GI Diagnostic Tests PDF

GASTROINTESTINAL NURSING ABDOMINAL CONFIRMATORY TESTS AND DIAGNOSTICS NON-INVASIVE PROCEDURES Abdominal Ultrasonography = uses high-frequency sound waves which are passed into body structures and recorded as they are reflected (bounded). A conductive gel (lubricant jelly) is applied to the...

GASTROINTESTINAL NURSING ABDOMINAL CONFIRMATORY TESTS AND DIAGNOSTICS NON-INVASIVE PROCEDURES Abdominal Ultrasonography = uses high-frequency sound waves which are passed into body structures and recorded as they are reflected (bounded). A conductive gel (lubricant jelly) is applied to the skin and a transducer is placed on the area.  Indication: ○ Useful in the detection of an enlarged gallbladder or pancreas, presence of gallstones, an enlarged ovary, an ectopic pregnancy, or appendicitis, and masses (cysts or tumors). Nursing responsibility: ○ Instruct patient to be NPO 8 – 12 hours before UTz. Air or gas can reduce quality of images. Abdominal Computed Tomography (CT) Scan = provides cross sectional images of abdominal organs and structures. Indication: ○ Tool for detecting appendicitis, diverticulitis, regional enteritis, ulcerative colitis, diseases of the liver, spleen, kidney, pancreas, and pelvic organs.  Nursing responsibility: ○ Contraindicated for cachectic or very thin patients. ○ Since contrast medium is used, the nurse should assess for any allergies to contrast agents, iodine, shellfish, serum creatinine level, urine human chorionic gonadotropin before administration of a contrast agent.  If patient is allergic to contrast agent, may be premedicated with IV prednisone 24 hours, 12 hours, and 1 hour before the scan. Renal protective measures: administration of IV sodium bicarbonate 1 hour before and 6 hours after IV contrast, and oral Acetylcysteine (Mucomyst) before or after the study. ○ Both sodium bicarbonate and Mucomyst are free radical scavengers that sequester the contrast byproducts. Abdominal Magnetic Resonance Imaging (MRI) = uses magnetic fields and radiofrequency waves to produce an image of the area being studied. Indication: ○ Useful in evaluating abdominal soft tissues as well as blood vessels, abscesses, fistulas, neoplasms, and other sources of bleeding.  Contraindication: ○ Ferromagnetic objects = (metals that contain iron) jewelries, pacemakers, dental implants, paperclips, pens, keys, IV poles, clips on patient’s gowns, oxygen tanks, patients with artificial heart valves and defibrillators, implanted insulin pumps, or implanted transcutaneous electrical nerve stimulation devices, patients with internal metal devices (aneurysm clips) or intraocular metallic fragments.  Nursing responsibility: ○ Place the patient NPO 6 – 8 hours before the study and removal of all jewelry and other metals. ○ Instruct the patient to lie still for 60 – 90 min. ○ Assess patients with claustrophobia. ○ Instruct to the patient that the machine will make a knocking sound during the procedure. ⦿ Foil-backed skin patches (e.g., nitroglycerine, scopolamine, clonidine) should be removed before an MRI because of the risk of burns. However, physician must be consulted first before the patch is removed.  Fecal Occult Blood / Guaiac Stool Exam − It is a microscopic analysis or by chemical tests for hemoglobin that may be present in stool. − Normally, stool contains small amount of blood (2– 2.5ml/day) −Used to detect GI bleeding and early signs of colorectal cancer.  Patient Preparation 48 – 72 hours before test, emphasize High Fiber diet and restriction from eating red meats, turnips, and horseradish prior to test and throughout the collection period. Stool collection of three (3) specimens randomly. Notify the lab and practitioner of drugs the patient is taking that may affect results. Obtain specimens from two different areas of each stool  Hemoccult Slide Test: A wooden applicator is used to apply a thin smear of the stool specimen on a guaiac-impregnated filter paper exposed in box A; or if done with a digital examination, smear the gloved finger on the filter paper. Apply a 2nd smear from another part of the specimen to the filter paper exposed in box B. Allow the specimen to dry for 3-5 minutes. Add 2 drops of Hemoccult developing solution on the paper over each smear. After 30 - 60 seconds, (+) result will show BLUE.  Hematest Reagent Tablet Test A wooden applicator is used to smear a bit of stool specimen on a filter paper; or if done with a digital examination, smear the gloved finger on the filter paper. Place smeared filter paper on a glass plate. Place the reagent tablet at the center of the stool specimen and add a drop of water to soak for 5-10 seconds. Add 2nd drop on the tablet and let it run from the specimen. After 2 minutes: (+) results = filter paper turns BLUE *Do not read the color that appears on the tablet or on the paper after 2 minutes.  Instant-View Fecal Occult Blood Test: Add a stool sample to the collection tube. Shake to mix the sample with the extraction buffer, then dispense 4 drops into the sample well of the cassette. In 5-10 minutes, results will appear. It will show the level of Hgb if >0.05mcg/ml of stool.  INVASIVE PROCEDURES These involve endoscopic procedures. Endoscopy refers to the direct visualization of a body structure through a lighted fiber-optic instrument. ⦿ Colonoscopy = is used to directly visualize entire colon up to ileocecal valve with flexible fiberoptic scopes. Indication: It is most frequently used for cancer screening because it allows biopsy and for surveillance in patients with previous colon cancer and polyps. It is also used to diagnose inflammatory bowel disease, detect tumors, diagnose diverticulitis, and dilate strictures. ⦿ Is performed while the patient is lying on the left side with the legs drawn up toward the chest. The patient’s position may be changed during the test to facilitate advancement of the scope.  Contraindication: Cannot be performed if there is suspected colon perforation. Nursing responsibility: (commonly ordered prior to procedure) Before the test: Place the patient in clear liquid diet 24 hours prior to procedure. ⦿ 1 gal of Polyethylene Glycol (Go-LYTELY, CoLyte, Nu-Lytely), an electrolyte lavage solution, is given to the patient evening before the procedure (8 oz glass q 10min) Drink the preparation as cold as possible to make it more palatable. The stool will become watery, clear and free of any solid material. Side effects: nausea, bloating, cramps or abdominal fullness, fluid and electrolyte imbalance, and hypothermia. Fleet’s Phospho-Soda, a laxative, is administered. ○ 1st dose (1.5 oz) is taken in the afternoon before the procedure, followed by 10 oz of clear liquid and then 3 – 5 additional glasses of clear liquid. ○ 2nd dose (1.5 oz) is taken before bedtime, followed by 10 oz of clear liquid and then 3 – 5 additional glasses of clear liquid.  Sodium Phosphate Monobasic Monohydrate (Visicol) = a laxative that is alternative used for bowel preparation. ○ 20 pills are taken over a 1-hour period the afternoon before the procedure. ○ At bedtime, 8 more tablets with 8 oz of water. ○ Bisacodyl (Dulcolax) tablet, a laxative, may be added to complete the regimen. Place the patient NPO 6 hours prior to the actual procedure. Informed consent is obtained.  During the test: Midazolam (Versed), an opioid analgesic or sedative, is administered to provide moderate sedation and relieve anxiety. Glucagon may be administered to relax the colonic musculature and to reduce spasm.  After the test: Abdominal cramp is normal due to increased peristalsis. Monitor for complications: Bowel perforation, most common complication (rectal bleeding, abdominal pain or distension, and fever) Cardiac dysrhythmias, respiratory depression, vasovagal reactions, circulatory overload or hypotension. ENDOSCOPIC PROCEDURE ESOPHAGOGASTRODUODENOSCOPY (EGD) = used to directly visualize mucosal lining of esophagus, stomach, duodenum with flexible, fiberoptic scope. Indication: Test to detect inflammations, ulcerations, tumors, varices, or Mallory-Weiss tear and neoplasms in the esophagus, stomach, and duodenum. Biopsies may also be taken.  Nursing Responsibility: Before the test: Keep NPO for 8 hours. Make sure signed consent is on the chart. Local anesthetic may be sprayed on throat before insertion of scope. Midazolam (Versed) is administered to provide moderate sedation and relieves anxiety.  Atropine may be administered to reduce secretions. Glugacon may be administered to relax smooth muscles. The patient is placed in left lateral position.  After the test: Assess for the return of gag reflex, level of consciousness, vital signs, oxygen saturation, and pain level. Monitor for signs of perforation: pain bleeding unusual difficulty swallowing rapidly elevated temperature. Capsule Endoscopy (PillCam ESO) = a pill-sized instrument equipped with cameras is swallowed by the patient and provides 57,000 images of the GI tract.  Capsule relays images to data recorder that patient wears on belt.  Indication: For the diagnosis of Crohn’s disease, celiac disease, malabsorption syndrome, and identify sources of possible GI bleeding.  Contraindication: Previously anastomosed section of the bowel. Nursing responsibility: Bowel preparation is similar to colonoscopy. NPO for 4 – 6 hours after swallowing the capsule. Laparoscopy (Peritoneoscopy) = is a diagnostic procedure where the peritoneal cavity, pelvis, and abdomen are examined. Gas (carbon dioxide) is insufflated into the peritoneal cavity to separate the intestines from the pelvic organs. Indication: Test used to detect cysts, adhesions, fibroids infections of the uterus, fallopian tubes, and ovaries, ectopic pregnancies, liver lacerations, and cirrhosis.  Nursing responsibilities: Patient is instructed to fast for 8 hours before the surgery. The patient is catheterized to ensure the bladder is empty. Make sure signed consent is on the chart. The test is performed under local or general anesthetic agent. Observe for bleeding and bowel perforation after the procedure. Proctosigmoidoscopy = directly visualizes rectum and sigmoid colon with lighted flexible endoscope.  Indication: Used to detect internal hemorrhoids, polyps, fissures, and rectal and anal abscesses.  Nursing responsibility: Secure consent. Clear liquids day before or no dietary restrictions. Administer enema (soap-suds, tap water, or Fleet enema) evening before and morning of procedure.  Explain to the patient knee-chest position, need to take a deep breaths during insertion of the scope, and possible urge to defecate as scope is passed. Conscious sedation is often used. Monitor patient for rectal bleeding and intestinal perforation. Endoscopic Retrograde Cholangiopancreatography (ERCP) = fiberoptic endoscope is inserted through the oral cavity into the duodenum, then common bile and pancreatic ducts are cannulated.  Indication: Used to retrieve a gallstone from distal common bile duct, dilate strictures, obtain biopsy for tumor, and diagnose pseudocysts. Nursing responsibility: Before the procedure: NPO for 8 hours. Ensure consent form is signed. After the procedure: Check vital signs, signs of perforation or infection, gag reflex. Be aware that pancreatitis is the most common complication. Paracentesis = is the aspiration of fluid from the abdominal cavity. Indication: Both diagnostic and therapeutic procedure for end-stage liver or renal disease when there is ascites. Aspiration in this instance is therapeutic, if a culture specimen is obtained, it is diagnostic.  Nursing responsibility: Have the patient void, and obtain body weight before the procedure. Place the patient in a high-Fowler’s position. The skin is prepared, before anesthetized and punctured with a trocar (a large bored abdominal paracentesis needle. Observe the patient for blood pressure changes that can result from rapid removal of fluid.  Postprocedure: apply a sterile dressing to the puncture site. Record the color, amount, consistency of drainage. Radiologic Procedures: Barium = a chalky white contrast medium, is an oral preparation that allows roentgenographic visualization of the internal structures of the digestive tract.  Barium Swallow (Upper Gastrointestinal Study) = also known as esophagography, is a fluoroscopic visualization of the esophagus following the ingestion of barium sulfate. Indication: Used to diagnose structural abnormalities of the esophagus, stomach, and duodenum. Nursing responsibility: Before the procedure: Tell the patient to avoid smoking 24 hours prior to procedure. Explain to the patient the need to drink contrast medium. Keep NPO for 8 – 12 hours before the procedure.  After the procedure: White stool is normal within 72 hours after the test. Force fluids and administer laxatives to prevent contrast medium impaction.  Barium Enema (Lower Gastrointestinal Study) = rectal infusion of barium sulfate, is the roentgenographic study of the lower intestinal tract (colon).  Nursing responsibility: Clear liquid diet evening before the procedure. NPO 8 hours before the procedure. Administer enema or laxative evening before the procedure.  Explain that cramping and urge to defecate may occur during administration of barium enema. Enforce fluids and administer laxatives after the procedure to prevent intestinal obstruction.  Acid Perfusion Test (Bernstein Test) Helps to distinguish pain caused by esophagitis (heartburn) from pain caused by angina pectoris or other disorders. It requires infusion of saline and acidic solutions into the esophagus through a nasogastric tube. Note: Absence of pain or burning during infusion of solutions indicates a healthy esophageal mucosa.  Patient Preparation Check for signed informed consent. No antacids 24-hours before the test. No food for 12-hours before the test. No fluids or smoking for 8 hours before the test. An NGT will be inserted and a 20ml syringe is attached to aspirate stomach contents.  Withdraw the NGT a few inches (with a 12” mark) into the esophagus. Inform the client that he should report immediately any discomfort or burning sensation during the infusion of liquid. Take and record accurately for baseline data (PR, RR, BP) prior to start of procedure. Intra-test: Hang labelled containers of Normal Saline Solution (NSS) and an acidic solution (0.1 Na HCl) and connect the NGT to the IV tubing. Open the line from NSS and infuse at a rate of 60-120 gtts/min. Continue infusion for 5-10 mins. Ask the client for any discomfort and record his response.  Close the NSS line and start infusion of Na HCl with the same infusion rate for 30 minutes w/o the knowledge of the client. Check with the client for any discomfort and record his response. −If there is presence of pain, close the line of the acidic solution and open the NSS solution to decrease pain sensation. −If ordered, repeat infusion to verify the response.  For complaints of pain or burning, give antacids. For sore throat, give lozenges or ice collar. Clamp the tube before removing it to prevent fluid aspiration into the lungs. PRECAUTIONS: Bernstein test is C/I to clients with esophageal varices, heart failure, acute MI, or other cardiac disorders. Assess for cyanosis or paroxysmal coughing, which is an indication for improper NGT placement. Assess for V/S to detect arrhythmias.