Gastrointestinal System Procedures Flashcards by Nucky Thompson

Preparation for Upper GI Series/ Barium Swallow

NPO 6- 8 hours - undergo XRAY

Laxatives (Barium Sulfate) night before- for clearer visualization cleansing of enema

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Expected stool output and for how many days after for Upper GI Series/ Barium Swallow

2-3 days of white stool

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Position during Upper GI Series/ Barium Swallow

Standing/ Sitting

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After procedure of Upper GI Series/ Barium Swallow; the patient will?

Increase fluid intake- to wash off the ingested drug

Use Laxatives (Barium Sulfate)- may constipate the patient and indicate that white stool is normal

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For Upper GI Series/ Barium Swallow, it will help visualize the

Esophagus, Stomach, Duodenum, and Jejunum

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BaSO4 for Upper GI Series/ Barium Swallow is administered through?

Mouth

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Preparation for Lower GI Series/ Barium Enema

Low residue (low fiber)

NPO 6-8 hours

Clear liquid diet for 2 days

Laxatives night before

Cleansing enema in the morning of the test

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After procedure of Lower GI Series/ Barium Enema, the nurse will?

Instruct the patient to increase fluid intake- to wash of ingested drug

Assess for signs of Barium Impaction

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Signs of Barium Impaction

Distended Abdomen

Constipation

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It is white chalky substance

Laxatives: Barium Sulfate (BaSO4)

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For Lower GI Series/ Barium Enema, it will help visualize the?

Colon

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For Lower GI Series/ Barium Enema, the BaSO4 is administered in?

Rectum

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After care for Lower GI Series/ Barium Enema

same as UGIS

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It is the direct visualization of esophagus, stomach and duodenum

Upper GI Endoscopy

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Recommended Position for Upper GI Endoscopy

Semi-fowler

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Preparation for Upper GI Endoscopy

Obtain written consent

NPO for 6-8 hours

Anticholinergic

Sedatives, narcotics, tranquilizers

Remove dentures, bridges

Local spray anesthetic (Lidocaine)

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Anticholinergic drug indication

To reduce mucus secretions and prevent aspiration

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Local spray anesthetic is administered to?

To depress gag reflex

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For maximum effect of anesthetic, the nurse will?

Instruct the patient not to swallow saliva

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We remove dentures, bridges to?

Prevent airway obstruction

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after Upper GI Endoscopy, place the client in what position?

Side-lying

to prevent aspiration since pt is given anticholinergics

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NPO until gag reflex return

to prevent aspiration

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NSS gargle, throat lozenges

to soothe the throat

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after Upper GI Endoscopy, assess pt if he/she have?

bleeding
crepitus (neck)
fever
neck/ throat pain
dyspnea
dysphagia
back/ shoulder pain

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Lower GI Endoscopy (Proctosigmoidoscopy) only visualizes the

Sigmoid, Rectum

Preparation for Lower GI Endoscopy (Proctosigmoidoscopy)

Clear liquid diet 24 hours Laxative Cleansing enema Intestinal evacuant like GoLytely in place of enema Assess signs of Vasovagal stimulation since GI tract is supplied by the Vagus nerves

Position of pt during Lower GI Endoscopy

Knee-chest/ lateral position

Aftercare for Lower GI Endoscopy

Assess Signs of Anorectal Perforation- Bleeding, Pain, and Fever Hot Sitz Bath to relieve discomfort in anorectal area

Position of pt during Colonoscopy

Left sided, Knees Flexed

Preparation for Colonoscopy

same as proctoisigmoidoscopy Sedatives

Aftercare for Colonoscopy

Monitor VS (note for vasovagal response- bradycardia, hypotension) Assess signs and symptoms of perforation

Signs and Symptoms of Perforation

Bleeding, Pain, and Fever

Elevated levels indicate presence of colorectal cancer

Carcinoembryonic Antigen (CEA)

Indicates presence of malabsorption disorders.

D - xylose Absorption Test

for Fecal Analysis (Guaiac Stool Examination), instruct pt to

No red meats, poultry for 3 days before collection of stool specimen. Withhold iron, steroids, NSAID's for 48 hours before collection of stool specimen as it may cause G.I. irritation

during Gastric Analysis, it collected every?

every 15 minutes to 1 hour

in Gastric Analysis, hypersecretion of HCl indicates?

duodenal ulcer or Zollinger- Ellison syndrome

in Gastric Analysis, decreased HCl secretion indicates?

gastric cancer or pernicious anemia.

Involves plain X-Ray of the abdomen

Scout Film of the Abdomen

Opening in the large intestines brought to the abdomen stoma

Colostomy

Normal Color during Colostomy

Red and slightly edematous for 5-7 days Pinkish red for the next few days

Abnormal color of Colostomy

Dark/brown (necrosis, ischemia) Blanched (decrease circulation) Dusk Brownish black

Colostomy: Protruded or Prolapse?

Protruded

Normal Protrusion during Colostomy

½ to ¾

When will you empty pouch during Colostomy?

if it is 1/3 to ½ full to prevent spillage of feces

Empty pouch with?

Weak vinegar solution

Which day will you expect flatus and fecal drainage for Colostomy?

4-7 days

during Colostomy Irrigation, position during bed rest?

Semi-fowlers

during Colostomy Irrigation, position during ambulatory?

Sitting on toilet or commode

Best time for Colostomy Irrigation

After meal

Height level of Colostomy Bag

12-18 inches above level of the shoulders

Solution for Colostomy Irrigation

500-1000 mL Warm NSS Luke Warm Water

time for better cleansing during Colostomy Irrigation

5-10 minutes

drainage time during Colostomy Irrigation

12-20 minutes

2-3 inches with forcing entry

If abnormal cramping occurs, clamp the tubing

For the healed stoma, wash with during cleansing of skin?

Warm water and soap

For not healed stoma, wash with during cleansing of skin?

Antiseptic solution

Food that increases odor

dairy product highly seasoned food cabbage celery

Foods that reduces odor

Yogurt Parsley Butter milk

skin barrier / protect stoma from infection

Karaya paste

indicates fungal infection (candida albicans)

White stoma

What will you apply if you have fungal infection?

Nystatin powder

Distance of stoma and emptying bag

1/16 - 1/8 inches

Recommended position for Adult during Enema

Left lateral

Recommended position for Infant/Child during Enema

Dorsal Recumbent

Purposes of enema

Relieves constipation Relieves gas Administer med Done prior to diagnostic / surgical procedure

Recommended temperature for Enema

37.7°C (100°F) too cold or too hot is uncomfortable and causes cramping.

exert osmotic pressure, stimulates peristalsis and thus defecation.

Hypertonic Solution

commonly used hypertonic enema

fleet phosphate enema

hypertonic solution constituents

90-120 ml of solution

hypertonic solution action

draws water into the colon

hypertonic solution time to take effect

5-10 min

exert a lower osmotic pressure causing water to move from the colon into the interstitial space.

Hypotonic solution (e.g. tap water)

hypotonic solution constituents

500-1,000 ml of tap water

hypotonic solution action

distends colon, stimulates peristalsis, and softens feces

hypotonic solution time to take effect

15-20 min

exert the same osmotic pressure, there is no fluid movement into or out of the colon.

Isotonic solution

safest enema solutions to use

physiologic (normal) saline

Isotonic solution constituents

500-1,000 ml of normal saline

Isotonic solution action

distends colon, stimulates peristalsis, and softens feces.

Isotonic solution time to take effect

15-20 min

stimulate peristalsis by increasing the volume in the colon and irritating the mucosa.

Soapsuds enemas

used in Soapsuds enemas in order to minimize irritation

only pure soap (i.e., Castile soap)

soapsuds constituents

500-1,000 ml (20 ml soap to 1.000 ml water)

soapsuds action

irritates mucosa, distends colon

soapsuds time to take effect

10-15 min

Oil constituents

(mineral, olive, cottonseed) 160ml

Oil action

lubricates the feces and the colonic mucosa

Oil time to take effect

1-3 hr

given to cleanse as much of the colon as possible.

High enema

high enema amount of solution

1,000 ml

height for high enema

18 inches

position during high enema

client changes from the left lateral position to the dorsal recumbent position and then to the right lateral position

used to clean the rectum and sigmoid colon only.

Low enema

position during low enema

client maintains a left lateral position

height for low enema

12 inches

low enema amount of solution

500 ml

introduces oil or medication into the rectum and sigmoid colon.

Retention enema

time of retention enema

1 to 3 hrs

retention enema action

acts to soften the feces and to lubricate the rectum and anal canal, thus facilitating passage of the feces

temperature of solution for retention enema

105 to 110 F

it is given primarily to expel flatus and to release tension or swelling in the colon and rectum

Carminative enema

this type of enema allows wastes and toxins to leave the body.

Carminative enema

also called a Harris flush

Return flow enema

return flow constituents

100-200 ml of fluid

repeated five or six times until the flatus is expelled and abdominal distention is relieved

Return flow enema

Tap water solution

500-1000 ml of water

Soapsuds solution

20ml castile soap in 500-1000ml

NSS 9ml NaCI solution

1000ml

Hypertonic solution / fleet enema solution

90-120 ml

3 consecutive stool test to check for hidden (occult) blood in the stool

Guaiac Test

route for TPN

subclavian vein – directly to Superior vena cava

alternate route for TPN

intrajugular vein

position during insertion for TPN

Trendelenburg To dilate the neck vein Prevent air embolism Dilate shoulder vein

solution used for TPN

hypertonic

Height of TPN solution

at least 12 inches above the shoulders

time to be consume for TPN

should be consumed for 24 hours only

Use of insertion pump for TPN

to maintain a slow administration to prevent hyperosmolar diuresis

main IV changed for TPN is every?

every 24hrs

How often to change the dressing for TPN

3x a week

Position while dressing change for TPN

low fowler

Solution for cleansing tubing for TPN

acetone then tincture of iodine

If interrupted / change out/ empty solution for TPN

change to d10 water temporarily to prevent hypoglycemia

Expected weight gain for TPN

0.5 kg per day

Position during NGT Insertion

High fowler

Measurement during NGT Insertion

tip of the nose to the ear lobe to the xiphoid process + 6 in

How to check NGT placement?

X-ray- most accurate Aspirate gastric contents. Check pH (4.0 or lower) Introduce air into NGT and auscultate epigastric area for gurgling sounds

Position after procedure of Lower GI Endoscopy

Supine position to prevent Orthostatic Hypotension