A.

DRUGS AFFECTING GASTROINTESTINAL SECRETIONS

(a) DRUGS USED TO TREAT GASTROPHAGEAL REFLUX DISEASE AND ULCER DISEASE
Histamine-2 Antagonist
cimetidine nizatidine
famotidine ranitidine

Nursing Assessment:
o Assess for possible contraindications or cautions: history of allergy to any H 2
o Perform a physical examination to establish baseline data before beginning therapy, determine effectiveness of
the therapy, and evaluate for any adverse effects associated with drug therapy.
o Inspect the skin for evidence of lesions or rash to monitor for adverse reactions.
o Evaluate neurological status, including orientation and affect, to assess CNS effects of the drug and to plan for
protective measures.
o Assess cardiopulmonary status, including pulse, blood pressure, and electrocardiogram (if intravenous use is
needed), to evaluate the cardiac effects of the drug.
o Perform abdominal examination, including assessment of liver, to establish a baseline and rule out underlying
medical problems.
o Monitor the results of laboratory tests, including liver and renal function tests, to predict changes in metabolism
or excretion of the drug that might require dose adjustment.
Nursing Diagnoses:
o Acute Pain related to CNS and GI effects
o Disturbed Sensory Perception (Kinesthetic, Auditory) related to CNS effects
o Risk for Injury related to CNS effects
o Decreased Cardiac Output related to cardiac arrhythmias
o Deficient Knowledge regarding drug therapy
Implementation
o Administer oral drug with or before meals and at bedtime.
o Arrange for decreased dose in cases of hepatic or renal dysfunction.
o Monitor the patient continually if giving intravenous doses
o Assess the patient carefully for any potential drug–drug interactions if given in combination with other drugs.
o Provide comfort, including analgesics, ready access to bathroom facilities, and assistance with ambulation.
o Periodically reorient the patient and institute safety measures if CNS effects occur.
o Provide patient teaching regarding drug name, dosage, and schedule for administration; importance of spacing
administration appropriately as ordered; need for readily available access to bathroom; signs and symptoms of
adverse effects and measures to minimize or prevent them; danger signs that necessitate notifying the
healthcare provider immediately; safety measures, such as avoiding driving and asking for assistance when
ambulating, to deal with possible effects of dizziness, somnolence, or confusion; the need for compliance with
therapy to achieve the intended results; and the importance of periodic monitoring and evaluation, including
laboratory testing.
Evaluation
o Monitor patient response to the drug (relief of GI symptoms, ulcer healing, prevention of progression of ulcer).
o Monitor for adverse effects (dizziness, confusion, hallucinations, GI alterations, cardiac arrhythmias,
hypotension, gynecomastia).
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for,
and specific measures to avoid them).
o Monitor the effectiveness of comfort measures and compliance with the regimen.

Antacids
aluminum salts magaldrate sodium bicarbonate
calcium salts magnesium salts

Nursing Assessment
o Assess for possible contraindications or cautions: any history of allergy to antacids to prevent
hypersensitivity reactions; renal dysfunction; electrolyte disturbances; and current status of pregnancy or
lactation due to possible effects on the fetus or newborn.
o Perform a physical examination to establish baseline data before beginning therapy, determine the
effectiveness of the therapy, and evaluate for any potential adverse effects associated with drug therapy.
o Inspect the abdomen. Auscultate bowel sounds to ensure GI motility.
o Assess mucous membrane status to evaluate potential problems with absorption and hydration.
o Monitor laboratory test results, including serum electrolyte levels and renal function tests, to monitor for
adverse effects of the drug and potential alterations in excretion that may necessitate dose adjustment.
Nursing Diagnoses
o Diarrhea related to GI effects
o Risk for Constipation related to GI effects
o Imbalanced Nutrition: Less Than Body Requirements related to GI effects
o Risk for Imbalanced Fluid Volume related to systemic effects
o Deficient Knowledge regarding drug therapy
 Implementation
o Administer the drug apart from any other oral medications approximately 1 hour before or 2 hours after to
ensure adequate absorption of the other medications.
o Have the patient chew tablets thoroughly and follow with water to ensure that therapeutic levels reach the
stomach to decrease acid.
o Obtain specimens for periodic monitoring of serum electrolytes to evaluate drug effects.
o Assess the patient for any signs of acid–base or electrolyte imbalance to ensure early detection and prompt
interventions.
o Monitor the patient for diarrhea or constipation to institute a bowel program before severe effects occur.
o Monitor the patient’s nutritional status if diarrhea is severe or constipation leads to decreased food intake to
ensure adequate fluid and nutritional intake to promote healing and GI stability.
o Offer support and encouragement to help the patient cope with the disease and the drug regimen.
Evaluation
o Monitor patient response to the drug (relief of GI symptoms caused by hyperacidity).
o Monitor for adverse effects (GI effects, imbalances in serum electrolytes, and acid–base status).
o Evaluate the effectiveness of the teaching plan (patient can name the drug and dosage, as well as describe
adverse effects to watch for, specific measures to avoid them, and measures to take to increase the
effectiveness of the drug).
o Monitor the effectiveness of comfort measures and compliance with the regimen.

Proton pump ihibitors

dexlansoprazole esomeprazole lansoprazole
omeprazole pantoprazole rabeprazole
Nursing Assessment
o Assess for possible contraindications or cautions: history of allergy to a proton pump inhibitor to reduce the
risk of hypersensitivity reaction; current status of pregnancy or lactation because of the potential for
adverse effects on the fetus or nursing baby.
o Perform a physical examination to establish baseline data before beginning therapy to determine the
effectiveness of the therapy and to evaluate for the occurrence of any adverse effects associated with
drug therapy.
o Inspect the skin for lesions, rash, pruritus, and dryness to identify possible adverse effects.
o Assess neurological status, including level of orientation, affect, and reflexes, to evaluate for CNS effects of
the drug.
o Inspect and palpate the abdomen to determine potential underlying medical conditions; assess for changes in
bowel elimination and GI upset to identify possible adverse effects.
o Assess respiratory status, including respiratory rate and rhythm; note evidence of cough, hoarseness, and
epistaxis, to monitor for potential adverse effects of the drug.
Nursing Diagnosis
o Diarrhea related to GI effects
o Risk for Constipation related to GI effects
o Imbalanced Nutrition: Less Than Body Requirements related to GI effects
o Disturbed Sensory Perception (Kinesthetic, Auditory) related to CNS effects
o Risk for Injury related to CNS effects
o Deficient Knowledge regarding drug therapy
Implementation
o Administer drug before meals to ensure that the patient does not open, chew, or crush capsules; they should
be swallowed whole to ensure the therapeutic effectiveness of the drug.
o Provide appropriate safety and comfort measures if CNS effects occur to prevent patient injury.
o Monitor the patient for diarrhea or constipation in order to institute an appropriate bowel program as
needed.
o Monitor the patient’s nutritional status; use of small frequent meals may be helpful if GI upset is a problem.
o Arrange for medical follow-up if symptoms are not resolved after 4 to 8 weeks of therapy because serious
underlying conditions could be causing the symptoms.
Evaluation
o Monitor patient response to the drug (relief of GI symptoms caused by hyperacidity; healing of erosive GI
lesions).
o Monitor for adverse effects (GI effects, CNS changes, dermatological effects, respiratory effects).
o Monitor the effectiveness of comfort and safety measures and compliance with the regimen.
o Evaluate the effectiveness of the teaching plan.

Gi protectant
sucralfate

Nursing Assessment
o Assess for possible contraindications or cautions: any history of allergy to sucralfate to prevent
hypersensitivity reactions; renal dysfunction or dialysis, which can lead to a buildup of aluminum; and
current status of pregnancy or lactation.
o Perform a physical examination to establish baseline data before beginning therapy, to determine the
effectiveness of therapy, and to evaluate for any adverse effects associated with drug therapy.
o Inspect the skin for color and evidence of lesions or rash that might indicate adverse drug effects.
o Assess the patient’s neurological status, including level of orientation, affect, and reflexes, to monitor for
CNS effects of the drug.
o Examine the abdomen; auscultate bowel sounds to evaluate GI motility; evaluate bowel elimination pattern or
changes that could suggest possible adverse effects.
o Assess mucous membrane status to evaluate potential problems with absorption.
o Monitor the results of laboratory tests such as renal function studies to identify the need for possible
dose adjustments and toxic effects.
Nursing Diagnoses
o Diarrhea related to GI effects
o Risk for Constipation related to GI effects
o Imbalanced Nutrition: Less Than Body Requirements related to GI effects
o Disturbed Sensory Perception (Kinesthetic) related to CNS effects
o Deficient Knowledge regarding drug therapy
Implementation
o Administer the drug on an empty stomach, 1 hour before or 2 hours after meals and at bedtime, to ensure
the therapeutic effectiveness of the drug.
o Monitor the patient for GI pain, and arrange to administer antacids to relieve pain if needed.
o Administer antacids or antibiotics, if ordered, between doses of sucralfate, not within 30 minutes of a
sucralfate dose, because sucralfate can interfere with absorption of oral agents.
o Provide comfort and safety measures if CNS effects occur to prevent patient injury.
o Provide frequent mouth care, including sugarless lozenges to suck, to alleviate dry mouth.
Evaluations
o Monitor the patient response to the drug (relief of GI symptoms; healing of erosive GI lesions).
o Monitor for adverse effects (GI effects, CNS changes, dermatological effects).
o Monitor the effectiveness of comfort and safety measures and compliance with the regimen.
o Evaluate the effectiveness of the teaching plan (patient can name drug and dosage and describe the
adverse effects to watch for, specific measures to avoid them, and measures to take to increase the
effectiveness of the drug).

Prostaglandin
misoprostol

Nursing Assessment
o Assess for possible contraindications or cautions: any history of allergy to misoprostol to prevent
hypersensitivity reactions, and current status of pregnancy or lactation because of the potential for
adverse effects on the fetus or nursing baby.
o Perform a physical examination to establish baseline data before beginning therapy, and during therapy to
determine the effectiveness of the drug and to evaluate for the occurrence of any adverse effects
associated with drug therapy.
o Examine the abdomen for possible changes to rule out medical conditions.
o Perform a pregnancy test and assess normal menstrual activity to make sure that the woman is not
pregnant.
o Monitor the results of laboratory tests, including renal and hepatic function tests, to determine the need
for possible dose adjustment and identify toxic effects.
Nursing Diagnoses
o Diarrhea related to GI effects
o Risk for Constipation related to GI effects
o Imbalanced Nutrition: Less Than Body Requirements related to GI effects
o Ineffective Sexuality Pattern related to genitourinary effects
o Deficient Knowledge regarding drug therapy
Implementation
o Administer to patients at high risk for NSAID-induced ulcers during the full course of NSAID therapy to
prevent the development of gastric ulcers. Administer four times a day, with meals and at bedtime, to
ensure maximum benefit of the drug.
o Arrange for a serum pregnancy test within 2 weeks before beginning treatment, and begin therapy on the
second or third day of the menstrual period, to ensure that women of childbearing age are not pregnant
and to prevent abortifacient effects associated with this drug.
o Provide the patient with both written and oral information regarding the associated risks of pregnancy to
ensure that the patient understands the risks involved; advise the use of barrier contraceptives during
therapy to ensure the prevention of pregnancy.
o Evaluate nutritional status if GI effects are severe to arrange for appropriate measures to relieve
discomfort and ensure nutrition, such as small, frequent meals, and increased fluid intake if appropriate.
 o Explain the risk of menstrual disorders and pain, miscarriage, and excessive bleeding related to the drug
effects on prostaglandin activity in the uterus.

Evaluation
o Monitor the patient response to the drug (prevention of GI ulcers related to NSAIDs).
o Monitor for adverse effects (GI, genitourinary).
o Monitor the effectiveness of comfort and safety measures and compliance with the regimen.

(b) DRUGS USED TO TREAT DIGESTIVE ENZYME DYSFUNCTION

pancrelipase saliva substitute

Nursing Assessment
o Assess for possible contraindications or cautions: any history of allergy to any of the drugs or to pork
products; heart failure or hypertension and current status of pregnancy or lactation
o Perform a physical examination
o Perform an abdominal examination
o Monitor mucous membranes
o Assess cardiopulmonary status, including blood pressure and cardiac rate and rhythm
o Monitor the results of laboratory tests, including renal function tests.
Nursing Diagnoses
o Diarrhea related to GI effects
o Imbalanced Nutrition: Less Than Body Requirement related to GI effects
 o Deficient Knowledge regarding drug therapy
Implementation
o Have the patient swish a saliva substitute around the mouth as needed for dry mouth and throat
o Monitor swallowing
o Administer pancreatic enzymes with meals and snacks so that enzyme is available when it is needed. Avoid
spilling powder on the skin
o Assess nutritional status if there are GI effects
o Obtain laboratory specimens as indicated
Evaluation
o Monitor the patient response to the drug
o Monitor for adverse effects
o Monitor the effectiveness of comfort and safety measures and compliance with the regimen.

B. DRUGS AFFECTING GASTROINTESTINAL MOTILITY

(a) LAXATIVES
Chemical lactulose polycarbophil docusate
Stimulants magnesium polyethylene glycerin
bisacodyl citrate glycol- mineral oil
cascara magnesium electrolyte Other
castor oil hydroxide solution Laxatives
senna magnesium psyllium lubiprostone
Bulk Stimulants sulfate Lubricants
 methylnaltrexo ne

Nursing Assessment
o Assess for possible contraindications or cautions: history of allergy to laxative to prevent hypersensitivity
reaction; fecal impaction or intestinal obstruction; acute abdominal pain, nausea, or vomiting.
o Perform a physical examination to establish baseline data before beginning therapy and during therapy to
determine the effectiveness of the drug and to evaluate for any adverse effects associated with drug therapy.
o Inspect the skin for rash.
o Assess the patient’s neurological status.
o Obtain a baseline pulse rate.
o Assess bowel elimination patterns, including the patient’s perception of normal frequency, actual frequency, and
stool characteristics.
o Investigate the patient’s nutritional intake, including fluid intake and ingestion of fiber-containing foods.
o Assess the patient’s level of activity.
o Perform an abdominal examination, including inspecting abdomen for distention, palpating for masses, and
auscultating for bowel sounds.
o Monitor results of laboratory tests, including serum electrolyte levels.
Nursing Diagnosis
o Acute Pain related to CNS and GI effects
o Diarrhea related to drug effects
o Deficient Knowledge regarding drug therapy
Implementation
 o Administer a laxative only as a temporary measure
o Arrange for appropriate dietary measures, exercise, and environmental controls
o Administer the oral form with a full glass of water, and caution the patient not to chew tablets.
o Administer bulk laxatives with plenty of water
o Insert rectal suppositories high into the rectum; encourage patients to retain enemas or rectal solution as long as
possible.
o Do not administer in the presence of acute abdominal pain, nausea, or vomiting.
o Monitor bowel function to evaluate drug effectiveness. If diarrhea or cramping occurs, discontinue the drug
Evaluation
o Monitor patient response to the drug
o Monitor for adverse effects
o Monitor the effectiveness of comfort measures and com-
o pliance with the regimen.

(b) GASTROINTESTINAL STIMULANTS

dexpanthenol metoclopramide

Nursing Assessment
o Assess for possible contraindications or cautions: any history of allergy to these drugs.
o Perform physical examination
o Perform abdominal examination
o Assess Cardiopulmonary status
o Inspect skin for color and evidence of lesions or rash
Nursing Diagnoses
o Diarrhea related to drug effects
o Acute Pain related to GI effects
o Deficient Knowledge regarding drug therapy
Implimentation
o Administer at least 15 minutes before each meal and at bedtime.
o Monitor blood pressure carefully if giving the drug intravenously.
o Monitor diabetic patients, who will have increased speed of transit through the GI tract, which could alter
absorption and glucose levels.

(c) ANTIDIARRHEALS
bismuth subsalicylate loperamide opium derivatives

Nursing Assessment
o Assess for possible contraindications or cautions: any history of allergy to these drugs to prevent
hypersensitivity reactions; acute abdominal conditions
o Assess bowel elimination pattern, including frequency and characteristics of stool.
o Assess the patient’s neurological status, including level of orientation and affect.
Nursing Diagnosis
o Constipation related to GI slowing caused by antidiarrheal agent
o Acute Pain related to GI effects
o Disturbed Sensory Perception (Kinesthetic, Gustatory) related to CNS effects
o Deficient Knowledge regarding drug therapy
 Implementation
o Administer the drug after each unformed stool
o Monitor the response carefully; note the frequency and characteristics of the stool.
o Provide appropriate safety and comfort measures if CNS effects occur to prevent patient injury.

(d) IRRITABLE BOWEL SYNDROME DRUGS

alosetron tegaserod hyoscyamine

(e) ANTIEMETIC AGENTS

Phenothiazines Anticholinergics/A granisetron Miscellaneous
chlorpromazine ntihistamines ondansetron Agents
perphenazine buclizine palonosetron dronabinol
prochlorperazine cyclizine Substance P/ hydroxyzine
promethazine meclizine Neurokinin 1 nabilone
Nonphenothiazine 5-HT 3 Receptor Receptor trimethobenzamide
metoclopramide Blockers Antagonist
dolasetron aprepitant
Nursing Assessment
o Assess for possible contraindications or cautions: history of allergy to antiemetic
o Perform a physical examination
o Assess the patient’s neurological status, including level of orientation, affect, and reflexes,
o Assess cardiopulmonary status, including baseline pulse and blood pressure,
o Inspect the skin for color and evidence of lesion or rash
o Examine the abdomen, including the liver, and auscultate bowel sounds
o Assess complaints of nausea and evaluate emesis; note color, amount, and frequency of vomiting episodes
o Monitor laboratory test results, including liver and renal function tests,

Nursing Diagnoses
o Acute Pain related to CNS, skin, and GI effects
o Risk for Injury related to CNS effects
o Decreased Cardiac Output related to cardiac effects
o Deficient Knowledge regarding drug therapy
Implementation
o Assure that route of administration is appropriate for each patient; if used to prevent motion sickness, should be
given 30 minutes before activity that involves motion; some oral tablets can be placed in the mouth and allowed to
dissolve slowly; rectal suppositories should be inserted high into the rectum; IV infusions should be run slowly,
monitoring the patient for CNS depression.
o Assess the patient carefully for any potential drug–drug interactions if giving antiemetics in combination with
other drugs
o Provide comfort and safety measures, including mouth care, ready access to bathroom facilities, assistance
with ambulation and periodic orientation, ice chips to suck, protection from sun exposure, and remedial measures
o Provide support and encouragement, as well as other measures (quiet environment, carbonated drinks, deep
breathing)