effects.
Encourage fluid
intake throughout the day as appropriate
to
maintain fluid balance and improve GI movement.
■
■
Administer bulk laxatives with plenty of water.
If only a little water is used, it may absorb enough
fluid in the oesophagus to swell into a gelatine-like
mass
that can obstruct the oesophagus and cause
severe problems.
■
■
Insert rectal suppositories high into the rectum;
encourage people to retain enemas or rectal solution
as long as possible
to improve effectiveness
.
■
■
Do not administer in the presence of acute
abdominal pain, nausea or vomiting,
which might
indicate a serious underlying medical problem
that could be exacerbated by laxative use
due to
potential risk of bowel perforation.
■
■
Monitor bowel function
to evaluate drug
effectiveness.
If diarrhoea or cramping occurs,
discontinue the drug
to relieve discomfort and to
prevent serious fluid and electrolyte imbalance.
■
■
Provide comfort and safety measures
to improve
compliance and to ensure safety
, including ready
access to bathroom facilities, assistance with
ambulation and periodic orientation if CNS effects
occur.
■
■
Offer support and encouragement
to help the
person deal with the discomfort of the condition
and drug therapy.
■
■
Offer support and encouragement
to help the person
deal with the diagnosis and the drug regimen.
■
■
Provide thorough teaching, including the drug name,
dosage and schedule for administration; method of
administration, such as taking the oral form with a
full glass of water, thoroughly mixing the powdered
or granular form with water or juice
to ensure
complete dissolution
, inserting the suppository
form or using and retaining an enema; approximate
time for achievement of results and importance of
having bathroom facilities readily available; safety
measures, such as changing positions slowly and
using assistance with ambulation if dizziness or
weakness occurs; signs and symptoms of possible
adverse effects and measures
to minimise or prevent
them
; possible leakage and staining when liquid
paraffin is used and the stool cannot be retained by
the external sphincter; danger signs and symptoms
to be reported to a healthcare provider immediately
;
the importance of daily activity
to promote bowel
function
; the need for the ingestion of high-fibre
foods and adequate fluids
to stimulate GI motility
;
the importance of avoiding the overuse of laxatives
to prevent chronic or long-term problems with
elimination
; a bowel training program if indicated
to prevent dependence on laxatives
; and importance
of periodic monitoring and evaluation
to evaluate
the effectiveness of therapy, enhance knowledge
about drug therapy and promote compliance.
Evaluation
■
■
Monitor response to the drug (relief of GI
symptoms, absence of straining, evacuation of
GI tract).
■
■
Monitor for adverse effects (dizziness, confusion,
GI alterations, sweating, electrolyte imbalance,
cathartic dependence).
■
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Monitor the effectiveness of comfort measures and
compliance with the regimen.
■
■
Evaluate the effectiveness of the teaching plan
(person can name the drug and dosage, describe
adverse effects to watch for and specific measures
to use to avoid them).
