Question

John Stokes is a 42-year-old banking executive who has been diagnosed with a duodenal ulcer due to H. pylori infection. He reports persistent abdominal pain associated with the ulcer. His medical history includes a recent knee injury, and he has been taking ibuprofen as needed for knee pain. His physician has prescribed treatment with Prevpac. (Learning Objectives 1, 5, and 6)

John asks the nurse about the Prevpac. When he is informed that it contains three drugs, he responds, “Wait a minute. I don’t like to take a lot of medications. Isn’t three drugs excessive?” How should the nurse respond?

Please describe the 3 meds that are in prevpac and why they are used for duodenal ulcer.

John informs the nurse that he has been taking Mylanta for relief of abdominal pain and asks if he can continue taking the Mylanta with the Prevpac. How should the nurse respond? Describe some things Mr. Stokes can be taught to avoid future ulcers.

What is Carafate and how does it work?

3. Case Study, Chapter 39, Drug Therapy for Constipation and Elimination Problems Melissa Drake is a 22-year-old college student who suffered a fractured femur, pelvis, and tibia in a motor vehicle accident. She recently has been discharged after recovering from her injuries and is taking opioid analgesics several times daily for pain. On a routine follow-up visit to the medical clinic, she tells the nurse that she has been constipated; her last bowel movement was 1 week ago and was small, hard, and difficult to pass. She is instructed on risk factors for constipation and advised on lifestyle modifications that may ease the constipation and to take psyllium daily. (Learning Objectives 1, 2, and 6)

Melissa states “I have never been constipated in the past. Why is this happening now?” How should the nurse respond?

Discuss the lifestyle modifications that the nurse should include when providing client education to Melissa.

Melissa states “Wait a minute. Isn’t psyllium for older people?” How should the nurse respond?

Compare and contrast 3 different types of laxatives and when they might be prescribed.

Answer 1

Case-1

Patient's name:John stokes

Age; 42 years

Diagnosis: Duodenal ulcer due to H.Pylori infection

Treatment prescribed: Prevpac

The nurse should explain detaily about the three medicines and their role in duodenal ulcer to the patient.Prevpac contains three medicines.They are Lansoprazole,Amoxicilin, and Clarithromycin.Lansoprazole is a protein pump inhibitor,binds to H+/K+- exchanging ATPase in gastric parietal cells resulting in blocking acid secretion. Amoxicillin inhibits bacterial cellwall synthesis by binding to one or more pencillin binding proteins that in turn inhibit the final transpeptidation step of peptoglycan synthesis in cell wall biosynthesis. Clarithromycin inhibits protein synthesis by binding to 50S ribosomal subunit causing antibacterial activity. So the three drugs are not excessive.

Mylanta contains Aluminium hydroxide, Magnesium hydroxide, and simethicone.Aluminium hydroxide neutralises stomach HCL to form AlCl3 salt+H2O, and increases gastric pH. Magnesium hydroxide promotes bowel evacuation by causing osmotic retention of fluid,which causes the colon to distend with increased peristaltic activity. Also Mylanta doesn't have any proven interaction with prevpac. So he can continue the medication along with prevpac. But self medications is not good, so if he is taking mylanta without the prescription of doctor, it should be avoided. By avoiding smoking, doing meditation and avoiding foods that irritating GI tract, he can prevent the future ulcers.

Carafate is sucralfate which is a gastro intestinal agent. It forms an ulcer adherent complex that protects ulcer from acid,pepsin,and bile salts, thus allowing it to heal.

Case-2

Name:Mellissa

Age:22

Diagnosis: Fracture of Femur, pelvis and tibia

Treatment history: opioid analgesics several times daily

Presenting complaint: constipation

Since the patient is taking opioid analgesics several times daily for pain, the cause of her constipation will be opioid intake, because opioids can induce constipation. Opioids are generally known to inhibit gastric emptying and peristalsis in the GI tract which results in increased absorption of fluid.The lack of fluid in the intestine leads to hardening of stool and constipation. This opioid induced constipation can be controlled by some lifestyle modifications.

1. Drink plenty of water
2. Eat more fibre containing foods
3. increase physical activity: Exercise and physical activity can stimulate bowel movements.

Psyllium is a bulk producing laxative.It absorbs liquid in the intestines, swells and forms a bulky stool which is east to pass.It is also indicated for fibre supplementation and It can be given to every ages not only to older ages.

Three types of laxatives are Lubricant laxatives, stimulant laxatives, and osmotic laxatives. Lubricant laxatives are used for acute or subacute management of constipation.They lubricate the intestine and facilitate passage of stool by decreasing water absorption from the intestine.

Stimulant laxatives include Bisacodyl, senna, and sodium picosulphate. Bisacodyl stimulates peristalsis potentally by stimulatin the colonicintramural neuronal plexus;alters water and electrolyte secretion, resulting in net intestinal fluid accumalation and laxation.Sennasoids induce defeacation by acting directly on the intestinal mucosa or nerve plexus, which stimulates peristaltic activity, and increase intestinal motility.

Osmotic laxatives: small doses of osmotic agents are useful for long term treatment of constipation with slow colonic transit in patients who are refractory to dietary fibre suplementation.In large doses these agents may also be used as part of a bowel evacuation protocol for invasive procedures or surgery.It includes Glycerin, Lactulose, Sorbitol etc.