7 Chapter 7
Answer Key to Chapter 7
You can review additional information regarding these answers in the corresponding section in which the Critical Thinking activities appear.
Critical Thinking Activity Section 7.3
Postoperative clients often require a proton pump inhibitor due to the stress response that occurs during surgery and hospitalization. Pantoprazole suppresses the secretion of hydrochloric acid and prevents the formation of a stress ulcer.
Critical Thinking Activity Section 7.4a
- The client may be experiencing increased heart rate as a symptom of dehydration associated with water loss from the diarrhea. Additionally, a Boxed Warning for loperamide is abnormal heart rhythm. The nurse should assess the client’s heart rate and rhythm and notify the provider.
- The nurse can recommend providing over-the-counter probiotics, which are also found in yogurt, for the prevention of diarrhea associated with antibiotic use or to assist in decreasing the symptoms of diarrhea.
Critical Thinking Activity Section 7.4b
- A postoperative client has many risk factors for constipation, including side effects of anesthesia and opiates, sedentary levels of activity, and decreased fluid and food intake after surgery. In addition to administering docusate or other laxatives as needed, the nurse should educate the client about nonpharmacological interventions to relieve constipation, such as increasing fluid and fiber intake and walking.
- Docusate softens the stool and improves the regularity of bowel movements.
- Docusate usually works within 12-72 hours. If it is not effective in creating a bowel movement with soft stool, the client should be instructed to notify the nurse and additional laxatives can be administered.
- Preventative measures for constipation include increasing fluid and fiber intake, ambulating, and using the least amount of opiates needed to effectively treat the pain.
- Bowel protocols usually include a stepwise approach to constipation. Docusate or polyethylene glycol 3350 is often used preventively, but if a bowel movement does not occur within the expected time frame, additional laxatives such as bisacodyl or an enema may be added. A bisacodyl suppository generally produces a bowel movement within one hour whereas a mineral oil enema usually works within 15 minutes of administration.
Critical Thinking Activity Section 7.5
- The nurse assesses for dehydration by monitoring blood pressure for hypotension, heart rate for tachycardia, urine output for decreased level, skin for tenting, and mucus membranes for dryness.
- The dissolving tablets eliminate the risk of vomiting the medication before it is absorbed. If the client can’t tolerate the dissolving tablets, the nurse can request the provider to change the route of ondansetron to the intravenous route.
- The nurse should plan to proactively administer medications before meals to prevent nausea. The client can also be instructed to follow a bland diet to prevent feelings of nausea that can be stimulated by spicy food or strong flavors. Fluids should be encouraged to prevent dehydration, but if fluids increase the client’s feelings of nausea, the client can be instructed to take frequent sips of fluid or suck on ice chips.
Section 7.6 Case Study 1
- Proton pump inhibitors (PPIs) are a class of drugs that reduce the production of stomach acid. They work by blocking the proton pump in the parietal cells of the stomach that produces acid. Examples of PPIs include omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole.
- PPIs work by irreversibly binding to the proton pump, which is responsible for the final step in acid production in the stomach. By blocking the proton pump, PPIs reduce the production of stomach acid.
- The most common side effects of PPIs include headache, diarrhea, abdominal pain, and nausea. Long-term use of PPIs has been associated with an increased risk of osteoporosis-related fractures, kidney disease, and infections such as pneumonia and Clostridioides difficile (C. difficile) infection.
- The nurse should monitor Mrs. Jones for relief of her GERD symptoms, as well as any adverse effects of omeprazole, such as headache, diarrhea, abdominal pain, and nausea. The nurse should also monitor Mrs. Jones’ electrolyte levels, particularly magnesium and potassium, as long-term use of PPIs can lead to electrolyte imbalances. Additionally, the nurse should monitor Mrs. Jones for signs and symptoms of C. difficile infection, such as diarrhea and abdominal pain.
- The nurse should instruct Mrs. Jones to take omeprazole once a day, preferably in the morning before breakfast. Omeprazole should be taken at the same time each day to maintain a consistent blood level. The nurse should also instruct Mrs. Jones not to crush, chew, or break the capsules, but to swallow them whole. If Mrs. Jones has difficulty swallowing the capsule, the nurse may suggest opening the capsule and mixing the contents with applesauce or water.
- Omeprazole can interact with other drugs that are metabolized by the liver, such as warfarin, diazepam, and phenytoin. Omeprazole can increase the effects of these drugs, leading to a higher risk of bleeding or sedation. Additionally, omeprazole can decrease the absorption of certain drugs, such as ketoconazole and atazanavir, so it is important to separate the administration of these drugs from omeprazole by several hours.
- The nurse should instruct Mrs. Jones to follow up with her health care provider if her GERD symptoms do not improve or if she experiences any adverse effects of omeprazole. The nurse should also instruct Mrs. Jones to follow up with her health care provider if she experiences any signs or symptoms of C. difficile infection, such as diarrhea and abdominal pain.
Section 7.6 Case Study 2
- Loperamide is an antidiarrheal medication that works by slowing down the movement of the intestines and reducing the frequency of bowel movements.
- Loperamide works by binding to opioid receptors in the gut, which decreases the activity of the intestinal muscles and reduces the speed at which food moves through the digestive tract. This results in decreased diarrhea and increased water absorption.
- The most common side effects of loperamide include constipation, abdominal cramping, and bloating. In rare cases, loperamide can cause severe constipation, which can lead to intestinal obstruction.
- The nurse should monitor Mr. Lopez’s bowel movements and symptoms of dehydration, such as thirst, dry mouth, and decreased urine output. The nurse should also monitor Mr. Lopez’s electrolyte levels, particularly potassium, as loperamide can cause electrolyte imbalances. Additionally, the nurse should monitor Mr. Lopez’s pain level and bowel sounds, as severe constipation can lead to abdominal pain and distension.
- The nurse should instruct Mr. Lopez to take loperamide as directed by his health care provider. Typically, the initial dose is two capsules (4 mg) followed by one capsule (2 mg) after each loose stool, up to a maximum of eight capsules (16 mg) per day. The nurse should also instruct Mr. Lopez to drink plenty of fluids to prevent dehydration and to avoid alcohol and caffeine, as they can worsen diarrhea.
- Loperamide can interact with other drugs that slow down the movement of the intestines, such as opioids and anticholinergics. Loperamide can increase the effects of these drugs, leading to constipation and other adverse effects. Additionally, loperamide can decrease the absorption of certain drugs, such as digoxin and quinidine, so it is important to separate the administration of these drugs from loperamide by several hours.
- The nurse should instruct Mr. Lopez to follow up with his health care provider if his diarrhea persists for more than two days, if he experiences severe constipation or abdominal pain, or if he develops a fever or bloody stools. The nurse should also instruct Mr. Lopez to follow up with his health care provider if he experiences any adverse effects of loperamide, such as severe constipation or bloating.