The document discusses several topics related to gastrointestinal health, including hypothyroidism, constipation, hemorrhoids, and various treatments. Hypothyroidism occurs when the thyroid gland does not produce enough hormones and can cause fatigue, weight gain, dry skin and other symptoms. Constipation is discussed in elderly patients and can be treated with laxatives like PEG 3350. Hemorrhoids are swollen veins in the rectum that can cause pain, itching and bleeding, and can be treated with lifestyle changes, office procedures or surgery. Various treatments are also presented for hemorrhoids, including suppositories, analgesics, fiber and vitamins. The document concludes with instructions on administering and responding to PRN medications.

1. Agenda
At the endof the post conference,the listenerswill be able to learn the followingtopicsto be discuss.
1. Hypothyroidism
2. Constipationinelderly
3. Lax A Day (PEG)
4. Hemorrhoids
5. Anodan HC
6. PRN Medication
Hypothyroidism
 Developswhen the thyroidglandfailstoproduce orsecrete asmuch thyroxine (T4) asthe body
needs.Because T4regulatessuchessentialfunctionsasheartrate,digestion,physical growth,
and mental development,aninsufficientsupplyof thishormone canslow life sustaining
processes,damage organsandtissuesineverypartof the body,and leadto life-threatening
complications.
 The thyroidglandregulatesthe metabolicfunctionsof the bodyinvirtuallyeverycell.
Everythingfromthe brainto the skinisaffected bythe hormone made bythe thyroidgland.
 Hypothyroidism,"Itslowsyoudown,Itmakesyoulethargicandfatigued.Yourhairbecomes
brittle,andyourskinbecomesdry.Youbecome coldmucheasierthanthe average person.”
Types ofHypothyroidism
 Primaryhypothyroidismoccursdue toimproperfunctioningof the thyroidgland
 Secondaryhypothyroidismoccursdue toinadequate stimulationof thyroidglandbythyroid
stimulatinghormone(TSH)
Signs and Symptoms
 Tiredness/weakness
 Weightgainwithpoorappetite
 Dry skin
 Coldsensation
 Hair loss(diffuse alopecia)
 Nail growthisretarded
 Poorconcentration/memoryloss
 Constipation
 Dyspnea
 Hoarsenessof voice

2.  HearingImpairment
 Carpal tunnel syndrome
Treatment
 Goal: To mimicnormal,physiological levelsand alleviate signs,symptoms,andbiochemical
abnormalities.
 Treatmentshouldbe tailoredtoindividual needs.
 Treatmentof choice:
Levothyroxine (LT4) replacementtherapy
LAX A DAY
 Polyethylene glycol 3350 (PEG 3350) belongstothe class of medicationscalled laxatives.
PEG 3350 is usedforthe relief of occasional constipation.It worksby softeningthe stoolsand
keepingwaterinthe intestines.Thiscausescolonmusclestocontractand produce a bowel
movementmore quickly.
 The recommendeddose is17 g (1 sachetor heapingtablespoon)of PEG3350 once a day. The
powdershouldbe addedto250 mL (1 cup) of water,juice,pop,coffee,orteaand stirreduntil
all the contentsare dissolved.Drinkthe solutionassoonasit's made.
 It may take 2 to 4 days forthe medicationtowork.Donot use thisproductfor longerthan7
daysunlessrecommendedbyyourdoctor.Prolongedorexcessive use mayresultinelectrolyte
imbalance andlaxative dependence.
PEG 3350 shouldnot be taken by anyone who:
 isallergictoPEG 3350 or to any of the ingredientsof the medication
 has an intestinal blockage
Side Effects
Contact your doctor if you experience these side effectsandtheyare severe or bothersome.Your
pharmacist may be able to advise you on managing side effects.
 abdominal crampsor bloating
 diarrhea
 excessivestool frequency
 flatulence (gas)
 nausea
Hemorrhoids
 Hemorrhoidsare vascularcushionsinthe anal canal andare a normal part of humananatomy.
 These cushionsorplexus normallyhelptoseal the upperanal canal and contribute to
continence.

3.  Become medical problemsonlyif theybecomeenlarged,inflamed,thrombosed,orprolapsed.
Dilatedorenlargedveinsinthe lowerportionof the rectumoranus.
Types ofHemorrhoids
 Those originatingabove the dentate line whichare termed internal
 Those originatingbelowthe dentate line whichare termed external
Causes
 Most popularetiologictheorystatesthatHemorrhoidsresultfrom chronicstrainingat
defecation.
 Continuedstrainingcauses engorgementandbleeding,aswell ashemorrhoidal prolapse.
Other causesthat can aggravate the condition:
 Constipation
 Diarrhea
 Sittingorstandingforlong periodsof time
 Obesity
 HeavyLifting
 Pregnancy
Symptoms
 All Classes:
 Bleedingfrom the rectumthatappearsas brightredblood. The bleedingmayvaryfrom
lightspottingonthe toiletpapertocopiousamountsinthe toiletbowl
 Constipationordiarrhea
 Strainingwithdefecation
 External hemorrhoids
 Rarelypainful unlessthrombosed
 Rarelybleeding(exceptforcloterodingthroughskin)
 A palpable “lump”canbe feltoftenwhenthe hemorrhoidhasthrombosed
 Internal hemorrhoids
 Usuallypainless
 More severe internal hemorrhoidsmayresultinfeelingof fullnessandincomplete
evacuation afterdefecation
 Protrudinghemorrhoidspresentasa mass withmore prominentbleeding

4.  If 4th degree internal hemorrhoid,increasedriskof strangulationand/orthrombosis
withacute pain
 Individualsoftenhave fecalsoiling -->pruritusandirritation
Treatment and Prevention
 Treatmentsare classifiedinto threecategories:
1) Dietaryand lifestylemodification.
2) Nonoperative /office procedures.
3) Operative hemorrhoidectomy.
 Eat highfiberdiet
 DrinkPlentyof Liquids
 FiberSupplements
 Exercise
 Avoidlongperiodsof standingorsitting
 Don’tStrain
 Go as soon as youfeel the urge
Anodan HC
 It is usedto treat hemorrhoids.It may alsobe usedto treatdiscomfortaftersurgerytothe anal
area and otherconditions affectingthe anal area. Itworks by reducingswelling,irritation,and
itching.
 Suppositories:Washand dry the affectedanal area.Insertone suppositoryintothe anusinthe
morningandeveningandaftereachbowel movement.Continue treatmentuntilthe
acute phase of painand discomfortpassesandinflammationsubsides.
Check withyour doctor as soon as possible ifany of the followingside effectsoccur:
 burninganditchingof skin
 chills
 diarrhea
 false sense of well-being
 fever
 infection
 painful,red,oritchypus-containingblisters inhairfollicles
 rectal bleeding,burning,dryness,itching,orpainnotpresentbefore treatment
 sensationof pinsandneedles

5. Acetaminophenand VitaminB12
 Analgesicssuch as acetaminophen or ibuprofencanbe usedfor painrelief. Avoidibuprofenif
bleedingispresent.
 VitaminB complex playsa role infacilitatingdigestion.Bcomplex mayrelievehemorrhoidsby
improvingdigestion.Thiscanalleviate constipationthatcanleadto hemorrhoids.VitaminB12,
additionally,isabioflavonoidandmaydecrease inflammationandirritation.
PRN Medication
 Administeringa PRN
1. Scan a PRN that youwouldlike toadminister.The medicationwill highlightgreen.
2. Type in the reasonforadministering.
3. Clicksignoff.
 Respondingto a PRN
1. Go to the resident’sHomepage,PRN tab.
2. Clickon PRN response requiredlinkunderthe remindersection.
3. Choose yourresponse andtype incommentif necessary,clickSave.
 To requesta refill
1. Clickthe PharmacyRequesttab.Refill page willappearbydefault.
2. Selectthe appropriate OrderType option(PRN orRoutineMeds)
3. Selectthe checkbox of the refill request.
4. ClickSendOrder.