PREPARATION AND GIVING LAXATIVES ...pptx

this topic is essentially for GNM students. it contains all the information related to preparation and giving laxatives to patient whether in hospital settings or at home along with the nurses role. this topic gives important information to students in concise way regarding how to prepare the laxatives for patient and what precautions are to be taken during giving and after laxatives.

1. LAXATIVES

2. DEFINITION : Drugs that are used to promote the evacuation of bowel. Group of medicines that are used to treat constipation, can be taken mouth as liquids, tablets, capsules, powder dissolved in water or via the back passage (rectum) for e.g. suppositories or enemas. A food, compound or medication which when consumed either induces bowel movements or loosens the stool. All laxatives increase the water content of the feaces .

3. CLASSIFICATION:

4. BULK - FORMING LAXATIVES:

5. Must be followed with a large amount of fluid. If chewed or taken in dry form, these agents can cause esophageal obstruction and feacal impaction. Examples: ispaghula Methycellulose (Citrucel) and related compounds, psyllium (Metamucil), or sterculia. Unprocessed bran is a cheapest fibre supplement. This Photo by Unknown Author is licensed under CC BY-NC This Photo by Unknown Author is licensed under CC BY-NC-ND

6. OSMOTIC LAXATIVES: Osmotic laxatives are soluble but non absorbable compounds that results in increased stool liquidity due to increase in faecal fluid. Onset of action is upto 48 hrs. It includes – Saline laxatives such as magnesium hydroxide & magnesium sulfate. Poorly absorbed sugars such as lactulose or sorbitol & macrogols or polyethylene glycol (PEG) Non absorbable sugars or salts may be used for the treatment of acute constipation or the prevention of chronic constipation. Magnesium oxide (milk of magnesia) is a commonly used , not be used for prolonged periods in patients with renal insufficiency due to risk of hypermagnesemia.

7. Osmotic laxatives increase faecal water content results in bowel distention, increased peristalsis and evacuation than improving stool frequency. Lactulose can take 2-3 days to have any effect, so they are not suitable for the rapid relief of constipation. Osmotic laxatives are used to treat simple constipation & for bowel cleansing/preparation before surgery or investigative procedures. This Photo by Unknown Author is licensed under CC BY This Photo by Unknown Author is licensed under CC BY

8. STIMULANT LAXATIVES: Stimulant laxatives (cathartics) induce bowel movements through a no. of mechanisms. Increase secretion of water into large small intestine. Increase intestinal motility by stimulating colonic nerves Useful with opioids. Onset of action 8-12 hrs Adverse effect include cramping, diarrhoea, dehydration.

9. Stimulant laxatives in common use include – Phenolphthalein 60-130mg : LAXIL 130mg tab, to be taken at bedtime (not chewed). Bisacodyl 5-15mg: DULCOLAX 5 mg tab or 10 mg. Senna Castor oil (15ml) Glycerol Sodium picosulfate This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY-SA

10. STOOL SOFTENERS: Work by wetting and softening the feaces . Detergent like drugs. May be useful with anal fissures ang haemorrhoids. Usually work within 12 – 72 hrs. Examples : Docusates (Dioctyl sodium sulfosuccinate: DOSS), Liquid paraffin and arachis(peanut) oil enemas

11. Docusate : DOSE – 100 – 400mg/day, acts in 1-3 days, softens the stool by net water accumulation in the lumen by an action on the intestinal mucosa. Liquid paraffin is a viscous liquid mixture of petroleum hydrocarbons . Taken for 2-3 days, it softens the stools and is said to lubricate hard scybali by coating them. Dose: 15-30ml/day – oil as such or in emulsified form. Liquid paraffin is not recommended for the treatment of constipation. long term use may result in depletion of Vit A,D,E,K.

12. Laxatives that are given via the back passage (rectum) include : enemas Suppositories , usually work within 15 -30 minutes.

13. NURSES ROLE: Check order, collect the equipment & supplies & wash your hands. Identify & prepare the patient. Provide privacy & perform safety precautions, arrange supplies & equipment if needed or if patient is in hospital. Obtain a through client history related to normal elimination pattern, medications or conditions that may contribute to constipation Current symptoms, onset & duration, stool characteristics & frequency, presence of flatus, abdominal pain, nausea, straining should be assessed. Nurse should check the vital signs & perform physical assessment. Nurse should teach the patient, if constipation is unrelieved, signs & symptoms of dehydration or electrolyte imbalance is not maintained contact the HCP as soon as possible. Nurse should provide information to the patient about life style modifications such as increase fibre- containing foods, physical activity, & fluids & also do not ignore urge to defecate.

14. In bulk forming laxatives – When administering, put one dose into an empty glass & mix at least 8 ounces of water or other fluids. Taking this product without enough liquid may cause choking. Stir briskly & drink promptly. If mixture thickens add more liquid & stir

15. Administer at least 2 hours before & 2 hours after other medications. Ask patient that it can effect absorption & may cause bloating & cramping. When teaching patient how to take laxatives(psyllium) at home, in addition to above considerations, advise them to start with one dose/day but may gradually increase to 3 doses/day as necessary to maintain soft stools. In stool softeners- Docusate is a common OTC stool softener that is also used frequently in health care settings. Ask patient that Docusate usually produces a bowel movement in 12 – 72 hrs. Provide information regarding the side effects i.e. stomach cramping.

16. Nurse should collect the information regarding other medications as they may interact with stool softeners such as blood thinners or antibiotics. If patient or individual is with intestinal blockage stool softeners should not be used. In Osmotic laxatives- Teach patient that osmotic agents (PEG) usually produces a bowel movement in 1-3 days. These agents may cause loose watery stools Nurse should read label for children as some brands can be used in children aged for 2 or older, whereas others are not intended for children.

17. In Stimulant Laxatives – Check for dosage whether its oral or rectal suppositories See instructions for how to insert a rectal suppository. Instruct the patient to retain suppository for about 15 to 20 minutes as bowel movement is generally produced in 15 minutes. Bisacodyl may cause stomach cramps, dizziness, or rectal burning. Teach patient about the overuse of Senna (if advised), can result in diarrhoea & dehydration, as well an electrolyte imbalance in elderly. Inform patient, after consuming senna discoloration of urine is usual, turning into a reddish-brown colour. Teach patient that it is important to take senna at lowest possible doses for the shortest duration of time.

18. Thank you!