GI Agents Part 2: Laxatives

Professor Hoffman Lecture Notes

Reading Assignment

• Online Text: Section 7.4
• Focus on Fiber Supplements, Stool Softeners, and Other Laxatives

Definition of Constipation

• Fewer than 3 bowel movements per week
• Hard, dry, or lumpy stools
• Difficult/painful stools to pass
• Feeling of incomplete stool passage
• Caused by delayed bowel movements leading to increased water reabsorption

Causes of Constipation

• Decreased Fluid Intake: Necessary to keep stools moist
• Inadequate Dietary Fiber: Fiber pulls fluid into the GI tract
• Inactivity: Slows down GI motility
• Diseases and Medications: Conditions and drugs (especially narcotics and anticholinergics) that slow GI activity

Nursing Considerations

• Assessment: History and physical exam; observe stool characteristics
• Implementation: Introduce bowel protocols, dietary/fluid intake, medication awareness, and treatment compliance
• Evaluation: Assess effectiveness, stool normalization, and bowel sound activity

Types of Laxatives

Fiber Supplements

• Example: Metamucil (psyllium)
• Mechanism: Non-digestible fibers attract fluid, increase bulk, and stimulate peristalsis
• Reactions: Bloating, cramping; may affect medication absorption
• Nursing Considerations: Advise patients on expected effects and ensure medications are taken 2 hours apart from fiber supplements

Stool Softeners

• Example: Docusate
• Mechanism: Introduces water and fats into the stool, making it softer and easier to pass
• Reactions: Intestinal cramping
• Nursing Considerations: Similar to fiber supplements; ensure proper assessment, implementation, and evaluation

Osmotic Agents

• Example: Miralax, Milk of Magnesia
• Mechanism: Create a hyperosmotic environment, drawing water into the GI tract, softening stools, and encouraging peristalsis
• Usage: For constipation and bowel prep for GI procedures
• Reactions: Cramping, nausea, loose stools, and diarrhea
• Nursing Considerations: Proximity to bathroom; assess, implement, and evaluate

Lubricants

• Example: Mineral oil (enema or oral ingestion)
• Mechanism: Coats stool with oil to facilitate easier passage
• Reactions: Cramping, bloating, GI upset, diarrhea
• Nursing Considerations: Similar general nursing steps

Stimulant Laxatives

• Example: Bisacodyl
• Mechanism: Increase motility of intestinal smooth muscle, enhancing peristalsis
• Reactions: Cramping, dizziness, lightheadedness
• Nursing Considerations: Same assessment, implementation, and evaluation steps, but with a focus on the stimulant effects

Key Points

• Effective maintenance of bowel health involves understanding various types of laxatives and their mechanisms
• Proper nursing assessment, implementation, and evaluation are crucial for effective treatment and patient comfort