Term
constipation occurs most frequenly in what population? |
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Definition
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Term
constipation is a disorder of... |
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Definition
colonic motility
or anorectal function |
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Term
acute constipation becomes chronic constipation when symptoms last longer than how many weeks? |
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Definition
6 weeks
(may respond to laxatives but returns when laxatives are removed)
*Does not respond to dietary changes alone* |
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Term
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Definition
fewer than 3 bowel movements per week |
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Term
Common causes of Constipation
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Definition
- dietary (poor fluid intake, ↓caloric intake)
- failure to heed defecation reflex
- impaired physical mobility
- lack of privacy
- psychological distress
- disease that slows GI motility
- drugs
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Term
Drugs that Commonly Cause Constipation |
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Definition
- Opiods
- Antacids
- Anti-cholinergics
- Antidepressants
- Antihypertensives (verapamil, clonidine)
- Iron
- Diuretics
- Chronic use of stimulant laxatives (only in those who have GI motility)
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Term
When to refer a patient for constipation |
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Definition
- sx for >2 weeks
- black/tarry stools
- abdominal pain/discomfort
- fever
- N/V
- FH of inflamm bowel disease (crohn's) or colon cancer
- drastic change in severity/nature of sx
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Term
Tool to assist in patient assessment |
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Definition
poop journal for 2-4 weeks |
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Term
Questions to ask a patient complaining of constipation |
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Definition
Length of constipation
Frequency of normal bowel movements
Size and Color of stools
Constipation with bouts of diarrhea?
Change in caliber of stools
Gas
Appetite/Weight change |
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Term
Bristol Stool Scale is used to measure what? |
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Definition
Transit time in the GI
harder feces indicating slower transit
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Term
desired outcome for constipation treatment |
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Definition
return to comfortable point and provide relief |
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Term
How many glasses of water per day qualifies as ample fluid intake to promote regular bowel habits? |
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Definition
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Term
Measures to Help Promote Regular Bowel Habits |
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Definition
- include ample fluids and fiber in diet
- add high-fiber foods to diet slowly
- do not ignore the urge to have a bowel movement
- establish a regular, unhurried time for BM
- encourage defecation first thing in AM or w/in 30 minutes after meals
- routine physical activity
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Term
What is the recommended amount of fiber per day for regular bowel habits? |
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Definition
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Term
Dried Plums
(affectionately known as Prunes) |
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Definition
- contain high conc of simple sugars (sorbitol)
- 1 cup = 12g of fiber
- dihydrophenylsatin (natural laxative)
*Good for adding fiber to diet* |
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Term
Agents causing relief from acute constipation in 0.5 to 3 hours |
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Definition
magnesium citrate
sodium phosphate
Large doses of PEG
enemas
bisacodyl/glycerin suppositories |
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Term
Agents providing relief from acute constipation in 6-24 hours |
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Definition
Milk of Mag
standard doses of PEG (Miralax)
bisacodyl/senna tablets (oral)
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Term
5 steps to treatment of chronic constipation |
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Definition
- dietary interventions (failed prior)
- bulk forming laxatives + adequate fluid intake
- sorbitol/lactulose/PEG
- stimulant laxative (short term)
- lubiprostone (Amitiza)(Rx only)
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Term
therapy for constipation in spinal cord injury patients |
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Definition
routine use of stimulant laxative (suppositories)
attempt to "train bowel" (bowel program)
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Term
tx for constipation during pregnancy |
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Definition
diet, fiber, docusate
senna in more severe cases |
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Term
tx of constipation in children |
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Definition
glycerin
Karo syrup (infants) |
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Term
tx of constipation for diabetics |
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Definition
metoclopramide (↑GI motility)
stimulant laxative |
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Term
tx of constipation for chronic opiod users |
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Definition
Stimulant laxative
Then add lactulose, sorbitol, or PEG PRN
AVOID Bulk laxatives (bc no GI motility, will only lead to increased probs due to inability to move feces out)
Methylnaltrexone (Relistor) mu opiod receptor antagonist
8-12mg SC every other day
BM w/in 30 min
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Term
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Definition
hyperosmotics/saline laxatives
clear liquid diet beginning day prior
prep with laxative starts afternoon before
large quantities of fluids |
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Term
Oral Prep Agents for GI Procedure should be avoided in patients with what |
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Definition
heart failure
renal disease
electrolyte abnormalities
*use in these patients is why these agents are Rx only |
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Term
Bulk laxatives mechanism of action |
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Definition
form emollient gel which retains water and stimulates a bowel movement |
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Term
advantages of bulk forming laxative |
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Definition
+ soften stools better than docusate
+ well tolerated with few SE |
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Term
disadvantages of bulk forming laxatives |
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Definition
- taste
-must have adequate fluid intake
- gas formation (only with metamucil)
- impacts drug absorb
- not good for bedridden patients (bc have poor GI motility)
- Not for patients on chronic opiods |
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Term
Examples of bulk laxatives |
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Definition
Metamucil (psyllium)
Citrucel (methylcellulose)
Fiber tabs |
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Term
Example of surfactant/emollient laxatives |
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Definition
aka stool softeners
Docusate (100mg QD or BID)
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Term
Mechanism of action for surfactant/emollient laxatives |
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Definition
decrease fecal surface tension
stool softener |
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Term
Advantages/Disadvantages of surfactant/emollient laxatives |
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Definition
+ safe
+ helps prevent hard stools (hemorrhoids)
- efficacy is questionable
- Not Effective for Active Constipation |
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Term
Lubricant (aka slip-n-slide) laxatives |
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Definition
lubricate lumen of colon
Mineral Oil (30-60mL QD) |
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Term
Disadvantages of Lubricant Laxatives |
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Definition
- poor patient acceptance (oily and can be leaky)
- may ↓ absorption of fat-soluble vitamins (A,D,E,&K) |
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Term
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Definition
MOA: draw fluid into colon which stimulates motility
milk of mag
Mg Citrate
Phospha-soda
Fleet's Saline Enema |
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Term
Advantages/Disadvantages of Saline Laxatives |
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Definition
+ quick onset
+ most economical
- avoid in renal patients bc have a hard time excreting Na and Mg |
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Term
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Definition
draw fluid into colon due to high conc of sugar, PEG, or glycerin |
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Term
Examples of oral Hyperosmotic Agents |
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Definition
Sorbitol (30-60mL QD)
Lactulose (30-60mL QD)
PEG (17g in water QD)
PEG = Miralax |
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Term
Advantages/Disadvantages of oral Hyperosmotic Agents |
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Definition
+ well tolerated
+ softens while stimulating bowel movement
+ excellent for Chronic constipation
- 1-4 DAY onset
- sweet taste of some
- minor nausea, cramping |
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Term
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Definition
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Term
polythylene glycol
(Nulytely, Golytely, HalfLytely) |
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Definition
hyperosmotic agent
used as bowel prep (4L)
8oz Q 10 minutes |
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Term
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Definition
hyperosmotic agent
sometimes used in kids
1 tsp in 6-8 oz formula |
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Term
Examples of Stimulant Laxatives |
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Definition
Senna (2T QD to BID)
Bisacodyl (enteric coated) (1-2T QD)
Castor Oil (30-60mL)
Bisacodyl suppositories (10mg PR)
quick onset |
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Term
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Definition
Locally irritates nerves which stimulates mobility |
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Term
Advantages/Disadvantages of oral Stimulant Laxatives |
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Definition
+ 6-12 H onset
+ works for patients with mobility issues
+ DOC for patients on opiods
- risk of cramping
- avoid long-term use in patients with GI motility |
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Term
Chloride Channel Activator |
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Definition
Lubiprostone (Amitiza)
24mcg BID with food
8mcg BID for women with IBS
increase influx of fluid into small intestine |
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Term
Disadvantages of lubiprostone |
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Definition
diarrhea/nausea/HA
Expensive
Avoid in pregnancy |
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Term
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Definition
1-2 days for acute
1-2 weeks for chronic constipation
look for:
stool frequency, diarrhea episodes, dietary changes |
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