Assessment of the Gastrointestinal System Flashcards
Atrophy of Gastric Mucosa
Decrease in hydrochloric acid levels
Nursing Interventions
GI changes with aging - stomach
Decreased absorption of iron and vitamin B12
Proliferation of bacteria - more likely have bacteria/infections and gastritis
Atrophic gastritis occurs as a consequence of bacterial overgrowth
Decrease in hydrochloric acid levels - GI changes with aging - stomach
Not eat spicy foods
Encourage bland foods high in vitamins and iron
Assess for epigastric pain to detect gastritis and do dietary changes
Nursing Interventions - GI changes with aging - stomach
Peristalsis decreases
Nerve impulses are dulled
Decreased sensation to defecate can result in postponement of bowel movements
Nursing Interventions: - prevent constipation
GI changes with aging - intestine
Leads to constipation and impaction
Decreased sensation to defecate can result in postponement of bowel movements - GI changes with aging - intestine
Encourage a high-fiber diet and 1500 mL of fluid intake daily (if not contraindicated)
Encourage as much activity as tolerated
These interventions increase the sensation of needing to defecate
Nursing Interventions: - prevent constipation - GI changes with aging - intestine
Distension and dilation of pancreatic ducts
Calcification of pancreatic vessels occurs with a decrease in lipase production
Nursing Interventions:
GI changes with aging - pancreas
Decreased lipase level results in decreased fat absorption and digestion
Excess fat in the feces (steatorrhea)occurs because of decreased fat digestion - can lead to diarrhea
Calcification of pancreatic vessels occurs with a decrease in lipase production - GI changes with aging - pancreas
Encourage small, frequent meals
Helps prevent steatorrhea
Assess for diarrhea and dehydration
Nursing Interventions: - GI changes with aging - pancreas
Decrease in the number and size of hepatic cells and increase in fibrous tissue
Nursing Interventions:
GI changes with aging - liver
Leads to decreased protein synthesis and changes in liver enzymes
Depresses drug metabolism
Leads to accumulation of drugs – possibly to toxic levels
Decrease in the number and size of hepatic cells and increase in fibrous tissue- GI changes with aging - liver
Assess for adverse effects of medications, specifically drug toxicity
Nursing Interventions: - GI changes with aging - liver
Patient history
Nutrition history
Family history and genetic risk
Current health problems
Physical assessment of abdomen
Psychosocial assessment
Assessment: history and phys assessment
Diet - big part; how tolerate certain foods
food allergies
Anorexia
N/V
Changes in taste
Pain or difficulty swallowing - not aspirating
Abdominal pain or discomfort with eating
Dyspepsia – indigestion or heartburn
Unintentional weight loss
Alcohol and caffeine consumption
Nutrition history
Change in bowel habits
Unintentional weight gain or loss
Pain
Changes in the skin - alterations in liver func
Current health problems
discoloration or rashes, itching, jaundice, increased bruising, increased tendency to bleed
Changes in the skin - alterations in liver func
Inspection, Auscultation, light Palpation, Percussion
If appendicitis or an abdominal aneurysm is suspected, palpation is not done
Check mouth; no abnormalities in oral cavity; not coughing when eating
Physical assessment of abdomen
Stress can exacerbate some gastrointestinal disorders
Psychosocial assessment
Liver Function Tests (liver enzymes)
Bilirubin (0.3-1.0 mg/dL)
Albumin (3.5-5)
Ammonia (10-80 mg/dL)
Ca 19-9 and CEA
Serum amylase (30-220 units/L)
Serum lipase (0-160 units/L)
Prothrombin time (PT) (11-12.5 sec)
Electrolytes
CBC
Stool
Assessment: labs
Elevated means liver disease/concern for liver func
Alanine aminotransferase-ALT (4-36 units/L)
Aspartate aminotransferase–AST (0-35 units/L)
Alkaline phosphatase-ALK (30-120 units/L)
Liver Function Tests (liver enzymes)
Increased values may indicate liver disease, hepatitis, cirrhosis
Alanine aminotransferase-ALT (4-36 units/L)
Increased values may indicate liver disease, hepatitis, cirrhosis
Aspartate aminotransferase–AST (0-35 units/L)
Increased values may indicate cirrhosis, biliary obstruction, liver tumor
Alkaline phosphatase-ALK (30-120 units/L)
Increased values may indicate hemolysis, biliary obstruction, hepatic damage - common in liver disease
Make pat have yellow tone when levels high
Bilirubin (0.3-1.0 mg/dL)
Decreased values may indicate hepatic disease - indic of nutrition
Albumin (3.5-5)
Increased values may indicate hepatic disease specifically cirrhosis
Neurological issue, ammonia odor
Ammonia (10-80 mg/dL)
Evaluated to diagnose cancer and could be increased in benign GI conditions
Indication for colon cancers
Ca 19-9 and CEA
Increased values may indicate acute pancreatitis
Pancreatic enzymes
Serum amylase (30-220 units/L)
Increased values may indicate acute pancreatitis
Pancreatic enzymes
Serum lipase (0-160 units/L)
Useful in evaluating clotting
If elevated could indicate hepatic issue
Liver disease higher risk for bleeding
Prothrombin time (PT) (11-12.5 sec)
Calcium (9-10.5)
Potassium (3.5-5)
Some alterations in Na
Electrolytes
Decreased values may indicate malabsorption, kidney failure, acute pancreatitis
Calcium (9-10.5)
Decreased values may indicate vomiting, gastric suctioning, diarrhea, drainage from intestinal fistulas
Potassium (3.5-5)
Decreased values may indicate vomiting, gastric suctioning, diarrhea
Some alterations in Na
Low Hbg/Hct could indicate anemia with GI bleedin
Elevated WBC could indicate infection
CBC
Annual guaic heme fecal occult blood test (gFOBT) or fecal immunochemical test (FIT) to detect colorectal cancer or GI bleeding
Ova and parasites – aid in diagnosis of parasitic infection
Fecal fats - malabsorption and fats not absorbed
Cytotoxic assay or culture
Stool
Imaging Tests:
Esophagogastroduodenoscopy (EGD)
Endoscopic retrograde cholangiopancreatography (ERCP)
Small bowel endoscopy (enteroscopy)
Colonoscopy
Assessment: diagnostic tests
Abdominal x-ray
Acute abdominal series
Abdominal computerized tomography (CT) - drink and IV dye
Abdominal magnetic resonance imaging (MRI)
Upper GI series (Barium Swallow)
Small bowel follow-through
Barium enema
Magnetic resonance cholangiopancreatography (MRCP)
Imaging Tests:
Can identify tumors, strictures and obstructions
Abdominal x-ray
Includes chest x-ray, supine and upright abdominal x-ray
2 diff views of abdomen and esophageal things going on
Acute abdominal series
X-ray from mouth to duodenojejunal junctions with use of barium
Upper GI series (Barium Swallow)
Extension of the upper GI x-ray with use of barium
Small bowel follow-through
X-ray of large intestine with use of barium
Barium enema
MRI to check biliary ducts of pancreas; pancrease, liver, gallbladder
Magnetic resonance cholangiopancreatography (MRCP)
Visual exam of the esophagus, stomach, duodenum with use of fiberoptic scope
Preparation: NPO for 6-8 hours and avoid anticoagulants, aspirin, NSAIDS several days before procedure - not want give anything that increases bleeding
Procedure: Moderate sedation and lasts about 20-30 minutes
Look for bleeding/strictures
Post procedure:
Esophagogastroduodenoscopy (EGD)
Keep patient NPO until gag reflex returns
Priority care includes preventing aspiration and assess for any bleeding or pain that could indicate perforation
Post procedure: - Esophagogastroduodenoscopy (EGD)
Visual and radiographic exam of the liver, gallbladder, bile ducts, and pancreas
Scope
Use radiopaque dye
Used to diagnose obstruction as well as treat obstructions
Preparation: NPO for 6-8 hours and typically avoid anticoagulants as determined by provider (other meds determined by HCP)
Procedure: Moderate sedation and lasts 30 minutes to 2 hours
Post procedure:
Endoscopic retrograde cholangiopancreatography (ERCP)
Keep patient NPO until gag reflex returns
Priority care includes preventing aspiration and assess for any bleeding or pain that could indicate perforation
Assess for gallbladder inflammation and can cause pancreatitis- severe abdominal pain, nausea and vomiting, fever and elevated lipase - notify HCP because irritates gallbladder and cause pancreatitis
Post procedure: - Endoscopic retrograde cholangiopancreatography (ERCP)
Provides a visual view of the small intestine
Swallow capsule and monitoring device outside and monitor as go moves through them
Used to evaluate and locate source of GI bleeding
Prepration:
Procedure:
Post procedure:
Small bowel endoscopy (enteroscopy)
NPO except water for 8-10 hours then complete NPO for 2 hours before swallowing capsule
Prepration: - Small bowel endoscopy (enteroscopy)
Sensors are placed on abdomen and patient wears a data recorder
Patient swallows the capsule endoscope and can resume normal activity
Patient may eat 4 hours after swallowing the capsule
Procedure lasts 8 hours
Procedure: - Small bowel endoscopy (enteroscopy)
Explain to the patient that the capsule endoscope is excreted naturally and will be seen in the stool
Post procedure: - Small bowel endoscopy (enteroscopy)
Endoscopic exam of the entire large intestine
Can be used to visually diagnose, biopsy and treat
Baseline test should be done at age 50 and every 10 years - screening; catch colon cancer early
Preparation:
Procedure: Moderate sedation and procedure lasts 30-60 minutes
Post procedure:
Colonoscopy
Clear liquids the day before
PO prep
NPO 4-6 hours prior
Avoid aspirin, anticoagulants, and antiplatelet drugs for several days before
Adequate bowel cleansing is essential
Follow provider orders for oral and rectal preparation; Patient should be passing clear liquid prior to procedure
Bowel cleansing most imp part
Preparation: - Colonoscopy
Observe for signs of perforation (severe pain) and hemorrhage - esp post interventions; check VS for potential internal bleeding
Feelings of fullness and cramping are expected
Fluids are permitted after the patient passes flatus to indicate that peristalsis has returned
Post procedure: - Colonoscopy
