Digestive and Gastrointestinal Assessment Module PDF

DIGESTIVE AND GASTROINTESTINAL ASSESSMENT ❑ HISTORY AND CLINICAL MANIFESTATIONS ❑ PHYSICAL ASSESSMENT ❑ DIAGNOSTIC TESTS/ EVALUATION ROSELLE JOY C. BALAQUIT, RN, MAMSN, DHCM(c) Health History and Clinical Manifestations Pain ✓can be a major...

DIGESTIVE AND GASTROINTESTINAL ASSESSMENT ❑ HISTORY AND CLINICAL MANIFESTATIONS ❑ PHYSICAL ASSESSMENT ❑ DIAGNOSTIC TESTS/ EVALUATION ROSELLE JOY C. BALAQUIT, RN, MAMSN, DHCM(c) Health History and Clinical Manifestations Pain ✓can be a major symptom of GI disease ✓character, duration, pattern, frequency, location, distribution of referred pain and time of the pain vary greatly depending on the COMMON SITES OF REFERRED ABDOMINAL PAIN underlying cause NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc Dyspepsia ✓upper abdominal discomfort or distress associated with eating (commonly called indigestion) is the most common symptom of patients with GI dysfunction ✓result from disturbed nervous system control of the stomach or from a disorder in the GI tract or elsewhere in the body ✓fatty foods tend to cause the most discomfort, because they remain in the stomach longer than proteins or carbohydrates do ✓salads, coarse vegetables, and highly seasoned foods may also cause considerable GI distress NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc Intestinal Gas ✓ accumulation of gas in the GI tract may result in belching (the expulsion of gas from the stomach through the mouth) or flatulence (the expulsion of gas from the rectum) Nausea and Vomiting ✓ nausea, which can be triggered by odors, activity, or food intake ✓ the emesis, or vomitus, may vary in color and content - may contain undigested food particles or blood (hematemesis) Change in Bowel Habits and Stool Characteristics ✓ stool is normally light to dark brown ✓ the ingestion of certain foods and medications, can change the appearance of stool NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc Foods and Substances that Alter Stool Color NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc PHYSICAL ASSESSMENT ✓ includes assessment of the mouth, abdomen, and rectum ✓ the mouth, tongue, buccal mucosa, teeth, and gums are inspected, and ulcers, nodules, swelling, discoloration, and inflammation are noted ✓ people with dentures should remove them during this part of the examination to allow good visualization. ✓ the patient lies supine with knees flexed slightly for inspection, auscultation, palpation, and percussion of the abdomen NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc Division of the abdomen into four quadrants or nine regions. NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc Diagnostic Evaluation ✓ common blood tests include (CBC), carcinoembryonic antigen (CEA),liver function tests, serum cholesterol, and triglycerides ✓ test findings may reveal alterations in basal metabolic function and may indicate the severity of a disorder. ✓ the preparation for many of these studies (endoscopy or GI laboratory). includes fasting, ✓ the use of laxatives or enemas, and ingestion or injection of a contrast agent or a radiopaque dye NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc General nursing interventions for the patient who is undergoing a GI diagnostic evaluation include: Establishing the nursing diagnosis Providing needed information about the test and the activities required of the patient Providing instructions about post-procedure care and activity restrictions Providing health information and procedural education to patients and significant others Helping the patient cope with discomfort and alleviating anxiety Informing the primary provider of known medical conditions or abnormal laboratory values that may affect the procedure Assessing for adequate hydration before, during, and immediately after the procedure, and providing education about maintenance of hydration NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc STOOL TESTS ✓ includes inspecting the specimen for consistency, color, and occult (not visible) blood ✓ additional studies, including fecal urobilinogen, fecal fat, nitrogen, Clostridium difficile, fecal leukocytes, calculation of stool osmolar gap, parasites, pathogens, food residues, and other substances, require laboratory evaluation BREATH TESTS ✓ hydrogen breath test was developed to evaluate carbohydrate absorption ✓ it also is used to aid in the diagnosis of bacterial overgrowth in the intestine and short bowel syndrome ✓ this test determines the amount of hydrogen expelled in the breath after it has been produced in the colon NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  A. LABORATORY TESTS 1) CEA (Carcinoembryonic Antigen) – tests (+) colorectal Ca NC: ✓ No heparin for 2 days ✓ Specimen by venipuncture 2) D-Xylose Absorption Test- diagnose malabsorption NC: ✓ Blood/ urine specimen to be collected ✓ Initial and put pt in NPO for 10-12 hours ✓ Blood/ urine levels are measured NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  3) Exfoliative Cytology- detects malignant cells NC: ✓ Written consent ✓ Pt on liquid diet ✓ UGI: NGT insertion ✓ LGI: laxative, enema ✓ Cells are obtained from saline lavage- NGT/ proctoscope NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  4) Fecal analysis a) stool for occult blood (Guaiac stool exam)- detects GI bleeding NC: ✓ Inc. fiber diet 48-72 hrs. ✓ No red meats, poultry, fish, turnips, horseradish ✓ Withhold for 48 hrs. (iron- causes stool discoloration, steroids, indomethacin, colchicine- may cause GI irritation thereby, bleeding) ✓ 3 stool specimen (3 successive days) NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  b) Stool for ova and parasites NC: send fresh, warm stool specimen c) Stool culture NC: use sterile test tube/ cotton- tipped applicator d) Stool for lipids- assess steatorrhea NC: ✓ Inc. fat diet, no alcohol (3days) ✓ 72 hrs stool specimen (store in ice) ✓ No mineral oil, neomycin SO4 NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  5) Gastric Analysis -measures secretion of HCl and pepsin NC: ✓ NPO for 12hrs ✓ NGT insertion connected to suction ✓ Gastric contents collected every 15 mins to 1 hour RESULTS: Inc HCl= Zollinger-Ellison Syndrome, Duodenal Ulcer Dec HCl= Gastric Ca, Pernicious anemia NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  6) Bernstein Test (Acid Perfusion Test)- to assess if chest pain is related to gastroesophageal reflux NC: ✓ NPO 6-8hrs ✓ NGT insertion ✓ Alternate instillation of NSS and 0.1% HCl ✓ No pain (-) result, with pain (+) result ✓ Antacid after the procedure NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  B. RADIOGRAPHIC TEST 1) Scout film/ flat plate of the abdomen- plain x-ray of the abdomen NC: no belts/ jewelries 2) UGIS (Upper GI series/BARIUM SWALLOW)- to visualize the esophagus, stomach, duodenum and jejunum NC: ✓ NPO 6-8hrs ✓ Barium Sulfate (BaSO4) per orem ✓ X-rays are taken on standing and lying position NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  Post-procedure: ✓ Laxative ✓ Increase fluid intake ✓ Inform client that the stool will be white for 24-72 hrs ✓ Observe for Ba impaction: distended abdomen, constipation NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  3) LGIS (Lower GI series/ BARIUM ENEMA)- visualize the colon NC: ✓ Low residue/ clear fluid diet for 2 days ✓ Laxative (cleans the bowel) ✓ Suppository/ cleansing enema in AM ✓ BaSO4 per rectum ✓ Post procedure: same as UGIS NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  4) Computed Tomography- uses beam of radiation to assess cross sections of the body NC: ✓ Clear liquid diet in AM ✓ If done with contrast medium, NPO 2-4hrs assess history of allergy to seafoods and iodine ✓ Inform the client that procedure is painless ✓ Advise client to remain still during the entire procedure NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  C. VISUALIZATIONS/ IMAGING 1) Ultrasonography NC: NPO 8-12 hrs laxative, as ordered (dec bowel gas) 2) MRI- produces cross- sectional images of organs by using magnetic fields NC: ✓ NPO 6-8 hrs ✓ Instruct pt to remain still ✓ Inform it lasts 60-90mins ✓ Remove jewelries/ metals ✓ CI: pacemakers, aneurysm clips, orthopedic screws NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  3) Endoscopy a) UGI Endoscopy- direct visualization of the esophagus, stomach and duodenum NC: ✓ Obtain written consent ✓ NPO for 6-8 hrs ✓ Anticholinergic (AtSO4), as ordered- reduces mucus secretions ✓ Sedative, narcotics, tranquilizers- relaxes the client ✓ Remove dentures, bridges- to prevent airway obstruction NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  ✓ Local spray anesthetic on the posterior pharynx (instruct client not to swallow saliva)- depresses the gag reflex ✓ Post-procedure: side-lying position- prevent aspiration NPO until gag reflex returns (2-4hrs) NSS gargle, throat lozenges – soothe the throat Monitor V/S Assess: bleeding, crepitus (nuchal), fever, neck/ throat pain, dyspnea, dysphagia, back/ shoulder pain Advise to avoid driving for 12 hrs, if sedative was used NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  b) LGI endoscopy Proctosigmoidoscopy (sigmoid, colon) NC: ✓ Clear liquid diet 24 hrs before ✓ Administer cathartic/ laxative, as ordered ✓ Cleansing enema ✓ Knee-chest/ lateral position ✓ Post-procedure: ▪ Supine position for few minutes- prevent postural hypotension ▪ Assess for signs of perforation (bleeding, pain, fever) ▪ Hot sitz bath for discomfort in the anorectal area NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  Colonoscopy NC: ✓ Sedation is done ✓ Left lateral or knee flexed position ✓ Post procedure: ▪ Monitor V/S (note for vasovagal response – bradycardia, hypotension) ▪ Assess for signs and symptoms of perforation NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc  Ultrasonography: NC: NPO- 8-12 hours laxative, as ordered (to decrease bowel gas) MRI (Magnetic Resonance Imaging)- produces cross-sectional images of organs using magnetic fields NC: NPO- 6-8 hrs ▪ remain still during the proc ▪ procedure (60-90 mins) ▪ remove jewelries/ metals ▪ C/I: pacemakers, aneurysm clips, orthopedic screws NCM109 BY: ROSELLE JOY C. BALAQUIT, RN, MANc