this is Professor Hoffman in this video we're going to look at the second part of the GI agent uh topic and we're going to look specifically at laxatives so your reading for this section is going to come from 7.4 uh in the online text and we're going to be looking at um the fiber supplements the stool softeners looking at these uh specific classes that all serve as laxatives so we going to use laxatives for the treatment of constipation or for the the treatment of constipation that has occurred or is preventative me um means to keep constipation from developing so the definition of constipation is three or four three or fewer bowel movements in a week uh stools that are extremely hard dry or have a lumpy form and there is a diagram in your text that shows the different characteristics of stool uh stools that are difficult or painful to pass or the feeling that not all of the stool has passed that their stool residual stool staying in the rectum uh constipation and these changes in the quality of the stool happen when there's a delay in having bowel movements or moving the fecal matter through the intestine and that there's increased water absorption back into the body back into circulation drying out the fecal material so it becomes again harder dry lumpy and again it can be painful to pass at that point so there's a number of causes and um when you go into the laxitive section of the reading uh it's under figure 7.6 uh the numbering on that figure is a little bit off compared to the others so uh just scroll through your reading until you see the one um that's talking about listing out the causes of constipation so some things with CA causes again stools should have a certain amount of moisture in them they should have some softness or moistness to them so decreased fluid intake can be a problem leading to constipation inadequate dietary fiber because fiber helps pull fluid into the GI tract uh inactivity uh tends to U result in our GI system moving a little more slowly so the fical matter has a chance to just sit longer in spaces the longer it takes to get through the small intestine and moving through the large intestine the more water that's going to be absorbed back into the body uh there's certain diseases that will um affect the ability to get water in the GI system and lead to constipation and they can be medication related when we talked about narcotics that was one of the issues we talked about because it slows down um the GI system any of the drug classes that inhibit the activity of the GI system so the anticholinergic some of the sympathomimetics um that would end up slowing down the activity of the small intestine and the large intestin will have side effects of constipation in their list our general nursing considerations is um an assessment is mainly going to be history and physical finding out from the individual how often are they having bowel movements what's the characteristics of the stool if they have a bowel movement uh during the stay of observing what does the stool look like the qualities of it uh in terms of an implementation of a plan we may introduce the individuals to a bow protocol which will be certain behaviors to help them develop a regularity in Bow patterns teaching about their diet and fluid intake awareness of medications and um the enforcement of the importance of compliance with any treatment plan that's developed uh the evaluation phase from a nursing standpoint is essentially looking at how effective was it is the bowel pattern has it changed is the frequency back to what we would consider normal is the stool characteristics uh more of what we would want as normal um bow assessment or the bowel sounds active uh not hypoactive and not extremely hyperactive so all those types of things would be part of our nursing assessment with any of these um drugs that we're going to be talking about drug classes first one we want to look at is fiber supplements so Metamucil or psyllium uh these are non-digestible uh fiber materials so they get into the intestine again they're non-digestible they're going to stay there they create an environment that's basically almost a hypertonic type situation they're going to attract fluid back into the GI tract so it's going to start adding bulk to it plus they stay in the gut as they get moisture and take moisture going to expand a little bit that increase in size or bulk is going to stimulate peristalsis and that's going to help move not just the fiber supplement but all the other feal matter um in the G tracts to move it on um towards the large intestine and towards elimination so it's got purpose again treatment of constipation to either avoid constipation or in the early stag of the constipation this may be enough to increase the GI activity through St through the use of this bulk increasing perosis to help alleviate the constipation some reactions and these going to be um you going to see some Crossover with most of the classes um we may affect the medication uh absorption so we just really have to be aware of medications that are absorbed in the small intestine um that if we move things through a little bit too quickly they're not going to have a chance to be absorbed so we need to be aware of that um as the stomach adjusts to this increased bulk in it we're going to have some bloating and some cramping um so our involvement along with that assessment and implementation is really focusing on preparing the patient letting know what to expect letting them know time frames uh and help them to be compliant with taking the medication that has order and particularly timing so because that medication absorption issue we want to increase that these medications are taken about 2 hours before or at least 2 hours before or after medications so we don't have that impact uh by moving the medications through too quickly the next class of drugs U or laxes are the stool softeners so docusate uh these help introduce water and fats into the fecal material into the stool so it's going to make the stool um have a little bit more moisture and going to have a little bit of a fatty lipid type surface to it so essentially softens the stool so it can pass through the GI system more easily some of the reactions as it increases the intestinal activity we're going to have some cramping our nursing considerations again similar to the bulk um laxatives uh and those General um assessment implementation and evaluation considerations osmotic agents um such as mirax in milk of magnesia they are an again a nondigestible substance uh they're going to work um to create essentially a again a hyperosmotic environment in the stomach are going draw water into the GI tract and hold it there so as the water stays in the GI tract it's going to start filling gives us some pressure against the walls of the GI lining so it ENC encourages peristalsis the excess water is also going to be soaked into the stool so it's going to soften the stool loosen it up make it softer possibly to more liquid form so again it's going to be used for constipations could also be used for a preparation for someone who's going to have a uh GI procedure whether it's a colonoscopy or um GI surgery and we want to empty the vow the osmotic agents are one of the prep uh drugs that might be used to uh liquefy the stool and just move all the contents out so we have a a clean bowel in general the reactions again we're going to have some of that um cramping that um maybe a little bit of nausey nausea feeling it's it will can cause the stools to be more than soft it can go to loosen watery stools so and once it starts hitting it's going to be very effective so the individual needs to uh not be too far away from the commode or the bathroom our general nursing considerations again same assessment implementation evaluation type processes another form of um lack of treatment is lubricants a mineral oil again it can be taken as an enema some individuals as far as home remedies will drink a small amount of mineral oil on a regular basis again that mineral oil is not a digestible oil um so it's going to stay in the GI tra and it's essentially going to coat the surface of the stool uh with an oily film and that's going to allow it to slide through the GI system a little more easily similar reaction going cramping bloating uh can cause some GI upset um can loosen soften the stool and that's it moves to diarrhea botal is an example of a stimulant drug uh these drugs are going to act on uh the smooth muscle of the intestines and it's going to increase their motility so we're increasing peristalsis so again we're trying to push the um vehicle matter on through uh with a little more force and a little more speed get some cramping um there can be some dizziness lie headedness um can be associated with this and again we're just watching you're doing all those same steps as far as our assessment implementation and evaluation just focusing on the fact this is a stimulant type drug so that those are the groupings of drug for laxatives and so with laxatives and um the anti-ulcer drugs in the first video that will be the content uh for topic 10