NUR 635 Topic 10 DQ 2

Sample Answer for NUR 635 Topic 10 DQ 2 Included After Question

A nurse practitioner is working in an outpatient setting. Her first patient is complaining of constipation five times a day. Select a medication and apply the available evidence and treatment guidelines to determine appropriate therapeutic options used for the treatment of constipation. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions, including interactions with CAM. Discuss any ethnic, cultural, and genetic differences in patients that should be considered in the treatment of constipation in order to ensure the safety and efficacy of the medication. Be sure to comment on how chronic laxative use could be associated with C. difficile. In addition, include a peer-reviewed article showing benefit of your agent. Include the name of the medication in the subject line so that the medications can be followed.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 5.2, 6.4, 9.2

A Sample Answer For the Assignment: NUR 635 Topic 10 DQ 2

Title: NUR 635 Topic 10 DQ 2

Polyethylene Glycol is an osmotic laxative used for the treatment of constipation. It is generally known as PEG, MiraLAX, GlycoLax, or Peglax. PEG is a hydrophilic, non-absorbable polymer. It does not get absorbed into circulation at significant levels, has a strong affinity for water, and works through the gastrointestinal system after consumption. It does this by attracting water into the colon, which then causes an increase in the amount of water included in the stool (Rosenthal & Burchum, 2020). Because of this, the feces become less solid and bulkier, which makes it much simpler for it to go through the intestine.

Patients using PEG should have their hydration levels checked since the efficacy of the medicine is dependent on water retention in the colon. Patients should also be made aware of any potential adverse effects of the medication. During therapy, it is essential to consume adequate hydration (Rosenthal & Burchum, 2020).

Side effects: bloating, flatulence (gas), and stomach pain are common adverse reactions associated with the use of PEG. The effects are, in most cases, modest and transient. Patients need to be made aware of the possibility of adverse effects, but in most cases, patientsn’tn’t report them once their bodies have adjusted to the medicine.

Interactions with Medications: One of the most noticeable benefits of PEG is that it has very few interactions with medications. Because it does not interfere with the absorption of other oral prescriptions, it may be safely used with other medications without altering the effectiveness of the different treatments. Because of this quality, it is an excellent option for people who need treatment for constipation but are also taking other prescription medications (Dudi-Venkata et al., 2021).

Interactions with Complementary and Alternative Medicine (CAM) Patients who use herbal treatments or dietary supplements for constipation and who are also taking PEG should exercise caution due to the possibility of PEG causing adverse reactions. Combining complementary and alternative medicine (CAM) therapies that have the potential to have laxative effects on their own with PEG may result in diarrhea and excessive stool softness. It is essential to ask about any complementary and alternative medicine (CAM) therapies the patient is undergoing and educate them on the possible interactions between their medications.

Constipation is a frequent gastrointestinal ailment that may affect people of various ethnic origins and cultures. Moreover, the prevalence is higher in non-Caucasians than Caucasians, in women (median female to male ratio of 1.5:1), and institutionalized rather than in community-living elderly patients; chronic constipation affects all ages, races, socioeconomic groups, and nationalities (Bharucha & Lacy, 2020).

Infection with Clostridium difficile (C. difficile) and Prolonged Use of Laxatives Prolonged use of laxatives, especially PEG, has been linked to an increased risk of infection with Clostridium difficile (C. difficile). Using laxatives for an extended period might upset the average balance of bacteria in the digestive tract, which can make the body more receptive to colonization by C. difficile. Patients should be informed about the possible dangers of chronic laxative usage as well as the significance of taking laxatives only as advised and for a specific amount of time. Patients should also be educated about the need to use laxatives only as directed. If, despite therapy, constipation continues, it is recommended that a further examination be referred to a specialist to identify the underlying cause of the condition and the treatment method that will be most effective (Tomkovich et al., 2021)

References

Bharucha, A. E., & Lacy, B. E. (2020). Mechanisms, evaluation, and management of chronic constipation. Gastroenterology, 158(5), 1232-1249.e3. https://doi.org/10.1053/j.gastro.2019.12.034

Dudi-Venkata, N. N., Kroon, H. M., Bedrikovetski, S., Lewis, M., Lawrence, M. J., Hunter, R. A., Moore, J. W., Thomas, M. L., & Sammour, T. (2021). Impact of Simulant and osmotic LAXatives (STIMULAX trial) on gastrointestinal recovery after colorectal surgery: Randomized clinical trial. British Journal of Surgery, 108(7), 797-803. https://doi.org/10.1093/bjs/znab140

Rosenthal, L. D., & Burchum, J. R. (2020ehne’se’s pharmacotherapeutics for advanced practice nurses and physician assistants – e-book (2nd ed.). Elsevier Health Sciences.

Tomkovich, S., Taylor, A., King, J., Colovas, J., Bishop, L., McBride, K., Royzenblat, S., Lesniak, N. A., Bergin, I. L., & Schloss, P. D. (2021). An osmotic laxative renders mice susceptible to prolonged clostridioides difficile colonization and hinders clearance. Msphere, 6(5), 629.

A Sample Answer 2 For the Assignment: NUR 635 Topic 10 DQ 2

Title: NUR 635 Topic 10 DQ 2

Bisacodyl is a medication used in the management and treatment of chronic or functional constipation. It improves bowel function, constipation-related symptoms, and disease-related quality of life. It has been used as a first-line laxative for functional constipation management (Lawrencia & Raja, 2022). 

Bisacodyl’s target of action is the gastrointestinal tract. Absorption from the GI tract is minimal because its formulation is a coated tablet, which is resistant to destruction in the stomach and small intestine and thus achieves transit to the colon in its intact form. It then dissolves in the colon and ensures a laxative effect after oral intake. Intestinal deacetylase and bacterial enzymes hydrolyze bisacodyl to a deacetylated active metabolite, bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM), which stimulates the intestinal mucosa, causing peristalsis, which is responsible for the laxative action (Lawrencia & Raja, 2022).

The most common adverse effects, seen in more than 5 percent of patients taking bisacodyl, are diarrhea, abdominal pain (mainly in the upper abdomen), and headache. Although it is unlikely that chronic use of bisacodyl is harmful to the colon, it could induce abdominal discomfort and cramping pain. But, it is generally well-tolerated, safe, and effective for adults and children. Joo JS et al. showed that 45 percent of patients using bisacodyl or other laxatives (phenolphthalein, senna, and casanthranol) more than three times per week for one year or longer (This is defined as chronic stimulant laxative use.) had subsequent radiographic changes of colonic redundancy and dilation of colon, with loss of haustral markings which did not occur in the control groups. It may suggest that these agents cause a neuronal injury or damage to colonic longitudinal musculature (Lawrencia & Raja, 2022).

Bisacodyl’s primary indicated use is for adults or children with constipation, especially chronic constipation. Bisacodyl is contraindicated in patients with acute gastrointestinal diseases such as appendicitis or diarrhea, with ileus or suspected bowel obstruction, bowel perforation, colitis, toxic megacolon, having severe dehydration, electrolyte imbalance (i.e., hypokalemia, hyponatremia, metabolic alkalosis or acidosis), or are allergic or hypersensitive to bisacodyl. It is not recommended for use for more than four weeks due to harmful long-term colonic effects and possible carcinogenic risk of stimulant laxatives; epidemiological studies investigating its effects and safety over longer terms are warranted (Lawrencia & Raja, 2022).

Reference:

Lawrensia S, Raja A. Bisacodyl. [Updated 2022 Oct 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547733/