Assessment of the Gastrointestinal System

Question 1

Atrophy of Gastric Mucosa
Decrease in hydrochloric acid levels
Nursing Interventions

Answer 1

GI changes with aging - stomach

Question 2

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

Answer 2

Decrease in hydrochloric acid levels - GI changes with aging - stomach

Question 3

Not eat spicy foods
Encourage bland foods high in vitamins and iron
Assess for epigastric pain to detect gastritis and do dietary changes

Answer 3

Nursing Interventions - GI changes with aging - stomach

Question 4

Peristalsis decreases
Nerve impulses are dulled
Decreased sensation to defecate can result in postponement of bowel movements
Nursing Interventions: - prevent constipation

Answer 4

GI changes with aging - intestine

Question 5

Leads to constipation and impaction

Answer 5

Decreased sensation to defecate can result in postponement of bowel movements - GI changes with aging - intestine

Question 6

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

Answer 6

Nursing Interventions: - prevent constipation - GI changes with aging - intestine

Question 7

Distension and dilation of pancreatic ducts
Calcification of pancreatic vessels occurs with a decrease in lipase production
Nursing Interventions:

Answer 7

GI changes with aging - pancreas

Question 8

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

Answer 8

Calcification of pancreatic vessels occurs with a decrease in lipase production - GI changes with aging - pancreas

Question 9

Encourage small, frequent meals
Helps prevent steatorrhea
Assess for diarrhea and dehydration

Answer 9

Nursing Interventions: - GI changes with aging - pancreas

Question 10

Decrease in the number and size of hepatic cells and increase in fibrous tissue
Nursing Interventions:

Answer 10

GI changes with aging - liver

Question 11

Leads to decreased protein synthesis and changes in liver enzymes
Depresses drug metabolism
Leads to accumulation of drugs – possibly to toxic levels

Answer 11

Decrease in the number and size of hepatic cells and increase in fibrous tissue- GI changes with aging - liver

Question 12

Assess for adverse effects of medications, specifically drug toxicity

Answer 12

Nursing Interventions: - GI changes with aging - liver

Question 13

Patient history
Nutrition history
Family history and genetic risk
Current health problems
Physical assessment of abdomen
Psychosocial assessment

Answer 13

Assessment: history and phys assessment

Question 14

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

Answer 14

Nutrition history

Question 15

Change in bowel habits
Unintentional weight gain or loss
Pain
Changes in the skin - alterations in liver func

Answer 15

Current health problems

Question 16

discoloration or rashes, itching, jaundice, increased bruising, increased tendency to bleed

Answer 16

Changes in the skin - alterations in liver func

Question 17

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

Answer 17

Physical assessment of abdomen

Question 18

Stress can exacerbate some gastrointestinal disorders

Answer 18

Psychosocial assessment

Question 19

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

Answer 19

Assessment: labs

Question 20

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)

Answer 20

Liver Function Tests (liver enzymes)

Question 21

Increased values may indicate liver disease, hepatitis, cirrhosis

Answer 21

Alanine aminotransferase-ALT (4-36 units/L)

Question 22

Increased values may indicate liver disease, hepatitis, cirrhosis

Answer 22

Aspartate aminotransferase–AST (0-35 units/L)

Question 23

Increased values may indicate cirrhosis, biliary obstruction, liver tumor

Answer 23

Alkaline phosphatase-ALK (30-120 units/L)

Question 24

Increased values may indicate hemolysis, biliary obstruction, hepatic damage - common in liver disease
Make pat have yellow tone when levels high

Answer 24

Bilirubin (0.3-1.0 mg/dL)

Question 25

Decreased values may indicate hepatic disease - indic of nutrition

Answer 25

Albumin (3.5-5)

Question 26

Increased values may indicate hepatic disease specifically cirrhosis Neurological issue, ammonia odor

Answer 26

Ammonia (10-80 mg/dL)

Question 27

Evaluated to diagnose cancer and could be increased in benign GI conditions Indication for colon cancers

Answer 27

Ca 19-9 and CEA

Question 28

Increased values may indicate acute pancreatitis Pancreatic enzymes

Answer 28

Serum amylase (30-220 units/L)

Question 29

Increased values may indicate acute pancreatitis Pancreatic enzymes

Answer 29

Serum lipase (0-160 units/L)

Question 30

Useful in evaluating clotting If elevated could indicate hepatic issue Liver disease higher risk for bleeding

Answer 30

Prothrombin time (PT) (11-12.5 sec)

Question 31

Calcium (9-10.5) Potassium (3.5-5) Some alterations in Na

Answer 31

Electrolytes

Question 32

Decreased values may indicate malabsorption, kidney failure, acute pancreatitis

Answer 32

Calcium (9-10.5)

Question 33

Decreased values may indicate vomiting, gastric suctioning, diarrhea, drainage from intestinal fistulas

Answer 33

Potassium (3.5-5)

Question 34

Decreased values may indicate vomiting, gastric suctioning, diarrhea

Answer 34

Some alterations in Na

Question 35

Low Hbg/Hct could indicate anemia with GI bleedin Elevated WBC could indicate infection

Answer 35

CBC

Question 36

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

Answer 36

Stool

Question 37

Imaging Tests: Esophagogastroduodenoscopy (EGD) Endoscopic retrograde cholangiopancreatography (ERCP) Small bowel endoscopy (enteroscopy) Colonoscopy

Answer 37

Assessment: diagnostic tests

Question 38

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)

Answer 38

Imaging Tests:

Question 39

Can identify tumors, strictures and obstructions

Answer 39

Abdominal x-ray

Question 40

Includes chest x-ray, supine and upright abdominal x-ray 2 diff views of abdomen and esophageal things going on

Answer 40

Acute abdominal series

Question 41

X-ray from mouth to duodenojejunal junctions with use of barium

Answer 41

Upper GI series (Barium Swallow)

Question 42

Extension of the upper GI x-ray with use of barium

Answer 42

Small bowel follow-through

Question 43

X-ray of large intestine with use of barium

Answer 43

Barium enema

Question 44

MRI to check biliary ducts of pancreas; pancrease, liver, gallbladder

Answer 44

Magnetic resonance cholangiopancreatography (MRCP)

Question 45

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:

Answer 45

Esophagogastroduodenoscopy (EGD)

Question 46

Keep patient NPO until gag reflex returns Priority care includes preventing aspiration and assess for any bleeding or pain that could indicate perforation

Answer 46

Post procedure: - Esophagogastroduodenoscopy (EGD)

Question 47

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:

Answer 47

Endoscopic retrograde cholangiopancreatography (ERCP)

Question 48

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

Answer 48

Post procedure: - Endoscopic retrograde cholangiopancreatography (ERCP)

Question 49

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:

Answer 49

Small bowel endoscopy (enteroscopy)

Question 50

NPO except water for 8-10 hours then complete NPO for 2 hours before swallowing capsule

Answer 50

Prepration: - Small bowel endoscopy (enteroscopy)

Question 51

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

Answer 51

Procedure: - Small bowel endoscopy (enteroscopy)

Question 52

Explain to the patient that the capsule endoscope is excreted naturally and will be seen in the stool

Answer 52

Post procedure: - Small bowel endoscopy (enteroscopy)

Question 53

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:

Answer 53

Colonoscopy

Question 54

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

Answer 54

Preparation: - Colonoscopy

Question 55

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

Answer 55

Post procedure: - Colonoscopy