PHARMACOLOGY NCM 106

GASTROINTESTINAL
DRUGS
GROUP 5
 WHAT WE'LL LEARN
TODAY
Learning Objectives

Compare the pharmacological treatment of vomiting,

diarrhea, and constipation
Differentiate the actions and side effects of
antiemetics, emetics, antidiarrheals, and laxatives
Apply the Clinical Judgement (Nursing Process) for
the patient taking antiemetics, antidiarrheals, and
laxatives
Differentiate contraindications to the use of
antiemetics, emetics, antidiarrheals, and laxatives

PHARMACOLOGY
OVERVIEW OF THE
GASTROINTESTINAL
SYSTEM ORAL CAVITY ESOPHAGUS STOMACH

SMALL LARGE
RECTUM ANUS
INTESTINE INTESTINE
VOMITING
Expulsion of stomach contents and
can be caused by motion sickness,
infections, food intolerance,
surgery, pregnancy, drugs,
radiation, pain, or issues with ear
balance.
It is often preceded by nausea, a
queasy feeling.

PHARMACOLOGY
HOW DOES VOMITING
OCCUR?

PHARMACOLOGY
NONPHARMACOLOGIC
MEASURES
Weak tea
Flat soda
Gatorade
Pedialyte (especially for kids)
Crackers or dry toast
IV fluids
ANTIEMETICS
“AGAINTS” OR “PREVENTING” “VOMITING”
NONPRESCRIPTION ANTIEMETICS
Prevent motion sickness

Inhibit vestibular stimulation in the middle ear.

Minimally effective for severe vomiting from anticancer agents

(antineoplastics), radiation, or toxins.

Antihistamine antiemetics

a. Dimenhydrinate

b. Cyclizine hydrochloride

c. Meclizine hydrochloride

d. Diphenhydramine hydrochloride

Side effects include drowsiness, dry mouth, and constipation.

NONPRESCRIPTION ANTIEMETICS

Several nonprescription drugs act directly on the gastric

mucosa to suppress vomiting.

Bismuth subsalicylate - Protects the stomach lining and

neutralizes toxins that cause irritation.

Phosphorated carbohydrate solution- Its effectiveness as

an antiemetic has not been verified

NONPRESCRIPTION ANTIEMETICS
Antiemetics previously used for nausea during pregnancy

are no longer recommended due to potential harm to the

fetus.

NONPHARMACOLOGIC METHODS
Ginger

Red raspberry leaf tea

PRESCRIPTION ANTIEMETICS
1. ANTIHISTAMINES
2. ANTICHOLINERGICS
3. DOPAMINE ANTAGONISTS
4. BENZODIASPINES
5. SEROTONIN ANTAGONISTS
6. GLUCOCORTICOIDS
7. CANNABINOIDS
8. MISCELLANEOUS
ANTIHISTAMINES
Act primarily on the vomiting center.

Decreases stimulation of the CTZ and vestibular pathways.

Hydroxyzine
Indication
Postoperative nausea/vomiting
Route: IM (give in deep large muscles)
Side effects
drowsiness, dizziness, fatigue, ataxia, headache, blurred
vision, dry mouth,
Adverse Effects:
urinary retention and constipation.
ANTICHOLINERGICS
Act primarily on the vomiting center.

Decreases stimulation of the CTZ and vestibular pathways.

Scopolamine
Uses

for nausea and vomiting, motion sickness, and procedural sedation

Route: Transdermal Patch (Topical)

Side effects

drowsiness, dizziness, fatigue, headache, blurred vision, dry

conjunctiva, dilated pupils, agitation, restlessness ,dry mouth and

constipation.

Adverse Effects

Othostatic hypotension, visual impairment, and confusion

DOPAMINE ANTAGONISTS
Suppress emesis by blocking dopamine (D2) receptors in

the CTZ.

Common side effects are extrapyramidal syndrome (EPS)

and hypotension .

Phenothiazines
Uses

Nausea and vomiting resulting from surgery, anesthetics,

chemotherapy, and radiation sickness

Act by inhibiting the Chemotherapy Trigger Zone (CTZ).

DOPAMINE ANTAGONISTS
Butyrophenones
Uses

Postoperative nausea, vomiting, and emesis from toxins,

chemotherapy, and radiation.

Blocks D2 receptors in the CTZ, similar to phenothiazines.

Benzodiazepines
Uses

Controls nausea and vomiting associated with cancer

chemotherapy.

Act by inhibiting the CTZ.

 DOPAMINE ANTAGONISTS

Phenothiazines Butyrophenones Benzodiazepines

Promethazine Droperidol Lorazepam

Indication: motion Indication: Chemo-

Indication: Postoperative
sickness, nausea, induced nausea and
nausea and vomiting
vomiting, and sedation vomiting
S.E and A.E: :
induction S.E and A.E: : dizziness,
hypo/hypertension,
S.E and A.E: drowsiness, drowsiness, ataxia,
tachycardia, dizziness,
confusion, insomnia, dry confusion, injection site
drowsiness, anxiety,
mouth, constipation, reaction, anxiety,
restlessness,
blurred vision, EPS, restlessness,
dysrhythmias, and EPS
dyspnea, etc dysrhythmias, and EPS
 BenZO think LOW and SLOW

BENZODIAZEPINES
Indication: Controls nausea and vomiting associated with

cancer chemotherapy.

Mechanism of Action: Benzodiazepines bind to specific

sites on the GABA-A receptor (gamma aminobutyric acid)

complex in the CNS.

GABA slows/ calms the activity of the nerves in the brain.

Lorazepam
Uses
Is the drug of choice; previously diazepam.
effectively provides emesis control, sedation, anxiety reduction,
and amnesia
Side Effects
Drowsiness and Sedation, Respiratory Depression, Constipation,
dry mouth.
SEROTONIN ANTAGONISTS
Suppress nausea and vomiting by blocking serotonin (5-HT3)

receptors in the CTZ and vagal nerve terminals in the upper GI

tract.

Common side effects : headache, dizziness, hypotension,

palpitations, constipation, edema, and fatigue

a. Ondansetron (the first serotonin antagonists)

b. Granisetron (do not block the dopamine receptors)

c. Dolasetron

d. Palonosetron
GLUCOCORTICOIDS
Dexamethasone and methylprednisolone are

effective in suppressing emesis from cancer

chemotherapy.
CANNABINOIDS
Indications: for patients receiving chemotherapy who do not

respond to or are unable to take other antiemetics.

Contraindications: for patients with psychiatric disorders

Side effects: Mood changes, euphoria, drowsiness, dizziness,

headaches, depersonalization, nightmares, confusion,

incoordination, memory lapse, dry mouth,

Adverse reactions : less common—depression, anxiety, and

psychosis.
MISCELLANEOUS
Acts on the CTZ

Trimethobenzamide
Mechanism: Suppresses impulses to the CTZ.

Side effects and Adverse Effects:

Hypotension

Blurred vision

Extrapyramidal symptoms (including abnormal involuntary

movements, postural disturbances, and alterations in muscle tone)

MISCELLANEOUS
Acts on the CTZ

Metocloramide
Uses: Tx of postoperative emesis, cancer chemotherapy, and radiation

therapy.

Mechanism: Suppresses emesis by blocking the dopamine receptors in the

CTZ.

Extrapyramidal symptoms: More common in children than adults.

Contraindications: In patients with GI obstruction, hemorrhage, or perforation.

Side Effects: Drowsiness, Fatigue, Headache, Anticholinergic symptoms

 NONPRESCRIPTION PRESCRIPTION
ANTIEMETICS ANTIEMETICS
These medications should be prescribed
Can be purchased as over-the-counter
by a healthcare provider based on the
(OTC) drugs.
Frequently used to prevent motion underlying cause of nausea and vomiting,

sickness the patient's medical history, and

Minimal effect on controlling severe potential drug interactions.
vomiting, due to:
anticancer agents (antineoplastic)
Antihistamine & Anticholinergic
radiation
toxins Dopamine Antagonist
Phenothiazine Antiemetics
ANTIHISTAMINE
Dimenhydrinate
Butyrophenes

Cyclizine hydrochloride Benzodiazepines

Meclizine hydrochloride Serotonin (5-HT3) receptor
Diphenhydramine antagonist
hydrochloride
Glucocorticoids (Corticosteroids)
Cannabinoids
Inhibit vestibular stimulation in the middle
ear
 ANTI-EMETICS (NURSING PROCESS)
PATIENT
CONCEPT ASSESSMENT PLANNING
PROBLEM

The patient will state

The they will adhere to
Determine onset, frequency, amount,
the treatment
maintenance and contents of vomiting. Hypotension
Ask about possible causative factors regimen to alleviate
of correct Vomiting vomiting.
(e.g., food, pregnancy, virus).
electrolyte Obtain history of present health Hypokalemia The patient will
concentrations problems; avoid antiemetics in Hyponatremia report that vomiting
glaucoma patients. Dehydration has decreased in
and fluid
Record vital signs for abnormalities frequency.
balance in and future comparisons.
Nausea
The patient will
body Assess urinalysis before and during Discomfort
retain small amounts
compartments. therapy.
of food and fluid
 ANTI-EMETICS (NURSING PROCESS)
NURSING
PATIENT TEACHING SIDE EFFECTS EVALUATION
INTERVENTION

Advise patients to report

Tell patients to avoid over-the-
sore throat, fever, mouth
Check vital signs. If counter (OTC) preparations. sores, and get a CBC if
vomiting is severe, Warn patients not to consume needed. Evaluate the
dehydration may occur, alcohol while taking antiemetics. Warn against driving or
effectiveness of
and shock-like dangerous activities due
Alcohol can intensify the sedative nonpharmacologic
symptoms may be to drowsiness; dosage
effect.
present. adjustment may help. methods and
Advise pregnant patients to avoid Patients with hepatic
Monitor bowel sounds
disorders should seek
antiemetics by noting
antiemetics during the first
for hypoactivity or medical advice before the absenceof vomiting.
hyperactivity. trimester because of possible
using phenothiazines. Identify any side effects
Provide mouth care teratogenic effects on the fetus. Report any dizziness.
after vomiting. Encourage these patients to seek Suggest non-
that may result from
Encourage patients to medical advice about OTC and pharmacologic methods drugs.
maintain oral hygiene. prescription antiemetics. like flat soda, weak tea,
crackers, and dry toast
for nausea and vomiting.
EMETICS
Emetics are drugs that cause vomiting.
Induced vomiting is sometimes used to remove toxic
substances before they're absorbed.
Caution: dangerous to induce vomiting if caustic
substances (like ammonia or bleach) or petroleum
distillates (like gasoline) have been ingested.
In those cases, activated charcoal or gastric lavage is
used instead.
Examples of common emetic medicines are
ipecac syrup
Apomorphine
DIARRHEA
Frequent, liquid stools caused by
various factors such as food, infections,
toxins, stress, or diseases like Crohn's.
Complications: dehydration, electrolyte
imbalance, and metabolic acidosis,
especially in vulnerable populations.
Treatment includes addressing the
cause and using antidiarrheals like
opiates, adsorbents, or miscellaneous
agents.

PHARMACOLOGY
CAUSES
1. Foods
2. Fecal Impaction
3. Bacteria and Viruses
4. Toxins
5. Drug Reactions
6. Laxative Abuse
7. Malabsorption Syndrome
8. Stress and Anxiety
9. Bowel Tumor
10. Inflammatory Bowel Disease (IBD)
DIETARY
RECOMMENDATIONS
Avoid milk products and high-fat foods during
episodes of diarrhea.

VULNERABLE
POPULATIONS
Young children and older adults are at higher
risk of complications from diarrhea due to their
limited ability to compensate for fluid and
electrolyte losses.
TRAVELER’S DIARRHEA
Also called acute diarrhea

Caused by E. coli

Less than 2 days

Medications

Fluoroquinolone - Severe

Loperamide

Slow peristalsis and decreased frequency of defecation

Slow the exit of the organism from the GI tract

Prevented by drinking bottled water, washing fruit, and eating

cooked vegetables. Meal should be cooked until well done.

NONPHARMACOLOGIC
MEASURES
1. Identify the Cause
Determine the underlying cause of diarrhea (e.g.,
infection, food intolerance, stress).
2. Hydration
Encourage the intake of clear liquids such as water, broth,
or herbal teas.
Use oral rehydration solutions like Gatorade (adults) and
Pedialyte/Rehydralyte (children) to replenish lost fluids
and electrolytes.
For severe dehydration, administer IV electrolyte
solutions as necessary.
3. General Recommendations
Avoid fatty, dairy, or spicy foods.
Maintain good hygiene to prevent the spread of
infectious diarrhea
ANTIDIARRHEALS
Used for treating diarrhea and decreasing
hypermotility (increased peristalsis)
Usually, an underlying cause of the diarrhea
need to be corrected as well.

1. OPIATE AND OPIATE-RELATED AGENTS

2. ADSORBENTS
3. MISCELLANEOUS ANTIDIARRHEALS
 OPIATE AND OPIATE-RELATED
AGENTS
Decrease intestinal motility, thereby decreasing

peristalsis

Common side effect: Constipation

Frequently combined with other antidiarrheal agents

Opium antidiarrheal can cause CNS depression when

taken with alcohol, sedatives, or tranquilizers

Duration of action: approx. 2 hrs

1. Diphenoxylate with atropine

2. Difenoxin with atropine

3. Loperamide
 OPIATE AND OPIATE-RELATED AGENTS

Diphenoxylate with atropine Difenoxin with atropine Loperamide

Structurally related to
medication that helps with diarrhea but has a
Difenoxin, an active metabolite of diphenoxylate, diphenoxylate but causes less
lower risk of causing drug dependence
It is more potent.
compared to other opiates like codeine.
central nervous system

(CNS)depression.

Available as an over-the-counter

(OTC) drug.
often used for travelers' diarrhea used for nonspecific and chronic diarrhea.
TAKE NOTE
People with glaucoma should not use medication

with atropine. They should take another

antidiarrheal that does not have an

anticholinergic effect.

Severe hepatic impairment: Avoid products

containing diphenoxylate, difenoxin, or

loperamide.

Children and older adults: Greater risk of

respiratory depression with diphenoxylate.

 ADSORBENTS
Coating the wall of the GI tract and absorbing bacteria or toxins

that cause diarrhea.

Mild and moderate antidiarrheals that can be purchased without a

prescription and used in combination with other antidiarrheals.

1. Bismuth subsalicylate

a. OTC drug that is commonly used to treat traveler’s diarrhea and

used as an antacid for gastric discomfort.

b. Side effects: dizziness, drowsiness, headache, tongue, and stool

discoloration and anxiety.

2. Colestipol and Cholestyramine

 MISCELLANEOUS
ANTIDIARRHEALS
Prescribed to control diarrhea

General side effects: dizziness, nausea, dry mouth,

flatulence, constipation, and fatigue.

1. Crofelemer: diarrhea in px with HIV/AIDS

2. Eluxadoline: IBS with diarrhea

3. Rifamixin: IBS with diarrhea, traveler’s

diarrhea, and hepatic encephalopathy

4. Rifamycin: traveler’s diarrhea

 NURSING PROCESS
PATIENT
CONCEPT ASSESSMENT PLANNING
PROBLEM

Obtain a history of bacterial or viral

The infection, drugs taken, and foods Hypotension
ingested that could be a factors to Patient will report
maintenance of Vomiting
diarrhea. having bowel
correct Check VS to provide a baseline for future
Hypokalemia movements that
electrolyte comparisons and to determine body fluid Hyponatremia are framed
concentrations and electrolyte losses. Dehydration Patient will drink an
Assess bowel sounds adequate amount
and fluid Nausea
Report if a px has a narcotic drug history. of fluids
balance in body If opiate or opiate-related drugs are Discomfort
compartments. given, drug abuse may occur
 NURSING PROCESS
NURSING INTERVENTIONS PATIENT TEACHING EVALUATION

Record VS. Report Tachycardia or systolic BP Instruct patients not to take sedatives,
decreases 10 to 15 mmHg. Monitor tranquilizers, or other narcotics with
Evaluate the
respirations. Opiates and Opiate-related drugs antidiarrheal drugs. CNS depression may
can cause CNS depression. occur. effectiveness of the
Monitor the frequency of bowel movements Tell patients to avoid over-the-counter (OTC) drug: diarrhea has
preparations; they may contain alcohol and
and bowel sounds. stopped
can promote liver damage, and concurrent use
Check for signs and symptoms of dehydration
with loratadine and loperamide may lead to Continue to monitor VS
resulting to persistent diarrhea. Fluid significant interaction.
replacement may be necessary. With
and report any abnormal
Counsel patients to take drugs only as
prolonged diarrhea, check serum electrolytes. prescribed. Advise that drugs may be habit- changes
Administer antidiarrheals cautiously to forming and that they should not exceed the Monitor long-term use
pregnant px, and those with glaucoma, liver recommended dose.
Encourage patients to drink clear liquids.
of opiates and opiate-
disorders, or ulcerative colitis.
Recognize that a drug may need to be withheld
Advise patients not to ingest fried foods or related drugs for
milk products until diarrhea has stopped. possible abuse and
if diarrhea continues for more than 48 hours or
Teach patients that constipation can result
acute abdominal pain develops. from overuse of antidiarrheal drugs. physical dependence.
CONSTIPATION
Constipation is the buildup of hard stool in the
large intestine, common in older adults. It can be
caused by:
1. Low water or fiber intake.
2. Fecal impaction or bowel obstruction.
3. Overuse of laxatives.
4. Neurological issues (e.g., paraplegia).
5. Ignoring the urge to defecate.
6. Lack of exercise.
7. Certain drugs (e.g., anticholinergics, narcotics,
some antacids).

PHARMACOLOGY
 NONPHARMACOLOGIC
MEASURES

Drink plenty of water.

Eat a high-fiber diet.
Exercise regularly.
a bowel routine.

Normal bowel habits range from 1–3 times a

day to 3 times a week and vary by person.
Laxatives may help if needed but should be
used alongside these healthy habits.
 LAXATIVES
promotes soft stool

CATHARTICS PURGATIVE
results in a soft to watery are harsh cathartics that
stool with some cramping cause a watery stool with
abdominal cramping.

TYPES OF LAXATIVES:
1. Osmotic (Saline) Laxatives
2. Stimulant (Contact) Laxatives
3. Bulk-Forming Laxatives
4. Emollients (Stool Softeners)

PHARMACOLOGY
OSMOTIC (SALINE)
LAXATIVES
Osmotic laxatives contains electrolyte salts, including: sodium salts

(sodium phosphate or Phospho-Soda, sodium biphosphate) and magnesium

salts (magnesium hydroxide [Milk of Magnesia], magnesium citrate).

Pulls water into the colon to soften stool and stimulate bowel movements.

High doses of salt laxatives are used for bowel preparation for diagnostic

and surgical procedures.

Common medications:

Glycerin

Lactulose: decreases the serum ammonia level and is useful in liver

diseases.

Magnesium Citrate

Magnesium hydroxide

Lactitol

Polyethylene glycol: used for bowel preparation

OSMOTIC (SALINE) LAXATIVES
Side Effects and Adverse effects:
Proper kidney function is essential to remove extra magnesium from the
body.
People with kidney problems should avoid magnesium salts.
Using magnesium salts for a long time can lead to high magnesium levels
(hypermagnesemia), causing symptoms like sleepiness, weakness, muscle
paralysis, heart block, low blood pressure, flushing, and trouble breathing.

Side Effects of Too Much Lactulose:

Can cause flatulence, diarrhea, stomach cramps, nausea, or vomiting.

People with diabetes should avoid lactulose because it contains sugars like
glucose and fructose.
STIMULANT (CONTACT)
LAXATIVES
These laxatives stimulate bowel movements by irritating nerves in the

intestinal lining.

Types include those that contain bisacodyl, senna, and castor oil (purgative).

Common side effect: dizziness, nausea, abdominal cramps, and weakness

Common medications:

Bisacodyl:

most frequently used and abused laxative and can be purchased OTC.

used to empty the bowel before diagnostic tests (barium enema).

Castor oil (purgative) that acts on the small bowel and produces a

watery stool. The action is quick, within 2 to 6 hrs, so the laxative

should not be taken at bedtime. It is not FDA approved to correct

constipation; rather, it is used mainly for bowel preparation.

Senna
BULK-FORMING
LAXATIVES
These are natural fiber-based laxatives that absorb water to increase stool size,

soften it, and stimulate bowel movements.

Defecation usually occurs within 8 to 24 hrs; however, it may take up to 3 days

after drug therapy is started for the stool to be soft and well formed.

Insufficient fluid intake can cause the drug to solidify in the GI tract, which can

result in intestinal obstruction.

Common side effect: no side effects

Excessive use of this can cause nausea, flatulence , or diarrhea

Common medications:

Polycarbophil

Methylcellulose

Psyllium

Polyethylene glycol
BULK-FORMING
LAXATIVES
This group of laxatives does not cause laxative dependence and may be used by patients

with diverticulosis, irritable bowel syndrome (IBS), and ileostomy and colostomy.

Patients with Hypercalcemia should avoid calcium polycarbophil because of the

significant amount of calcium in the drug.

EMOLLIENTS (STOOL
SOFTENERS)
Are lubricants and stool softeners (surface-acting or wetting drugs)

used to prevent constipation. These drugs decrease straining during

defecation.

Lubricants such as mineral oil, increase water retention in the stool.

Mineral oil absorbs the essential fat-soluble vitamins A, D, E, and K.

Some of the minerals can be absorbed into the lymphatic system.

Stool softeners work by lowering surface tension and promoting water

accumulation in the intestine and stool.

They are frequently prescribed for patients after myocardial infarction

or surgery.

They are also given before administration of other laxatives in treating

fecal impaction.
EMOLLIENTS (STOOL
SOFTENERS)
Common side effect: mild diarrhea, abdominal cramping, nausea

Common medications:

docusate: Docusate calcium; docusate sodium and Docusate sodium with senna

Mineral oil

Contraindication: Pregnancy and inflammatory disorders of the GI tract

Adverse Reactions: This laxative is not indicated for children, older adults, or patients

with debilitating diseases because they might aspirate the mineral oil, resulting lipid

pneumonia. The docusate group of drugs may cause mild cramping.

CHLORIDE CHANNEL
ACTIVATORS:
These laxatives work by directly increasing fluid secretion in the intestines, which softens

stool and helps with bowel movements.

These are used to treat idiophatic constipation.

Common side effect: headache, fatigue, dizziness, nausea, diarrhea, abdominal pain, and

flatulence

Common medication:

Lubiprostone:

activates chloride channels in the lining of the small intestine, leading to an increase

in intestinal fluid secretion and motility.

It also relieves constipation and accompanying symptoms of abdominal discomfort,

pain, and bloating.

Used for treatment of constipation, IBS, and opioid-induced constipation.

Contraindications: For patients with a history of mechanical GI obstruction, Crohn disease,

diverticulitis, and severe diarrhea.

Adverse effects: Nausea, headache, peripheral edema, fatigue, dizziness, diarrhea,

abdominal pain, and flatulence.

STIMULANT: LAXATIVES
NURSING PROCESS
PATIENT
CONCEPT ASSESSMENT PLANNING
PROBLEM

The excretion
Obtain a history of constipation and
of waste The patient will
possible causes (insufficient water or
report a normal
products fluid intake, diet deficient in bulk or Discomfort
fiber, inactivity), frequency and bowel elimination
through the Constipation pattern.
consistency of stools, and general health
intestinal tract status. Fatigue The patient will
and the Record baseline vital signs for Reduced exercise, eat foods
identification of abnormalities and for intestinal high in fiber, and
expelling of
future comparisons. have adequate
stool by means Assess renal function, urine output,
motility
fluid intake to
of intestinal blood urea nitrogen (BUN), and serum
avoid constipation
smooth muscle creatinine.

contraction
 NURSING PROCESS
NURSING SIDE
PATIENT TEACHING DIET
INTERVENTIONS EFFECTS

Check fluid intake and Check fluid intake and output. Note
Instruct patients to mix the drug in
output. Note signs and signs and symptoms of fluid and 8 to 10 oz of water and to stir and
symptoms of fluid and electrolyte imbalances that may drink it immediately. At least one
electrolyte imbalances result from watery stools. Habitual Encourage glass of extra water should follow
that may result from patients to insufficient water can cause the
use of laxatives can cause fluid
watery stools. Habitual use drug to solidify, which can lead to
volume deficit and electrolyte discontinue dry hard shoots fecal impaction; and
of laxatives can cause fluid
volume deficit and losses. use if nausea, esophageal obstruction
Monitor bowel sounds. vomiting, Encourage patients to increase
electrolyte losses.
foods rich in fiber such as bran,
Monitor bowel sounds. Identify the cause of constipation. cramping, or
grains. vege- tables, and fruits.
Identify the cause of Avoid inhalation of psyllium dust. rectal bleeding Advise patients to increase water
constipation. Advise patients to avoid inhaling occurs intake to at least 8 oz of fluids per
Avoid inhalation of psyllium dust; it may cause watery day. which will decrease hard, dry
psyllium dust. eyes, runny nose, and wheezing. stools.
 NURSING PROCESS

EVALUATION

Determine the effectiveness of

nonpharmacologic methods for
alleviating constipation.
Evaluate patients' use of laxatives in
managing constipation.
 NURSING PROCESS
PATIENT
CONCEPT ASSESSMENT PLANNING
PROBLEM

The excretion
of waste Obtain a history of constipation and
The patient will
possible causes (insufficient water or
products fluid intake, diet deficient in bulk or Discomfort report a normal
through the fiber, inactivity), frequency and consis- Constipation bowel elimination
intestinal tract tency of stools, and general health pattern.
Fatigue
status. The patient will
and the Record baseline vital signs for
Reduced
exercise, eat foods
expelling of identification of abnormalities and for intestinal high in fiber, and
stool by means future comparisons. motility have adequate
Evaluate renal function. fluid intake to
of intestinal
Assess electrolyte balance of patients
smooth muscle avoid constipation.
who frequently use laxatives.
contraction
 NURSING PROCESS
NURSING
PATIENT TEACHING SIDE EFFECTS DIET
INTERVENTIONS

Encourage patients to increase water intake if not

contraindicated), which will decrease hard, dry
stools.
Monitor fluid intake and Advise patients to avoid overuse of laxatives, Which
output. can lead to fluid and electrolyte imbalances and
Note signs and symptoms drug dependence. Suggest exercise to help
of fluid and electrolyte increase peristalsis
Advise patients to Inform patients to
imbalances that may result Teach patients not to chew tablets but to swallow
them whole. discontinue use it consume foods high
from watery stools.
Habitual use of laxatives Direct patients to store suppositories at less than rectal bleeding, in fiber such as bran,
86°F (30°C) nausea, voniting. or whole grains, and
can cause fluid volume
Counsel patients to take drugs only with water to
deficit, electrolyte losses, cramping occurs. fruits.
increase absorption.
and loss of the urge to Educate patients not to take the drug within 1 hour
defecate. of any other drug
Warn patents that the drug is not for long -tern use:
bowel tone may be lost.
Encourage patients to time administration of the
drug so as not to interfere with activities or sleep.
 NURSING PROCESS

EVALUATION

Determine the effectiveness of

nonpharmacologic methods for
alleviating constipation.
Evaluate the patient's use of laxatives
in managing constipation. Identify
laxative abuse.
 ANTIEMETICS ANTIDIARRHEALS LAXATIVES

Drowsiness or sedation Constipation Bloating

Dizziness
Abdominal discomfort or Flatulence
COMMON SIDE Dry mouth
cramping Stomach cramps
Constipation or diarrhea
EFFECTS Nausea and vomiting Feeling sick
Blurred vision
Drowsiness (opioid derivatives) Dehydration
Headache
Electrolytes imbalance
Fatigue

Antiemetics work by targeting specific Laxatives relieve constipation by

Antidiarrheals work to alleviate
receptors involved in the nausea and softening stool, increasing stool bulk,
diarrhea by targeting different
MECHANISM OF vomiting pathways, including the drawing water into the intestine,
mechanisms involved in the abnormal
ACTION gastrointestinal tract, chemoreceptor stimulating intestinal muscles, or
loss of fluids and electrolytes in the
trigger zone (CTZ), and vestibular lubricating stool for easier passage,
gastrointestinal (GI) tract. depending on their type.
system.

Severe infections (e.g., bacterial or

parasitic diarrhea) Dehydration
Glaucoma, Severe Central Nervous System Intestinal obstruction or conditions like Electrolyte imbalance
Depression, Severe Liver or Kidney toxic megacolon Rebound constipation
CONTRAINDACTION Impairment, Cardiac Conditions, GI Allergies to ingredients in the Rectal prolapse
medication Blood in stool and anemia
obstruction, hemorrhage, or perforation,
Liver disease (especially with opioid- Laxative dependency
Hypotension, Blurred vision Internal organ damage
based antidiarrheals)
Glaucoma