NCM116 Nutrition and Metabolism Part 2 PDF

NCM116 - CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND COORDINATION, ACUTE AND CHRONIC (PART 2) DIAGNOSTIC PROCEDURES  It can be useful in initial screening for several...

NCM116 - CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND COORDINATION, ACUTE AND CHRONIC (PART 2) DIAGNOSTIC PROCEDURES  It can be useful in initial screening for several disorders, although it is used most frequently General nursing interventions for the patient who in early cancer detection programs. is undergoing a GI diagnostic evaluation include:  It should not be performed when there is  Establishing the need for more hemorrhoidal bleeding. information  FALSE POSITIVE RESULTS: Patients are  Providing education to patients and advised to avoid ingesting red meats, aspirin, families on the diagnostic test, and pre- and nonsteroidal anti-inflammatory drugs for and post-procedure restrictions and care 72 hours prior to the study  Helping the patient cope with discomfort  FALSE NEGATIVE RESULTS: Patients are and alleviating anxiety advised to avoid ingesting vitamin C from  Informing the primary provider of known supplements or foods medical conditions or abnormal laboratory values that may affect the BREATH TESTS procedure  Assessing for adequate hydration before, during, and immediately after the procedure, and providing education about maintenance of hydration SERUM LABORATORY TESTS  CBC, complete metabolic panel, prothrombin time/partial thromboplastin time, triglycerides, liver function tests, amylase, and lipase.  More specific studies  The hydrogen breath test was  Carcinoembryonic antigen developed to evaluate carbohydrate (CEA) absorption, in addition to aiding in the  Cancer antigen (CA) 19-9 diagnosis of bacterial overgrowth in the  Alpha-fetoprotein intestine and short-bowel syndrome.  sensitive and specific for  This test determines the amount of colorectal and hydrogen expelled in the breath after it hepatocellular has been produced in the colon (on carcinomas contact of galactose with fermenting bacteria) and absorbed into the blood. STOOL TESTS  Detect the presence of Helicobacter pylori, the bacteria that can live in the  Basic examination of the stool includes mucosal lining of the stomach and cause inspecting the specimen for consistency, peptic ulcer disease. color, and occult (not visible) blood.  After the patient ingests a capsule of  Additional studies, including fecal carbon-labeled urea, a breath sample is urobilinogen, fecal fat, nitrogen, obtained 10 to 20 minutes later. Clostridium difficile, fecal leukocytes,  Because H. pylori metabolize calculation of stool osmolar gap, urea rapidly, the labeled carbon parasites, pathogens, food residues, and is absorbed quickly; it can then other substances, require laboratory be measured as carbon dioxide evaluation. in the expired breath to GUAIAC-BASED FECAL OCCULT BLOOD determine whether H. pylori is TESTING (gFOBT) present. NCM116 - CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND COORDINATION, ACUTE AND CHRONIC (PART 2)  Prior to urea breath testing, the patient is  The patient is instructed to fast for 8 to instructed to avoid antibiotics or bismuth 12 hours before ultrasound testing to subsalicylate for 1 month before the test; decrease the amount of gas in the bowel. proton pump inhibitors for 2 weeks before  If gallbladder studies are being the test; and cimetidine and famotidine performed, the patient should eat a fat- for 24 hours before the test. free meal the evening before the test.  H. pylori also can be detected by  If barium studies are to be performed, assessing serum antibody levels without they should be scheduled after requiring medication therapy ultrasonography; otherwise, the barium adjustments could interfere with the transmission of the sound waves. ABDOMINAL ULTRASONOGRAPHY  Patients who receive moderate sedation are observed for about 1 hour to assess for level of consciousness, orientation, and ability to ambulate.  Patients treated on an outpatient basis are given instructions regarding diet, activity, and how to monitor for complications UPPER GASTROINTESTINAL TRACT STUDY  Ultrasonography is a noninvasive diagnostic technique in which high frequency sound waves are passed into internal body structures, and the ultrasonic echoes are recorded on an  An upper GI series with small bowel oscilloscope as they strike tissues of follow-through provides visualization of different densities. the oropharyngeal area, esophagus,  It is particularly useful in the detection of stomach, and small intestine. an enlarged gallbladder or pancreas, the  The procedure consists of the patient presence of gallstones, an enlarged swallowing contrast medium (a thick ovary, an ectopic pregnancy, or barium solution or Gastrografin) and then appendicitis. assuming different positions on the x-ray  Can be limited by patient body type, table. bowel gas patterns, and operator  The movement of the contrast medium is experience. observed with fluoroscopy, and a series  Advantages: absence of ionizing of x-rays are taken. radiation, no noticeable side effects,  An upper GI series is useful in identifying relatively low cost, and almost immediate esophageal strictures, polyps, tumors, results. hiatal hernias, foreign bodies, and ulcers. NURSING INTERVENTIONS NURSING INTERVENTIONS  Instruction regarding dietary changes prior to the study may include a low NCM116 - CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND COORDINATION, ACUTE AND CHRONIC (PART 2) residue or clear liquid diet, and nothing entire colon, each portion of the colon by mouth after midnight the night before may be readily observed. The procedure the study. usually takes about 15 to 30 minutes,  The patient is advised to not smoke or during which time x-ray images are chew gum during the NPO period obtained. because these can increase gastric  Double-contrast or air-contrast secretions and salivation barium enema involves the instillation of  Polyethylene glycol (PEG)-based a thicker barium solution, followed by the solutions are considered the most instillation of air. The patient may feel effective bowel cleansing preparatory some cramping or discomfort during this agent; other agents include sodium process. This test provides a contrast phosphate, magnesium citrate, and between the air-filled lumen and the preparations containing sodium barium-coated mucosa, allowing easier picosulfate, citric acid, and magnesium detection of smaller lesions. oxide  CT colonography has replaced double-  Oral medications are withheld on the contrast barium enema for nearly all morning of the study and resumed that indicated GI disorders evening, but each patient’s medication  If active inflammatory disease, fistulas, or regimen should be evaluated on an perforation of the colon is suspected, a individual basis. water-soluble iodinated contrast  When a patient with insulin-dependent agent (e.g., diatrizoic acid [Gastrografin]) diabetes is NPO, their insulin can be used. The procedure is the same requirements will need to be adjusted as for a barium enema, but the patient accordingly must first be assessed for allergy to  Follow-up care is provided after the iodine or contrast agent. upper GI procedure to ensure that the  The contrast agent is eliminated readily patient has eliminated most of the after the procedure, so there is no need ingested barium. for post procedure laxatives. Diarrhea  Fluids may be increased to facilitate may occur in some patients until the evacuation of stool and barium. contrast agent has been eliminated. NURSING INTERVENTIONS LOWER GASTROINTESTINAL TRACT STUDY  Preparation of the patient includes emptying and cleansing the lower bowel.  A low residue diet 1 to 2 days before the test, a clear liquid diet and a laxative the evening before, NPO after midnight, and cleansing enemas until returns are clear the following morning.  The nurse makes sure that barium enemas are scheduled before any upper GI studies.  Visualization of the lower GI tract is  If the patient has active inflammatory obtained after rectal installation of disease of the colon, enemas are barium. contraindicated.  The barium enema can be used to  Barium enemas also are detect the presence of polyps, tumors, or contraindicated in patients with signs other lesions of the large intestine and of perforation or obstruction; instead, demonstrate any anatomic abnormalities a water-soluble contrast study may be or malfunctioning of the bowel. After performed. proper preparation and evacuation of the NCM116 - CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND COORDINATION, ACUTE AND CHRONIC (PART 2)  Active GI bleeding may prohibit the use of laxatives and enemas. NURSING INTERVENTIONS  Postprocedural patient education includes information about increasing  The patient should be NPO for 8 hours fluid intake, evaluating bowel movements prior to the examination. for evacuation of barium, and noting  Before the introduction of the endoscope, increased number of bowel movements, the patient is given a local anesthetic because barium, due to its high gargle or spray. osmolarity, may draw fluid into the bowel,  Midazolam, a sedative that thus increasing the intraluminal contents provides moderate sedation with and resulting in greater output loss of the gag reflex and relieves anxiety during the COMPUTED TOMOGRAPHY procedure, is given.  Atropine may be given to reduce secretions, and glucagon may be given to relax smooth muscle.  The patient is positioned in the left lateral position to facilitate clearance of pulmonary secretions and provide smooth entry of the scope.  After gastroscopy, assessment includes level of consciousness, vital signs, oxygen saturation, pain level, and monitoring for signs of perforation (i.e.,  A CT scan provides cross-sectional images of abdominal organs and pain, bleeding, unusual difficulty structures. swallowing, rapidly elevated temperature).  CT is a valuable tool for detecting and localizing many inflammatory conditions  Temporary loss of the gag reflex is in the colon, such as appendicitis, expected; after the patient’s gag reflex diverticulitis, regional enteritis, and has returned, lozenges, saline gargle, ulcerative colitis, as well as evaluating and oral analgesic agents may be offered the abdomen for diseases of the liver, to relieve minor throat discomfort. spleen, kidney, pancreas, and pelvic  Patients who were sedated for the organs, and structural abnormalities of procedure must remain in bed until fully the abdominal wall. alert.  The CT procedure is completely MAGNETIC RESONANCE IMAGING painless, but radiation doses are considerable.  A CT scan may be performed with or without oral or intravenous (IV) contrast, but the enhancement of the study is greater with the use of a contrast agent.  In patients at risk for complications from use of contrast, the radiologist and provider must be in agreement that the scan is medically necessary and that the benefits outweigh the risks (Yale School of Medicine, 2019). NCM116 - CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND COORDINATION, ACUTE AND CHRONIC (PART 2)  MRI is used in gastroenterology to CONTRAINDICATIONS FOR MRI supplement ultrasonography and CT.  This noninvasive technique uses Patients with permanent pacemakers, magnetic fields and radio waves to artificial heart valves and defibrillators, produce images of the area being implanted insulin pumps, or implanted studied. The use of oral contrast agents transcutaneous electrical nerve to enhance the image stimulation devices  has increased the application of this Patients with internal metal devices (e.g., technique for the diagnosis of GI aneurysm clips) or intraocular metallic diseases. fragments  It is useful in evaluating abdominal soft tissues as well as blood vessels, POSITRON EMISSION TOMOGRAPHY abscesses, fistulas, neoplasms, and other sources of bleeding.  MRI is not totally safe for all people; having the patient complete a pre- procedure MRI tool that screens for contraindications to MRI is required.  Any ferromagnetic objects (metals that contain iron) can be attracted to the magnet and cause injury.  Items that can be problematic or dangerous include jewelry,  PET scans produce images of the body dental implants, paper clips, by detecting the radiation emitted from pens, keys, IV poles, clips on radioactive substances. patient gowns, and oxygen  The radioactive substances are injected tanks. into the body IV and are usually tagged with radioactive isotopes of oxygen, NURSING INTERVENTIONS nitrogen, carbon, or fluorine.  These isotopes decay quickly, do not  Pre-procedure patient education harm the body, have lower radiation includes NPO status 6 to 8 hours before levels than a typical x-ray or CT scan, the study and removal of all jewelry and and are eliminated in the urine or feces. other metals.  The scanner essentially “captures”  The patient and family are informed that where the radioactive substances are in the study may take 60 to 90 minutes; the body, transmits information to a during this time, the technician will scanner, and produces a scan with “hot instruct the patient to take deep breaths spots” for evaluation by the radiologist or at specific intervals. oncologist  The close-fitting scanners used in many MRI facilities may induce feelings of NURSING INTERVENTIONS claustrophobia, and the machine will make a knocking sound during the  Common risks from IV contrast agents procedure. Patients may choose to wear include allergic reactions and contrast a headset and listen to music or wear a induced nephropathy (CIN) blindfold during the procedure.  Any allergies to contrast agents, iodine,  Open MRIs that are less close fitting or shellfish, the patient’s current serum eliminate the claustrophobia that many creatinine level, and pregnancy status in patients experience; however, they females must be determined before produce lower-resolution images. administration of a contrast agent. NCM116 - CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND COORDINATION, ACUTE AND CHRONIC (PART 2)  Patients allergic to the contrast agent may be premedicated with a GASTROINTESTINAL MOTILITY STUDIES corticosteroid and antihistamine.  Radionuclide testing also is used to  The most effective ways to prevent CIN assess gastric emptying and colonic include careful selection of patients, transit time. maintaining hydration status, using  During gastric emptying studies, newer contrast agents, and avoiding the liquid and solid components nephrotoxic agents pre- and post- of a meal (typically scrambled procedure. eggs) are tagged with radionuclide markers. SCINTIGRAPHY  After ingestion of the meal, the patient is positioned under a scintiscanner, which measures the rate of passage of the radioactive substance from the stomach  This is useful in diagnosing disorders of gastric motility, diabetic gastroparesis, and dumping syndrome.  Colonic transit studies are used to evaluate colonic motility and obstructive defecation syndromes.  The patient is given a capsule  Scintigraphy (radionuclide testing) containing 20 radionuclide relies on the use of radioactive isotopes markers and instructed to follow (i.e., technetium, iodine, indium) to reveal a regular diet and usual daily displaced anatomic structures, changes activities. Abdominal x-rays are in organ size, and the presence of taken every 24 hours until all neoplasms or other focal lesions such as markers are passed. This cysts or abscesses. process usually takes 4 to 5  Also used to measure the uptake of days; in the presence of severe tagged red blood cells and leukocytes. constipation, it may take as long  Tagging of red blood cells and leukocytes as 10 days. by injection of a radionuclide is  Patients with chronic diarrhea performed to define areas of may be evaluated at 8-hour inflammation, abscess, blood loss, or intervals. neoplasm.  The amount of time that it takes for the  A sample of blood is removed, mixed with radioactive material to move through a radioactive substance, and reinjected the colon indicates colonic motility. into the patient. UPPER GASTROINTESTINAL  Abnormal concentrations of blood FIBROSCOPY/ESOPHAGOGASTRODUODEN cells are then detected at 24- and 48- O-SCOPY hour intervals.  Tagged red cell studies are useful in determining the source of internal bleeding when all other studies have returned a negative result. NCM116 - CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND COORDINATION, ACUTE AND CHRONIC (PART 2) determination of the extent of inflammatory or other bowel disease.  Direct visual inspection of the large intestine (anus, rectum, sigmoid, transcending and ascending colon) is possible by means of a flexible fiberoptic colonoscope NURSING INTERVENTIONS  Cleansing of the colon can be accomplished in various ways.  Fibroscopy of the upper GI tract allows  The primary provider may prescribe a direct visualization of the esophageal, laxative for two nights before the gastric, and duodenal mucosa through a examination and a Fleet or saline enema lighted endoscope (gastroscope). until the return is clear the morning of the  EGD is valuable when esophageal, test. gastric, or duodenal disorders or  PEG electrolyte lavage solutions are inflammatory, neoplastic, or infectious used for effective cleansing of the bowel. processes are suspected.  Current preparations  This procedure also can be used to  Non-split dose regimen, in evaluate esophageal and gastric motility which the entire solution is and to collect secretions and tissue ingested the night before the specimens for further analysis. procedure,  Split-dose regimen, in which FIBEROPTIC COLONOSCOPY half of the dose is ingested the night before and half is ingested the morning of the procedure, 3 hours prior to the scheduled test.  Pre-procedure diet instructions include a clear liquid or a low residue diet starting the day before the procedure; diet type has not been shown to affect bowel preparation in patients ingesting the split preparations.  If necessary, the nurse can give the solution through a feeding tube if the  This procedure is used commonly as a patient cannot swallow. Patients with a diagnostic aid and screening device. colostomy can receive this same bowel  It is most frequently used for cancer preparation. The use of lavage solutions screening and for surveillance in patients is contraindicated in patients with with previous colon cancer or polyps. intestinal obstruction or inflammatory  Tissue biopsies can be obtained as bowel disease. needed, and polyps can be removed and  Sodium phosphate tablet can be used evaluated. for colon cleansing prior to colonoscopy.  Other uses of colonoscopy include the  Dosing consists of 32 tablets: evaluation of patients with diarrhea of  20 tablets (4 tablets unknown cause, occult bleeding, or every 15 minutes) with 8 anemia; further study of abnormalities oz of any clear liquid detected on barium enema; and (water, any clear diagnosis, clarification, and carbonated beverage, or NCM116 - CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND COORDINATION, ACUTE AND CHRONIC (PART 2) juice) on the evening  Colonoscopy cannot be performed if prior to the examination there is a suspected or documented  12 tablets (taken in the colon perforation, acute severe same manner) on the diverticulitis, or acute colitis. morning of the  Patients with prosthetic heart valves or a examination history of endocarditis require  Instructing the patient not to take routine prophylactic antibiotics before the medications when the lavage solution is procedure. ingested; the medications will not be digested and therefore will be ineffective ANOSCOPY, PROCTOSCOPY, AND  Intravenously an opioid analgesic or a SIGMOIDOSCOPY sedative (e.g., Midazolam) to provide moderate sedation and relieve anxiety  Endoscopic examination of the anus, during the procedure. rectum, and sigmoid and descending  Glucagon may be used, if needed, to colon is used to evaluate chronic relax the colonic musculature and to diarrhea, fecal incontinence, ischemic reduce spasm during the test. colitis, and lower GI hemorrhage and to  Elderly or debilitated patients may observe for ulceration, fissures, require a reduced dosage of these abscesses, tumors, polyps, or other medications to decrease the risks of pathologic processes. oversedation and cardiopulmonary  The flexible fiberoptic sigmoidoscope complications. permits the colon to be examined up to  Immediately after the test, the patient is 40 to 50 cm (16 to 20 inches) from the monitored for signs and symptoms of anus, much more than the 25 cm (10 bowel perforation (e.g., rectal bleeding, inches) that can be visualized with the abdominal pain or distention, fever, focal rigid sigmoidoscope. peritoneal signs).  It has many of the same capabilities as  Advising the diabetic patient to consult the scopes used for the upper GI study, with his or her physician about including the use of still or video images medication adjustment to prevent to document findings hyperglycemia or hypoglycemia resulting  For flexible scope procedures, the patient from dietary modifications required in assumes a comfortable position on the preparation for the test left side with the right leg bent and  Instructing all patients, especially the placed anteriorly. elderly, to maintain adequate fluid,  Biopsies and polypectomies can be electrolyte, and caloric intake while performed during this procedure. undergoing bowel cleansing  An electrocoagulating current is then used to sever the polyp and prevent SPECIAL PRECAUTIONS bleeding.  Implantable defibrillators and  All excised tissue be placed immediately pacemakers are at high risk for in moist gauze or in an appropriate malfunction if electrosurgical procedures receptacle, labeled correctly, and (i.e., polypectomy) are performed in delivered without delay to the pathology conjunction with colonoscopy. laboratory for examination  A cardiologist should be consulted before the test is performed for device management.  These patients require careful cardiac monitoring during the procedure NCM116 - CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND COORDINATION, ACUTE AND CHRONIC (PART 2)  The endoscope is advanced alternately inflating and deflating the balloons; this causes telescoping of the small intestine onto the overtube.  As a result of this telescoping, the endoscope can visualize much more of the small intestine than the length of the scope itself. The procedure takes between 1 and 3 hours and requires moderate sedation ENDOSCOPY THROUGH AN OSTOMY  Endoscopy through an ostomy stoma is useful for visualizing a segment of the small or large intestine  Indicated to evaluate the anastomosis for recurrent disease, or to visualize and SMALL BOWEL STUDIES treat bleeding in a segment of the bowel.  Capsule endoscopy allows the MANOMETRY AND ELECTROPHYSIOLOGIC noninvasive visualization of the mucosa STUDIES throughout the entire small intestine.  Useful in the evaluation of obscure GI  Manometry test measures changes in bleeding. intraluminal pressures and the  The technique consists of the patient coordination of muscle activity in the GI swallowing a capsule embedded with a tract with the pressures transmitted to a wireless miniature camera, a light computer analyzer. source, and an image transmission  Esophageal manometry is used to system. detect motility disorders of the  The capsule is the size of a large esophagus and the upper and lower vitamin pill. esophageal sphincter. Also known as  It is propelled through the esophageal motility studies, these intestine by peristalsis. studies are very helpful in the diagnosis  Images are transmitted from the of achalasia (i.e., absence of peristalsis), end of the capsule to a recording diffuse esophageal spasm, scleroderma, device worn by the patient. and other esophageal motor disorders.  The capsule allows for  The patient must refrain from eating or inspection of the small intestine drinking for 8 to 12 hours before the test. without patient discomfort  Medications that could have a direct  Double balloon enteroscopy has made effect on motility (e.g., calcium channel it possible to visualize the mucosa of the blockers, anticholinergic agents, entire small bowel as well as carry out sedatives) are withheld for 24 to 48 diagnostic and therapeutic interventions hours.  This endoscope is comprised of two  A pressure-sensitive catheter is inserted balloons, one attached to the distal end through the nose and is connected to a of the scope and the other attached to the transducer and a video recorder. The transparent overtube that slides over the patient then swallows small amounts of endoscope. water while the resultant pressure changes are recorded. NCM116 - CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND COORDINATION, ACUTE AND CHRONIC (PART 2)  Evaluation of a patient for GERD typically  Electrodes are placed over the abdomen, includes esophageal manometry. and gastric electrical activity is recorded for up to 24 hours. GASTRODUODENAL, SMALL INTESTINE,  Patients may exhibit rapid, slow, or AND COLONIC MANOMETRY PROCEDURES irregular waveform activity.  are used to evaluate delayed gastric DEFECOGRAPHY emptying and gastric and intestinal motility disorders such as irritable bowel  measures anorectal function and is syndrome or atonic colon. performed with very thick barium paste  An ambulatory outpatient procedure instilled into the rectum. lasting 24 to 72 hours.  Anorectal manometry measures the FLUOROSCOPY resting tone of the internal anal sphincter and the contractibility of the external anal  is used to assess the function of the sphincter. rectum and anal sphincter while the  It is helpful in evaluating patients with patient attempts to expel the barium. chronic constipation or fecal  The test requires no preparation. incontinence and is useful in biofeedback for the treatment of fecal incontinence. GASTRIC ANALYSIS, GASTRIC ACID  It can be performed in conjunction with STIMULATION TEST, AND PH MONITORING rectal sensory functioning tests.  Dibasic sodium (Phospho-soda) or a  Analysis of the gastric juice yields saline cleansing enema is given 1 information about the secretory activity of hour before the test, and positioning for the gastric mucosa and the presence or the test is either the prone or the lateral degree of gastric retention in patients position. thought to have pyloric or duodenal obstruction. RECTAL SENSORY FUNCTION STUDIES  It is also useful for diagnosing Zollinger- Ellison syndrome or atrophic gastritis.  are used to evaluate rectal sensory  The patient is NPO for 8 to 12 hours function and neuropathy. before the procedure. Any medications  A catheter and balloon are passed into that affect gastric secretions are withheld the rectum, with increasing balloon for 24 to 48 hours before the test. inflation until the patient feels distention.  Smoking is not allowed on the morning of Then the tone and pressure of the rectum the test because it increases gastric and anal sphincter are measured. The secretions. results are especially helpful in the  A small nasogastric tube with a catheter evaluation of patients with chronic tip marked at various points is inserted constipation, diarrhea, or incontinence. through the nose.  When the tube is at a point slightly less ELECTROGASTROGRAPHY than 50 cm (21 inches), it should be within the stomach, lying along the  an electrophysiologic study, also may be greater curvature. performed to assess gastric motility  Once in place, the tube is secured to the disturbances and can be useful in patient’s cheek and the patient is placed detecting motor or nerve dysfunction in in a semi reclining position. the stomach.  The entire stomach contents are aspirated by gentle suction into a syringe, NCM116 - CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND COORDINATION, ACUTE AND CHRONIC (PART 2) and gastric samples are collected every  The sensor is then connected to an 15 minutes for the next hour external recording device and is worn for 24 hours while the patient continues Important diagnostic information to be gained usual daily activities. from gastric analysis includes the ability of the  The result is a computer analysis and mucosa to secrete HCl. This ability is altered in graphic display of the results various disease states, including:  Pernicious anemia: Patients with this  Bravo pH monitoring system offers the disease secrete no acid under basal advantage of pH monitoring of the conditions or after stimulation. esophagus without the trans nasal  Severe chronic atrophic gastritis or catheter. gastric cancer: Patients with these  The clinician, by means of endoscopy, diseases secrete little or no acid. attaches a capsule (approximately the  Gastric ulcer: Patients with this disease size of a gel cap) to the patient’s secrete some acid. esophageal wall.  Duodenal ulcers: Patients with this  Data related to pH are transmitted from disease usually secrete an excess the capsule to a pager-sized receiver that amount of acid the patient wears.  Data are collected for up to 96 hours and  Gastric acid stimulation test usually is then downloaded and analyzed. performed in conjunction with gastric  The capsule spontaneously detaches analysis. from the esophagus in 7 to 10 days and  Histamine or pentagastrin is given then is passed through the patient’s subcutaneously to stimulate gastric digestive system. secretions.  The accuracy of this method of pH testing  It is important to inform the patient that is greater than methods in which a this injection may produce a flushed catheter is used because the patient can feeling. eat normally and continue typical  The nurse monitors the patient’s blood activities during the testing. pressure and pulse frequently to detect  The patient is evaluated for both acid hypotension. reflux and nonacid reflux events  Gastric specimens are collected after the injection every 15 minutes for 1 hour and are labeled to indicate the time of specimen collection after histamine injection.  The volume and pH of the specimen are measured; in certain instances, cytologic study by the  Papanicolaou technique may be used to determine the presence or absence of malignant cells.  Esophageal reflux of gastric acid may be diagnosed and evaluated by ambulatory pH monitoring  The patient is NPO for 6 hours before the test.  A sensor that measures pH is inserted and positioned via endoscopy. NCM116 - CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND COORDINATION, ACUTE AND CHRONIC (PART 2)  Laparoscopy usually requires general anesthesia and sometimes requires that the stomach and bowel be decompressed.  Gas (usually carbon dioxide) is insufflated into the peritoneal cavity to create a working space for visualization.  One of the benefits of this procedure is that after visualization of a problem, excision (e.g., removal of the gallbladder) can then be performed at the same time, if appropriate. LAPAROSCOPY (PERITONEOSCOPY)  Diagnostic laparoscopy is efficient, cost-effective, and useful in the diagnosis of GI disease.  After a pneumoperitoneum (injecting carbon dioxide into the peritoneal cavity to separate the intestines from the pelvic organs) is created, a small incision is made lateral to the umbilicus, allowing for the insertion of the fiberoptic laparoscope.  This permits direct visualization of the organs and structures within the abdomen, permitting visualization and identification of any growths, anomalies, and inflammatory processes.  Biopsy samples can be taken from the structures and organs as necessary.  This procedure can be used to evaluate peritoneal disease, chronic abdominal pain, abdominal masses, and gallbladder and liver disease.