L1-Assessment of Digestive & Gastrointestinal Functions Flashcards
what should we do during pretest phase (4)
- Informing the doctor of known medical conditions or abnormal laboratory results that mayaffect the procedure (e.g. bleeding tendency)
- Ensuring the consent form is signed
- Explaining the procedure and any special preparation needed to patient
- fasting
- temporary suspend one or more medications
- cleansing of the bowel
- Setting up intravenous site
- Helping the patient to alleviate anxiety
what should we do during test phase (5)
- Identifying right patient
- Monitoring and supporting the patient during the examination
- Correct specimen labeling and sending properly
- Ensuring equipment must be functional and secured properly for transport (e.g. IV line, foley)
- Documenting the procedure as appropriate
what should we do during posttest phase (5)
- Relieving discomfort or pain
- Monitoring the results of the test
- Reporting promptly for any critical values of the tests
- Performing post-procedural care
- Teaching patient for self-care at home
what does decreased Hb indicates?
Anemia (e.g. GI bleeding, GI cancer, peptic ulcer disease)
what does increased level of WBC indicates?
Infection (e.g. diverticulitis 憩室炎, at descending colon, and inflammatory bowel disease)
what does increased prothrombin time/ international normalized ratio indicates?
severe acute or chronic liver damage
impaired synthesis of clotting proteins
what does Sodium/Potassium depletion indicates?
Excessive vomiting/ diarrhea→ replacement
what is AST
asparate transaminase
what is ALT
alanine aminotransferase
what does increased AST and ALT indicates?
liver disease, hepatitis, cirrhosis, fatty liver
what does AST/ALT ratio (De Ritis Ratio)> 2 indicates
usually alcoholic liver disease
what does low De Ritis Ratio indicates
maybe hepatitis/ non-alcoholic fatty liver disease
what does decreased albumin level indicates
- hepatic disease, malnutrition
- edema, ascites
- ↑ increased unconjugated (indirect) bilirubin: excessive hemolysis, hepatic damage
what does increased ammonia indicates
- severe hepatocellar injury
- liver cirrhosis
- hepatitis
- may result in hepatic encephalopathy
how can increased level of ammonia causes hepatic encephalopathy
Excessive ammonia cannot be converted into urea because of hepatic dysfunction, and disrupts neuronal function–> brain dysfunction
what happens after hemolysis of old RBC
- hemolysis (breakdown) of old or damaged red blood cells
→ unconjugated bilirubin
→ conjugated bilirubin (converted by liver)
→ enters the hepatic duct to mix with bile
→ to digest fat
what can we assess based on level of bilirubin?
diagnose jaundice and evaluate liver & biliary tract functions
what does increased level of total bilirubin indicates
hemolysis, biliary obstruction, hepatic damage
what does increased unconjugated bilirubin (direct) level indicates
biliary obstruction
what does increased conjugated bilirubin (indirect) level indicates
excessive hemolysis, hepatic damage
what does increased level of amylase and lipase indicate, and what are the symptoms
acute pancreatitis (epigastric pain, nausea, and vomiting)
what does decreased cholesterol indicates
Liver cell damage and cirrhosis, which reduces capacity of cholesterol production
what does increased level of cholesterol indicates
pancreatitis, biliary obstruction
why increased level of cholesterol causes pancreatitis and biliary obstruction
excessive cholesterol in bile–> supersaturation and crystallization of cholesterol–> formation of gallstone
what is CA19-9
Cancer Antigen 19
how can CA19-9 help us
- a tumor marker (GI tract)
- monitor the effectiveness of cancer therapy
- predict the recurrence of cancer
what does increased level of CA19-9 indicates
Ca pancreas, stomach, colon, gallbladder, or
acute pancreatitis, inflammatory bowel diseas
what is CEA
Carcinoembryonic antigen
how can CEA help us
- a tumor marker
- help in the staging of the cancer
what does increased CEA level indicates
stomach, colon, ulcerative colitis, Crohn’s disease, hepatitis, cirrhosis
what is barium swallow test
- Observing the movement of a contrast medium (Barium) with a fluoroscope
- Provide contrast views during swallowing and peristalsis from the pharynx to the duodenojejunal
when to do barium swallow test
when suspected of oesophageal varices, inflammation, ulcerations, hernia, foreign bodies, mass or polyps of the oesophagus, stomach, and duodenum
nursing interventions of barium test (pretest) (2)
- fasting for 8-12 hrs before the test
- Withhold narcotics or anticholinergic medications for 24 hrs pretest
nursing interventions of barium test (posttest) (3)
- Ensure the patient eliminates the barium promptly by taking laxatives since Ba may affect renal function
- Encourage fluids if no contraindication (eg heart failure, edema)
- Inform patient stools may be light-colored for several days
what is the function of Oesophageal Acidity Test
Diagnose problems of the lower oesophageal sphincter (e.g. achalasia 食道賁門失弛緩症,rare)
and chronic reflux esophagitis
what is Oesophageal Manometry
A multi-lumen catheter is placed transnasally to the lower oesophageal sphincter
what is the function of oesophageal manometry
measure oesophageal sphincter pressure and peristaltic contractions
is oesophageal manometry high or low specificity
low
nursing interventions of Oesophageal Acidity Test & Oesophageal Manometry
(pretest) (2)
- Keep fasting for 8-12 hrs before the test
- Avoid the below medications before the test
what medications should be withhold before Oesophageal Acidity Test & Oesophageal Manometry and the reason behind (4)
- Antacids and H2 inhibitors (↑pH)
- Alcohol and corticosteroids (worsen the gastroesophageal reflux)
- Anticholinergics, adrenergic blockers (muscle strength weaken)
- Cholinergics (increase contractility)
what is the purpose of Magnetic Resonance Imaging (MRI) – Upper GI
- Identify the source of bleeding
- Identify lesions, staging of the tumors and breakdown of tissues
nursing interventions of MRI- Upper GI (pretest) (4)
- May keep fasting 6-8 hours before the procedure if contrast media needed
- Ensure a patent intravenous access (for contrast media)
- Remove dental appliances and other metallic objects, e.g. jewelry, hairpins, and watches
- Reassure the patient that he is able to communicate with the technician
at all times in case claustrophobic 幽閉恐懼症
what is the contraindications of MRI-upper GI
metal implant (pacemaker, defibrillator) or other metal fragments
nursing interventions of MRI-upper GI (posttest)
Monitor for any adverse reaction to the contrast medium (e.g. flushing, nausea, urticaria, etc.)
what is Oesophagastroduodenoscopy (OGD)
- a long, flexible fiber-optic tube
- light and a lens for magnification at the distal end
what are the characteristics about anesthesia of OGD
- conscious sedation
- local anesthetic throat spray
- necrotic analgesic for very anxious patient,
e.g. Midazolam (Dormicum) or Fentanyl
what can we do with OGD (3)
- Direct visualized the mucous membrane lining
- Detect inflammation, ulcerations, tumor, bleeding or varices, and gastric motility
- Collect tissue biopsy and secretion specimen
nursing interventions of OGD (pretest) (2)
- Remove dentures
- Keep fasting for 6-8 hrs before the procedure
nursing interventions of OGD (test phase) (2)
- Do suctioning to remove saliva if needed as they block vision with bubbles
- May prepare atropine to reduce the motility of
the intestinal tract and to dry secretion
nursing interventions of OGD (posttest) (5)
- Resume diet until resume gag reflex
- may have mild bloating, belching, or flatulence
- Monitor for any difficulty swallowing, epigastric
pain, fever, vomiting blood; or black tarry stools - prevent aspiration. Do not offer fluids or food by mouth until you are sure that the gag reflex is intact
- Monitor for signs of perforation, such as pain, bleeding, or fever in case the catheter from penetrating the GI tract and cause hemorrhage
what is the purpose of abdominal ultrasound (2)
- Detect abdominal masses or lesions, ascites, and disorders of the appendix
- For directing to take the biopsy of solid organs/masses or for drainage of ascites, abscesses and collections
nursing interventions of abdominal ultrasound (pretest) (2)
- Instruct the patient not to eat, drink, smoke, or chew gum for 6-8 hrs prior to the examination
- For gallbladder studies
- Eat a fat-free meal the evening before the USG (released bile will obstruct the image)
barium swallow, or abdominal ultrasound, should be performed first in case patient have to do both
abdominal ultrasound since USG will be affected by something with color
what is the route of barium enema
Contrast medium Barium will be administered per rectal
what is the purpose of barium enema
Identify structural abnormalities of the colon and rectum e.g. melena, obstruction or masses
nursing interventions of barium enema (pretest) (4)
- Low-residue diet 1 to 2 days before the test
- Clear liquid diet for 24 hrs
- Keep fasting for 8 hrs before the procedure
- Bowel preparation (Klean-Prep)
- A laxatives to empty all the feces the evening before the procedure
- Ingests the lavage solution orally at interval over 3 to 4 hrs
nursing interventions of barium enema (posttest)
- Ensure the patient eliminates the barium promptly by taking laxatives since Ba may affect renal function
- Encourage fluids if no contraindication (eg heart failure, edema, active
inflammatory disease of the colon) - Inform patient stools may be light-colored for several days
purpose of Colonoscopy
- Detect polyps & tumors in colon (most accurate method for colorectal
screening) - Dilate strictures and remove polyps or to take biopsy
nursing interventions of colonoscopy (pretest)
- Same bowel preparation and diet instruction as Barium test
- Fleet enema will be given until the return is clear in the morning of the test
- Ensure IV access for sedation
- Assess patient’s medications: any anticoagulant, anti-platelets & iron
supplements (risk of bleeding)
what situation is not suitable to have colonoscopy
there is a
suspected or documented
colon perforation, acute
severe infection
what conditions should not use colonoscopy
patients with internal
obstruction or inflammatory bowel disease (e.g. ulcerative colitis)
special precautions to conduct colonoscopy on elderly
Monitor any dehydration or electrolyte imbalance after a bowel preparation regarding that they are difficult to ingest large volume of lavage solution
special precautions to conduct colonoscopy on DM patients
Consult doctor about medication adjustment to prevent hyperglycemia
or hypoglycemia which can be caused by fasting
special precautions to conduct colonoscopy on Patients with implantable defibrillators and pacemakers
Consult cardiologist before the procedure since they have high risk for malfunction if the electrosurgical procedure (i.e. Polypectomy) is performed during colonoscopy
nursing interventions of colonoscopy (posttest, in-hospital patient) (4)
- Monitor vital signs every 30 mins/hour until the patient is alert
- Resume diet if patient is fully alert
- Remind the patient that fullness and mild abdominal cramping is expected for several hours
- Assess and monitor for complications:
- hypovolemic shock
- bowel perforation, e.g. rectal bleeding, abdominal pain or distension, fever
nursing interventions of colonoscopy (posttest, out-hospital patient) (4)
- For outpatient, someone must accompany the patient back home
- Education for patients removed polyps:
- Instruct patient to report any bleeding
- Avoid high-fiber foods for 1-2 days to avoid damage lesions
- Do no heavy lifting for 7 days
purpose of sigmoidscopy
Endoscopy for anus, rectum, and sigmoid colon
nursing interventions of sigmoidscopy (pretest)
- Similar to colonoscopy but may not need bowel preparation
- Aim to empty the fecal matter in the lower colon only
nursing interventions of sigmoidscopy (posttest)
same as colonoscopy
purpose of Guaiac fecal occult blood test (G-FOBT)
- Test feces for occult blood (not visible blood)
- Screening test for colon cancer
operation of Guaiac fecal occult blood test (G-FOBT)
- Commercial kit such as Hemoccult II or Occult test
- Collect three fecal samples on three separate days (intermittent bleeding)
nursing interventions of Guaiac fecal occult blood test (G-FOBT)
- Tell the patient to avoid taking (3 days prior to the stool collection)
- Medications: aspirin, NSAIDs, anticoagulants as they promote bleeding
- Food: red meats, fish, broccoli and other high-fiber vegetables, mushrooms
- Supplements: vitamin C, iron supplements (induce false-positive)
why Fecal immunochemical test (FIT) is better than Guaiac fecal occult blood test (G-FOBT)
more advanced, with less restrictions and more convenient
nursing interventions of FIT (3)
- No special dietary restrictions before sample collection
- Recommend 1-2 separate samples
- Enter specimen collection date and time
purpose of stool culture
Identify the bacterial organism that caused intestinal infection
nursing intervention of stool culture
- Provide a clean & dry container to collect stool
- Deliver the sample to the laboratory within 30 minutes
- For women on their menstrual period, take note on the laboratory request
purpose of Magnetic Resonance Imaging (MRI)-Abdomen
Identify sources of GI bleeding and to stage colon cancer
description of Percutaneous transhepatic cholangiogram
- Insert a percutaneous transhepatic biliary drainage (PTBD)
➢ guided by USG with contrast medium
➢ visualize the biliary tract and the location of its obstruction
pretest of Percutaneous transhepatic cholangiogram (5)
- Keep fasting for 12 hours
- Assess for allergy to iodine, seafood, or x-ray dye
- Assess precautions for using contrast medium
- Contraindication: poor clotting profile
- May start prophylactic IV antibiotics 1 hr prior and continue into the posttest period
posttest of Percutaneous transhepatic cholangiogram (3)
- Monitor s/s of bile leakage or haemorrhage or other complications (sepsis, peritonitis)
- Bed rest for 6 hours
- Place patient on right side with pillow support to let bile drained out
purpose of computer tomography of abdomen
- Detecting and localizing:
- inflammatory conditions in the colon (e.g. appendicitis)
- pathologic conditions of abdominal organs (e.g. biliary obstruction)
- Contrast medium may be used
what should we do id contrast medium is needed in abdomen ct (4)
- Assess for allergy to iodine, seafood, or x-ray dye
- Assess precautions for using contrast medium
- Prepare IV access for injection for the contrast medium
- Patient may feel warm and flushed or experience a metallic taste on injection
other nursing intervention for pretest of CT abdomen (2)
- Fasting for 8 hrs
- May need sedation
posttest of abdomen ct (2)
- encourage patient to increase fluid if contrast media was used to enhance excretion of dye
- observe for s/s of allergic reaction to contrast media
what is ERCP
Endoscopic retrograde cholangiopancreatography
purpose of ERCP
- Investigate the biliary or
pancreatic disorder - e.g. obstructive jaundice
- Retrieve gallstones
- Dilate strictures by placing stents
- Take biopsy of tumors
pretest of ERCP (3)
- Assess for allergy to iodine, seafood, or
x-ray dye - Assess precautions for using contrast
medium - Also refer the preparation of OGD
nursing intervention of ERCP in test phase
Do suctioning to remove saliva if needed
posttest of ERCP
- Resume diet until resume gag reflex
- may have mild bloating, belching, or flatulence
- Monitor for any difficulty swallowing, epigastric
pain, fever, vomiting blood; or black tarry stools - prevent aspiration. Do not offer fluids or food by mouth until you are sure that the gag reflex is intact
- Monitor for signs of perforation, such as pain, bleeding, or fever in case the catheter from penetrating the GI tract and cause hemorrhage
ERCP (Discharge education) (3)
- Teach the patient and family to monitor for severe postprocedure
complications at home, including cholangitis (gallbladder inflammation),
bleeding, perforations, sepsis, and pancreatitis - Severe pain or fever
- Remind them that these problems do not occur immediately after the procedure, they may
take several hours to 2 days to develop.
what is MRCP
Magnetic resonance cholangiopancreatography
purpose of MRCP
Evaluate biliary and pancreatic ducts
pretest of using contrast (5)
- Ensure consent signed as contrast may affect renal function
- Assess for allergy to iodine, seafood, or x-ray dye (contain iodine)
- May induce acute kidney injury (AKI)
➢ Assess renal functions i.e. RFT
➢ Withhold Metformin (Metformin cannot be excreted in AKI → lactic acidosis)
➢ Monitor blood glucose level (e.g. H’stix) after suspend metformin
➢ Provide adequate hydration if not contraindicated (e.g. increase fluid intake / IVF) - Prepare IV access
- May feel warm and flushed or experience a metallic taste on injection
test phase of using contrast
- Monitor patient vital signs (respiratory rate & BP) after sedated
- Observe for s/s of allergic reaction to contrast medium
posttest phase of using contrast
- Encourage patient to increase fluid intake to enhance excretion of dye
- Can resume Metformin after 48 hours if normal RFT
A patient with allergic to seafood is going to have CT abdomen with contrast medium. What medication will be given to the patient to prevent allergic reactions?
Steroid premedication before the scan
Two-Dose Regimen:
- 12 hours (or at least) and 2 hours prior to investigation
- 32 mg methyl-prednisolone or 40 mg prednisolone per oral dose
pretest of endoscopy (9)
- Consent
- Fast the patient for 6-8 hrs
- Monitor blood glucose for DM patient (under fasting)
- Suspend anticoagulants, aspirin, or other NSAIDs for several days before the test as prescribed
- Collect baseline of vital signs (RR, BP) as sedation may be given (e.g. Midazolam, fentanyl orpropofol)
- Atropine may be given to dry secretion
- Reassure patient that local anesthetic (to throat) is sprayed to inactivate the gag reflex
- Remove dentures
- Prepare IV access for injection of the contrast medium (in ERCP) or sedation
posttest of endoscopy (7)
- Assess vital signs every 30min/hour until stable
- Keep NPO until the gag reflex returns (usually in 30-60 mins)
- If contrast media is used:
-encourage patient to increase fluid to enhance excretion of dye
-observe for s/s of allergic reaction to contrast media - Observe for s/s of urinary retention if atropine is used
- Monitor and report any s/s of perforation or bleeding
- For outpatient, ensure the patient has someone to accompany him home
- Teach him that a hoarse voice or sore throat may persist for several days. Throat lozenges can be used to relieve throat discomfort
