GI system Medsurg Brief A&P, Assessment, & Diagnostics

What should you be noting Auscultation of the ABD? How often are normal bowel sounds? How do confirm absence of bowel sounds?

- Auscultate each quadrant • Note pitch, freq., location, quality • *Normal bowel sounds = Q5-30 sec. • Listen x 5 min. each quad. to confirm absence*

What should you be noting with Inspection of the ABD?

- Inspection • Flat, round, concave (scaphoid), distended • Dyspnea ? r/t distended abd. crowding chest

List different Lower GI diagnostics Tests What are some nursing cares?

-Colonoscopy -Barium Enema • Conscious sedation • Bowel prep is VERY important (GoLYTELY) • Low Residue diet for a few days before, Clear liquids the night before. • If clear liquids allowed, no red/orange/purple dyes. NPO excepts fluids before procedure.

________________________________ contrast agent may be used for lower GI studies if active inflammatory disease, fistulas, or ____________ is suspected.

1. A water soluble iodinated contrast agent 2.) Perforation

What is the main function of the Large intestine? What is the Anatomical order of the large intestine?

ABSORBS water and electrolytes from food that has not been digested yet. DEFECATION rids the body of any waste. 1.) Cecum--> Ascending colon--> Transverse--> Descending colon--> Sigmoid--> Rectum-->Anus

The pancreas excretes which enzymes? A.) Amylase B.) Insulin C.) Lipase D.) Protease E.) Trypsin

Amylase--> Breaks down carbs in glucose Protease--> Breaks down Proteins Lipase--> Breaks down fats (think lipids/lipase=fat) Insulin is a hormone not an enzyme. Trypsin is an enzyme found in the small intestine!

Radiopaque liquid used in GI diagnostic tests that causes stools to be white

Barium

A client is taking iron supplements. What color do expect this clients stool to be?

Black

Protein normally not detected in the blood of a healthy person. Screens for Cancer.

CEA

Diagnostic test possibly performed on a patient who has had a cholecystectomy and still has biliary complaints, nausea, or pain.

Cholangiogram

Which of the following is the most definitive means of assessing for liver disease? A.) Cholecystography B.) Paracentesis C.) Ultrasonography D.) Biopsy

D.) Biopsy

If the pancreas was functioning correctly, where would the bile and pancreatic enzymes enter the GI system?

Duodenum

What is the small bowel/intestine consist of?

Duodenum, Jejunum, & ileum. Function: Digestion & Absorption (fats, carbs, vit..etc)

Possible complications following this procedure include fever, chest pain secondary to esophageal rupture, bleeding and shock.

EGD

List different Upper GI Diagnostic tests What care do they have in common?

EGD • ERCP • Barium Swallow • Oral cholecystogram • Cholangiogram * No bowel prep needed • NPO • Conscious sedation for scopes • Cholangiogram sometimes in OR

When prepping a patient's bowel for GI studies, this intervention is contraindicated if the patient has active inflammatory bowel disease

Enemas

Diagnostic test that utilizes continual admin. of barium. Used to dx small bowel obstructions or diverticula. Can take up to 6 hrs.

Enteroclysis An enteroclysis is a visual examination of the small bowel. Regular x-rays and fluoroscopy, are used to see internal organs and abnormalities. Contrast (liquid) is put into the small bowel by way of a tube inserted through your nose and stomach, reaching down into the small bowel.

Functions of the Liver

Functions of the Liver: -Filters the blood & clotting -Metabolism -Synthesize lipoproteins (VLDLD &HDL) -Makes Vit. D -Detoxification & Bile formation

You are assessing a liver failure patient and their eyes/skin are yellow. What do you document this as? If the patient was African-American, where would you assess?

Icterus--technical term for Jaundice African-American check hard palate & gums & under tongue

Which substance influences vitamin B12 absorption?

Intrinsic Factor

The nurse is caring for a client who is having gastrointestinal symptoms. The nurse knows that a scintigraphy is used as a diagnostic tool for what purpose? (PrepU)

Locate the source of internal bleeding. Tagged red cell studies are useful in determining the source of internal bleeding when all other studies have returned a negative result.

Nursing care for a Barium Swallow & Enteroclysis Nursing Care

NPO before, push PO fluids after - Teach client stools will be white - Monitor for bowel obstruction

Can a patient eat before a GI MRI?

NPO for 6-8hours before.

When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are.... -Hypoactive, Hyperactive, or normal?

Normal Normal bowel sounds = Q5-30 sec

Used to ID stones in the gallbladder or ducts and determine the ability of the gallbladder to concentrate and store the contrast

Oral Cholecystogram

What are you assessing for when palpating an ABD?

Palpate - Light only - one hand, ½ inch deep in All Quadrants • Soft vs. firm • For masses (*Do not manipulate any masses* ABD aortic aneurysm is a concern) • Tenderness & pain • Enlarged liver • Measure girth at umbilicus (Mark the place for consistency)

Which enzyme is secreted by gastric mucosa? -Amylase, Pepsin, Trypsin, Lipase

Pepsin

What sounds should you hear when you percuss the liver & stomach? a distended bowel?

Percuss •Dull over liver •Tympanic over stomach & distended bowel

What is the opening between the stomach and duodenum called?

Pyloric Sphincter

Lower GI study is performed after _____________________ administration of barium.

Rectal

What is spider angioma? What does it indicate?

Spider angioma-->distended abd. veins = liver disfunction

Xray's "Flat plate, decubitus, fluoroscopy....etc" Can help with what part of diagnostics for GI?

To ID location & structure of organs & masses • Air, fluid, tumors, foreign objects, strictures, bowel gas patterns, differentiate ileus from obstruction - Insert/verify position of small bore feeding tubes

Diagnostic test performed to identify strictures or dysphagia/aspiration risk.

Upper GI Series

Patient is instructed to avoid antibiotics, bismuth subsalicylate for 1 month before this test; sucralfate and omeprazole for 1 week before the test.

Urea Breath Test

Barium Swallow Upper GI Series

Uses - Swallowing abnormalities - Tumors, varices, hiatal hernia - Observe stomach & first part of small intestine - Gastric tumors, peptic ulcers

This procedure can be used to identify strictures, differentiate an ileus from an obstruction and verify position of small bore feeding tubes.

X-ray

Does a patient need to be NPO for a GI ultrasound?

Yes--for 8-12 hours before they need to be NPO to decrease the amount of gas in bowel.