potassium - page 3

how do you administer potassium? on an empty stomach or full?... Read More

  1. by   cindyRN 2006
    O.k . Here we go, You would not have the GI upset as severe if given IV or IM,the reason why (I think) is because when you take a Po med like Toradol it sits in the stomach and as it travels through the bowel it "eats" away at it. Thus causing the N/V/D. If the PO med was enteric coated it would not cause erosion of the stomach lining but would still cause some GI distress.
    As far as the meds go that can cause N/V/D Is just about all PO meds like antihypertensives, antirheumatics, antiinnfectives, NSAIDS (big time), but the one that surprises me the most are the proton pump inhibitors like prevacid.
    I hope this is what you were asking, Thanks for the challenge. I needed the distraction from my finals I have next week. LOL
    Last edit by cindyRN 2006 on Nov 9, '05
  2. by   Bipley
    Quote from cindyRN 2006
    O.k . Here we go, You would not have the GI upset as severe if given IV or IM,the reason why (I think) is because when you take a Po med like Toradol it sits in the stomach and as it travels through the bowel it "eats" away at it. Thus causing the N/V/D. If the PO med was enteric coated it would not cause erosion of the stomach lining but would still cause some GI distress.
    As far as the meds go that can cause N/V/D Is just about all PO meds like antihypertensives, antirheumatics, antiinnfectives, NSAIDS (big time), but the one that surprises me the most are the proton pump inhibitors like prevacid.
    I hope this is what you were asking, Thanks for the challenge. I needed the distraction from my finals I have next week. LOL
    So tell me, would you give an ER pt with a GI bleed (unknown location) with pain IV Toradol, IV MS04, or PO Tylenol? It's a trick question, btw.
  3. by   SFCardiacRN
    What was the question? I forgot.
  4. by   cindyRN 2006
    None listed I would give a NSAID but I would give it with cytotec (if the PT. was not pregnant) IF that is not what you are asking then I would rest the bowel and only give IV or IM.
    thanks
  5. by   Bipley
    Quote from SFCardiacRN
    What was the question? I forgot.
    If a drug such as Toradol causes GI upset if given PO, will giving it IM or IV cause the same problems, and which classes of drugs cause GI upset.

    It's a test for the newbie students. <cackle cackle> :chuckle
  6. by   Bipley
    Quote from cindyRN 2006
    None listed I would give a NSAID but I would give it with cytotec (if the PT. was not pregnant) IF that is not what you are asking then I would rest the bowel and only give IV or IM.
    thanks
    Really? Which NSAIDs would you give?

    Keep in mind, drugs like Toradol *can* cause (not necessarily DO cause) the same exact problems given IV as IM. Long term it's even worse.

    ALL drugs can cause GI distress, anything can. A placebo can. We are all different and respond to drugs differently. There isn't a drug on the market that hasn't caused someone GI problems.

    Back to my question:

    >>So tell me, would you give an ER pt with a GI bleed (unknown location) with pain IV Toradol, IV MS04, or PO Tylenol? It's a trick question, btw.<<

    What is your reasoning for not giving IV Toradol, IV MS04, or PO Tylenol in an ER pt w/pain, with a GI bleed, somewhere?
  7. by   cindyRN 2006
    would an answer like, I havn't seen a doctors order yet be acceptable? I don't know let me ponder and maybe research this one. What is initially coming to mind is that toradol is for used for pain only on a short term basis, mgso4 is going to draw fluid into the colon and I need this pt. to reset his bowels and the tylenol I don't want to give because it can also irritate the bowel.
    Do I need to research more or is my first instrict close?
  8. by   Bipley
    Quote from cindyRN 2006
    would an answer like, I havn't seen a doctors order yet be acceptable? I don't know let me ponder and maybe research this one. What is initially coming to mind is that toradol is for used for pain only on a short term basis, mgso4 is going to draw fluid into the colon and I need this pt. to reset his bowels and the tylenol I don't want to give because it can also irritate the bowel.
    Do I need to research more or is my first instrict close?
    The patient already has a GI Bleed, giving Toradol (a drug that causes mega GI problems for many people) to a person with an existing GI problem is not wise. Yes, Toradol is used for pain but that is what we are treating, a GI bleed with pain. MS04 isn't good for GI problems, what if the guy is obstructed? MS04 is really the last narcotic you'd want to use (fluid and motility) although many docs still use it anyway, and in an ED setting with a person who has GI problems, gut pain, etc., they wouldn't likely be getting anything PO.

    BTW.. Toradol IS used on a short term basis, GREAT job!

    You done goodly.
  9. by   cindyRN 2006
    Thanks again for the challenge, My college needs instructors like you.
  10. by   Bipley
    Quote from cindyRN 2006
    Thanks again for the challenge, My college needs instructors like you.
    I've had quite a few students that would disagree! I still teach PRN at an allied health college but even those guys don't like me. They tend to like me a lot better after finals and they are done with my classes once and for all.

    Go figure. :chuckle
  11. by   RazorbackRN
    Quote from Bipley
    The patient already has a GI Bleed, giving Toradol (a drug that causes mega GI problems for many people) to a person with an existing GI problem is not wise. Yes, Toradol is used for pain but that is what we are treating, a GI bleed with pain. MS04 isn't good for GI problems, what if the guy is obstructed? MS04 is really the last narcotic you'd want to use (fluid and motility) although many docs still use it anyway, and in an ED setting with a person who has GI problems, gut pain, etc., they wouldn't likely be getting anything PO.

    BTW.. Toradol IS used on a short term basis, GREAT job!

    You done goodly.
    Personally, I would think that any NSAID would be withheld during a GI bleed, since NSAIDS can cause more bleeding. Also, since this guy was already bleeding, would MS04 be appropriate? I wouldn't think so, but I have different rationale. I would think that since he has an internal bleed, he is at a risk for shock (depending on the severity of the bleed), and MS04 is going to further decrease his respirations.

    As far as the original poster, I have to say that I agree with NursiePooh. I think she could've maybe sugar-coated her reply a bit more, but in the real world, things aren't sugar coated. Honestly, it makes me FURIOUS to think that I work so hard to research things and do my own work so that I can have an understanding, which takes time away from my kids and my family, and then other students just expect the answers to be handed out. Why shouldn't you have to work just as hard for the answers as I do? It's not fair to us who put forth the diligent effort.
  12. by   Bipley
    Quote from iwannabeanrn
    Personally, I would think that any NSAID would be withheld during a GI bleed, since NSAIDS can cause more bleeding. Also, since this guy was already bleeding, would MS04 be appropriate? I wouldn't think so, but I have different rationale. I would think that since he has an internal bleed, he is at a risk for shock (depending on the severity of the bleed), and MS04 is going to further decrease his respirations.

    As far as the original poster, I have to say that I agree with NursiePooh. I think she could've maybe sugar-coated her reply a bit more, but in the real world, things aren't sugar coated. Honestly, it makes me FURIOUS to think that I work so hard to research things and do my own work so that I can have an understanding, which takes time away from my kids and my family, and then other students just expect the answers to be handed out. Why shouldn't you have to work just as hard for the answers as I do? It's not fair to us who put forth the diligent effort.
    MS04 pulls fluid from the colon, it reduces motility, and many believe it can cause a spasm of the Sphincter of Oddi. There are simply better drugs vs. Morphine for colon or potential GI problems. My personal favorite (when I'm asked <g>) is Fentanyl for GI patients although it does still pull fluid from the colon and reduce motility. But many docs would disagree with me but you know what? I'll bet most PharmDs would agree with me. It's a difference of opinion, I suppose. Just like PO Protonix. Many believe it is a wonder drug but most don't know why it doesn't work effectively in a TPN patient. Yet they still prescribe it anyway.

    While I agree with you that students shouldn't come here to complete all their homework, sometimes we can give you guys things to think about that you just won't find in the books. I'm not going to spend every free moment answering questions but it actually helps me too. When we teach we learn a great deal. IOW, it keeps me on my toes.

    Personally, I'd LOVE to see a section of this forum called, "Stump the Student," or "Stump the Nurse." I think it would be fun to bounce this stuff back and forth. Usually we ALL learn something in those scenarios.

    I *just* signed up to take part in a program just like that for ED info. There is a doc working in an ED that is a gem, never met him in person but on line I adore him. He is doing a project he created himself. It's "Reading Group." We all read 10 pages of a specific book weekly and discuss it. It's for Emergency medicine. Everyone is welcome, paramedics, CPhTs, RNs, residents, anyone. But the requirements don't change for various levels of profession. No excuses for not getting tests correct because someone is a CPhT vs. MD. The work is the same across the board and CEs are given. We post questions on the boards and we all jump in and discuss the issues. I don't know, maybe it's nerdy stuff, could be! LOL But I like it because it challenges me.

    I just bought the book and I have catch up reading and testing to do, but from what I have read I have learned a great deal. Just little things here and there.

    This ER doc doesn't charge for any of this, it's just kind of a hobby of sorts for him. He personally grades all the (open book) tests and writes CE stuff up so we can use it for licensing.
  13. by   SKM-NURSIEPOOH
    Quote from cindyrn 2006
    bipley you are the type of teacher i admire, you realize that every question is an opportunity for you to teach and expand. thank-you.

    nursie pooh, you are right many of us me included have had a long hard road. do not think for one moment you have paved the road for me. you have not. i have worked my way through school and have paved my own road because unfortunately i have had to deal with several nurses like you who like to bring students down, don't worry i 'm probably not going to take your job, not today anyway. you can relax if that is what your problem is with students.
    as i read your hostility i realize you either need to research the following quote or remove it from your posts..."an expert at anything was once a beginner." - dr. pat benner, nursing theorist, & kenya, lpn
    well miss. cindyrn 2006, i do stand corrected! i've not pave any roads for *you* personally...but i certainly *have* paved the road for many *i've* personally precepted...thx for setting me straight there kiddo...lol :chuckle!

    now, it's your turn to stand corrected because i don't bring students down...to the contrary! i sincerely care about students & make it a point to make their experiences positive ones. whenever opportunities rises to teach, i'm right there to do so. i only ask that some effort is shown when questions are asked. not so much at the clinical site, but definitely when it comes to here on the bbs. you see....we've had problems with lots of students in the past coming here looking for answers that had to do with homework assignments. it was obvious that no work was put into the assignment & they *expected* us to just blindly answer. it's pretty easy to spot those students out as they tend to ask more & more assignment type questions when they see their other ones answered...in other words...it became quite *easy* for them...thereby...becoming habit forming. there's a difference in starting thought provoking threads based on something observed in clinical, for example, which is very valid & acceptable; it's another to expect answers just because they're asked without no effort on the students' part.

    once again....i've said this before & i'll say it a *third* time....i wish you all the best in school. i wouldn't do so if i wasn't a caring person...dispite your premature conclusion of me.

    cheers,
    moe

    eta: i quote pat benner because i do believe in this theory whole heartedly & wrote a research paper on it! i don't quite understand why it is you feel i need to "research" or "remove" it from my signature. it has nothing to do with the topic at hand.
    Last edit by SKM-NURSIEPOOH on Nov 10, '05

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