Pharmacology · chapter 30 · Gastrointestinal Disorder Drugs
Laxatives and Stool Softeners
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.
Key points
Causes of constipation
It often results from low fiber intake, dehydration, and a sedentary lifestyle. Certain medications can also promote constipation, such as anticholinergics and opioids.
Laxatives are for brief use
Treatment involves increasing fiber intake, staying hydrated, and being physically active. Laxatives and stool softeners can help if constipation persists, but they should be used briefly to avoid dependency.
Bulk-forming laxatives need water
However, it is imperative that these products are taken with an adequate amount of water. If these products are not taken with enough water, it may result in worsening constipation as well as esophageal and/or stomach obstruction.
When not to use bulk-forming laxatives
Bulk-forming laxatives should not be used in clients with symptoms of acute appendicitis, esophageal stricture or perforation, GI obstruction, or ileus.
Lubricants and fat-soluble vitamins
These laxatives are often preferred by pregnant clients and older adults. If used frequently, they may interfere with the absorption of fat-soluble vitamins (A, D, E, and K).
Mineral oil and lipid pneumonia
Mineral oil is not recommended for children under age 6 or individuals with swallowing issues or incapacitation due to the risk of lipid pneumonia if aspirated.
Stimulant laxative abuse
However, such abuse can result in electrolyte imbalances, dehydration, and potential harm to the gastrointestinal system's neuromuscular functions.
Positioning for a bisacodyl suppository
Assist the client to a comfortable left side–lying position with their right knee raised to their chest.
Castor oil in pregnancy
Castor oil is contraindicated in pregnancy due to risk of inducing uterine contractions.
Saline laxatives are short term
Because the hypertonic solution offers a rapid emptying of the bowels, saline laxatives are not recommended for long-term or repeated use (Mayo Foundation for Medical Education and Research, 2023a).
Linaclotide and severe diarrhea
Linaclotide is contraindicated if there is a suspicion of GI obstruction. If severe diarrhea occurs, linaclotide should be stopped and the provider contacted.
Who gets docusate
Docusate is used prophylactically for clients at risk for constipation or fecal impaction who should avoid straining, such as postoperatively or after a myocardial infarction.
Typical adverse effects
Typical adverse effects of laxatives and stool softeners include abdominal cramping, diarrhea, electrolyte imbalances (particularly sodium and potassium), dehydration, rectal irritation, and gas and bloating.
Linaclotide black box warning
Linaclotide is contraindicated in clients less than 2 years of age as it as been shown to cause death secondary to severe dehydration.
Terms to know
- Constipation
- Constipation is an unpleasant symptom or disorder that results in difficult stool evacuation or irregular and inconsistent stool passage, with common complaints like straining, incomplete or difficulty passing stools, or not defecating for a prolonged time.
- Saline laxatives
- Saline laxatives are hyperosmotic oral solutions that retain water in the intestine to increase the bulk of the stool.
- Stool softeners
- Stool softeners are a type of laxative medication that helps to alleviate constipation by softening the stool, making it easier to pass.
- laxative dependency
- Laxatives should be used cautiously, as over time the body can become reliant on the drug to have bowel movements, leading to a condition known as laxative dependency.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
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A client is starting psyllium powder for chronic constipation. Which instruction is most important?
- Take it dry to avoid bloating.
- Take it only with a small sip of water.
- Mix it with enough water or juice and drink adequate fluids.
- Take it at the same time as mineral oil.
Answer: Mix it with enough water or juice and drink adequate fluids.
Bulk-forming laxatives must be taken with adequate water; without it they can worsen constipation and cause esophageal or stomach obstruction or choking. Taking it dry or with little water creates exactly that risk.
A client recovering from a myocardial infarction should avoid straining. Which drug does the nurse anticipate for prevention of constipation?
- Magnesium citrate
- Castor oil
- Mineral oil enema
- Docusate sodium
Answer: Docusate sodium
Docusate is used prophylactically for clients at risk for constipation who should avoid straining, such as after a myocardial infarction. Castor oil and magnesium citrate cause rapid, forceful emptying rather than prevention.
A pregnant client asks whether she can use castor oil for constipation. What is the nurse's best response?
- Yes, it is the preferred laxative in pregnancy.
- No, castor oil is contraindicated in pregnancy because it can induce uterine contractions.
- Yes, if mixed with fruit juice.
- Yes, but only as an enema.
Answer: No, castor oil is contraindicated in pregnancy because it can induce uterine contractions.
Castor oil is contraindicated in pregnancy because it may induce uterine contractions. Mixing it in juice only masks the taste and does not change the risk.
The nurse is caring for a client receiving laxatives. Which findings suggest fecal impaction or bowel obstruction? Select all that apply.
- Inability to pass flatus
- Sudden watery diarrhea with stool leakage
- Soft, formed daily bowel movement
- Vomiting
- Severe abdominal bloating and cramping
Answer: Inability to pass flatus, Sudden watery diarrhea with stool leakage, Vomiting, Severe abdominal bloating and cramping
Signs of impaction and obstruction include stool leakage or sudden watery diarrhea around the impaction, severe bloating and cramping, vomiting, and inability to pass flatulence. A soft, formed daily stool is the expected result.
A client has been taking stimulant laxatives daily to control weight. Which problems is the client at risk for? Select all that apply.
- Electrolyte imbalances
- Laxative dependency
- Dehydration
- Improved absorption of fat-soluble vitamins
- Permanent weight loss without harm
Answer: Electrolyte imbalances, Laxative dependency, Dehydration
Stimulant laxative abuse causes electrolyte imbalances, dehydration and harm to GI neuromuscular function, and long-term use leads to dependence. Neither improved vitamin absorption nor harmless weight loss is supported.
An older adult client with difficulty swallowing has an order for oral mineral oil. What is the nurse's concern?
- Risk of hyperglycemia
- Risk of uterine contractions
- Risk of vitamin C overdose
- Risk of lipid pneumonia if aspirated
Answer: Risk of lipid pneumonia if aspirated
Mineral oil is not recommended for people with swallowing issues because of the risk of lipid pneumonia if aspirated. The other risks are not linked to mineral oil in the section.
Where every quote comes from
Section 30.3 Laxatives and Stool Softeners of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.