GI System Med Surg Flashcards
What is a Proctosigmoidoscopy?
An Exam of the distal, sigmoid colon, rectum, and canal using a flexible type of endoscope (sigmoidoscope).
What does a sigmoidoscopy Detect?
P-Puncture M-early stage Malignancies
L-Lacerations
A-abscess
T-Tumors
P-Polyps H-Hemorrhoids U-Ulcerations F-Fissures F-Fistulas
Nursing Process Proctosigmoidoscopy? Pre-opt
Clean out Bowel
- NPO stat 8 hr before test
- Low residue diet 3 days before
- Clear liquids
- Laxative or Enema right before
- Possible Enema morning before
- WARNING bowel prep not given to PT’s with bleeding, or sever diarrhea
Nursing Process Proctosigmoidoscopy? During Procedure
- Place PT in left lateral knee-chest position, to straighten colon.
- PT may feel pressure indicating a BM
- 1-2 pieces of intestinal tissue may be removed (biopsy).
- Rectal or sigmoid polyps removed with a snare.
- Electrocoagulating current is used to prevent/stop bleeding.
- Specimens labeled and sent to lab for immediate exam.
Nursing Process Practosigmoidoscopy? Post-Opt
- PT rests in the supine position to prevent orthostatic hypotension.
- Assess for signs of heavy bleeding, perforation, pain, and fever.
Liver Biopsy
Test used after less invasive test fail
Detects: Cancer, Cirrhosis, and Hepatitis
Liver Biopsy Pre-opt
Give local Anesthetic, Ultrasound may be ordered to guide the needle as it makes the incision.
Liver Biopsy During Procedure
Warning Procedure extremely vascular! Placing PT at risk for bleeding especially because liver disease hinders its ability to produce clotting factors.
- Nurse assists PT to their back or left side, they must hold very still.
- Patient should exhale and hold deep breath as needle is inserted
- After needle is removed (hold pressure on site for 5 minutes!!!)
- Then apply pressure dressing.
- PT lies on (right) side for 2 hrs to prevent bleeding
- Monitor vitals for signs of bleeding
- Avoid coughing, straining, excersise, or heavy lifting
- Analgesics offered for comfort as ordered
Critical Thinking What labs related to Jaundice would be elevated? What other lab may be important after liver biopsy?
- Serum Bilirubin maybe elevated
2. Check coagulation studies and prothrombin levels for lack of clotting ability
Define Appendicitis
Inflammation of the Appendix, which is a finger-like extension of the cecum.
Signs & Symptoms of Appendicitis
Most Important! Fever, RLQ rebound tenderness, and Classic Symptom!!!! Pain between the umbilicus and iliac crest McBurney’s Point.
Also, look for! (Rovsings sign) pain in RLQ, when LLQ palpated. Abdominal muscular rigidity (gaurding)
Anorexia, Nausea, and Vommiting
Increased WBC’s
PT may keep right leg flexed for comfort, PT my experience extreme pain when leg straightened.
Appendicitis Diagnostic Tests
CBC to reveal elevated leukocytes and neutrophils
CT and MRI to reveal enlarged in cecum area
Appendicitis Therapeutic Measures
- PT NPO stat
- Apply Ice to pain site, WARNING (Never, Heat!!!!!) may rupture appendix. WARNING Avoid Laxatives & Enemas may cause or complicate a rupture
- Surgery is usually performed immediately unless perforation or peritonitis is suspected.
Appendicitis RUPTURE!!!!!
- Start IV fluids/antibiotics to treat infection or peritonitis
- Surgery may or may not be done right away due to infection
- Orogastric or NG tube may be used for decompressing the stomach
- If infection presents radiologist may insert drain in the abdomen.
- Surgery may be postponed several weeks until the infection resolves
Further Complications of Appendicitis
- Peritonitis
- Appendix Abscess, collection of puss separated by small bowel, peritoneal cavity, or omentum.
Treatments IV antibiotics and surgical drainage. Surgery can be done 6 weeks after abscess discovery.