DIARRHEA

Etiology: Overflow around fecal impaction (important to do rectal exam), viral or bacterial infection, radiotherapy induced enteritis, malabsorption, broad spectrum antibiotics, tumor infiltration of colon or rectum, anxiety.

Treatment: In mild diarrhea:

• Kaopectate 30-60 cc P.O q4h prn
• Donnagel 30-60 cc P.O. q3h prn

In moderate -severe diarrhea:

• Lomotil 2tabs q4-6h P.O prn
• Immodium 2-4 mg q4-6h P.O prn
• Codeine 15-60 mg P.O q4h prn

Protect peri-anal area with frequent cleansing and a barrier cream until diarrhea is controlled.

CONSTIPATION

Etiology: Inactivity/immobility, low residue diet, inadequate fluid intake, general weakness, narcotics, TCA, tranquilizers, hypercalcemia, hypokalemia, mechanical obstruction.

Treatment: Important to reassess quantity and consistency of stool on a daily basis. Important to do a rectal exam - is it empty and collapsed? An empty balloon? Impacted?

Encourage bran, fruit juices and good hydration

Stool Softners:

• Colace 100 -200 mg PO bid-tid
• Glycerin suppository 1 supp PR prn
• Surfak 240mg PO od

Prokinetic Agents:

• Senna 2-4tabs, 1tsp granules or 10-15 cc syrup PO od-tid
• Dulcolax 10mg PO/PR prn

Others:

• Pericolace (combination stimulant and stool softner) 1-2 tabs PO od-tid
• Lactulose (osmotic laxative) 30-60 cc PO od-tid
• Milk of Magnesia (laxative-antacid) 5-15 cc P.O q6h prn
• Sodium Bisphosphonate (fleet enema) 1 PR prn

NAUSEA AND VOMITTING

Etiologies: Drugs (opioids, cytotoxic agents), Metabolic causes (hypercalcemia, renal failure, other electrolyte abnormalities), abdominal disorders (gallbladder, pancreas, liver), Pharyngeal irritation (thick inspissated sputum, cough), Infections (candida, gastritis, enteritis), Gastric stasis, Bowel obstruction, Constipation, Gastric compression, Increased ICP, Anxiety

Nonpharmacological Approaches:

Explaining etiology of symptoms, Foster peaceful atmosphere, Avoid sudden abrupt movements, Eliminate unpleasant odor or site, Ensure good oral hygiene, Hydration, Diet in small portions more frequently, Treat constipation

PHARMACOLOGICAL APPROACHES

• Break the cycle by first using medication P.R and S/C, then switch to P.O.
• When combining meds, use ones from different classes that work differently

DYSPHAGIA AND ODYNOPHAGIA

Etiology: extension of mouth care problems, mechanical obstruction of the esophagus secondary to radiation induced stricture or mediastinal lymphadenopathy

Treatment:

• Pureed diets

• Crushed, liquid, or rectal suppository forms of needed meds

• Tube insertion or gastrostomy (if reversible/transient dysphagia or when a few days of improved nutrition might help a pt. achieve an important goal)

• Lidocaine (Xylocaine viscous solution 2%), 10-15 mL po q3-4 hr prn, or 15 mins prior to meals

Reflux esophagitis:

• Antacids (Maalox Plus, Mylanta) 30-60 mL po q2-4 hr
• Cimetidine 300 mg po q6 hr
• Ranitidine 150 mg po q12 hr

Gastric outlet obstruction:

• Metoclopramide 10-20mg po q6-8 hr

Candidal esophagitis:

• Ketoconazole 400mg po od x 1-2 weeks
• Clotrimazole vaginal tablets 100mg, sucked qid x 10 days
• Amphotericin B 10-20 mg IV od x 5-7 days

HICCUPS:

Can be extremely distressing to a patient.

Etiology: Unknown (phrenic nerve irritation - ?tumor mass,�)

Treatment:

MOUTH CARE

Etiology: Local radiation, mouth breathing, anorexia, dehydration, drugs (TCAs, antihistamines, anticholinergics), candida (patients on Abx)

Treatment:

• Bedside hydration
• Therapeutics Mouthwash (1 tsp. Salt + � tsp. Baking soda + 1-2 drops peppermint in 1L H2O) use qid
• Dry Mouth - use mouthwash, Vaseline to outside of lips, K-Y jelly applied inside mouth, spray with H2O frequently

• Painful Mouth (Ulceration/stomatitis) - Mouthwash qid, Tantum mouthwash oral swish 15ml PO qid, Xylocaine Viscous 2% to paint mouth

• Oral Candidiasis (thrush) - mouthwash qid, Nystatin 500 000 units to swish & swallow qid, for severe cases Ketoconazole 200mg PO OD for 7 days