L1 Assessment of Digestive & Gastrointestinal Functions Flashcards
What history do we need to ask our patients?
Previous and current relating disorders, treatment/surgeries/diagnostic studies, medication or supplements taken, nutritional status(daily food intake, appetite.BW, bowel)
Any special history that we need to ask?
Spiritual:Religious food restrictions
What do we call “err氣” and “fart”?
Belching(burping) & flatulence
Which 3 aspects should we assessed for nausea and vomiting?
1.visceral afferent stimulation:infections, obstruction, heptaobiliary disorders
2.CNS disorders:increase ICP, migraine, psychogenic
3.irritation of the chemotherapy
What kinds of food alter these stool colors respectively? 1.Dark brown 2.Light yellow/Green 3.Black
4.Milky white
1.Cocoa 2.Senna 3.Bismuth,Iron,Licorice,
Charcoal 4.Barium
What problem leads to pencil-like stool?
Rectal area contraction, stenosis from malignancy
What is the correct sequence of physical assessment of the abdomen?
Inspection–>Auscultation–>Percussion–>Palpation
What could be the sign of abdominal aortic aneurysm(AAA)? And what should we do?
Bulging and pulsating mass. DO NOT touch and report immediately
What could peristaltic movements mean?
1.Normal since the patient is thin and has increased peristalsis 2.intestinal obstruction
What position is chosen for rectal physical exams?
knee-chest, left lateral with hips and knees flexed
What are the purpose of diagnostic tests?
1.Assess nutritional status and function of GI and accessory organs
2.Provide info to identify/modify appropriate medication or therapy used
3.Moniter response to treatment and nursing interventions
What lab assessment need to be done before carrying out the diagnostic test?
BLOOD:
1.CBC(Hb↓&WBC↑)
2.Clotting Profile(Prothrombin Time↑&INR)
3.Renal function(Electrolyte)
LIVER:
1.↑AST(Aspartate transaminase)&↑ALT(Alanine aminotransferase)
2.↓Albumin
3.↑Ammonia
4.↑Bilirubin
OTHER:
1.Amylase&Lipase
2.Cholesterol
3:Oncofetal antigens
3a:CA19-9(tumor marker of GI)
3b:CEA(tumor marker for staging)
For Barium used diagnostic test, Barium swallow and enema, what should be ensured for the post-test?
Eliminate the barium promptly(asap) by laxatives +/- encourage fluid intake; inform patient that the stools may be light-coloured (milky white)for few days
What is the difference of the purpose of the two Barium-used diagnostic test?
Swallow: Check any varices, inflammation, ulcerations, hernia, foreign bodies, mass, polyps of oesophagus, stomach and duodenum
Enema: Identify structural abnormalities of colon and rectum, e.g. melena, obstruction, masses
How does the Barium-used tests are done?
Contrast medium (Barium) is administered(swallow/per rectal) to provide a contrast view. For swallow, the view is during swallowing and peristalsis from pharynx to the duodenojejunal
What is the difference of the pretest of the two Barium-used tests?
Both need fasting for 8-12hrs before the test
Swallow: withhold narcotics/anticholinergic medications for 24hrs
Enema: Low-residue diet 1-2 days before→Clear liquid diet for 24hours→keep fasting 8 hours+Klean-Prep
What is Klean-Prep?
By ingesting laxative solution orally Q3/4H to empty all feces the evening before the test
How does Oesophageal Acidity Test & Manometry be done?
Place a multi-lumen catheter transnasally to lower oesophageal sphincter which measure the sphincter pressure and peristaltic contractions
What are oesophageal acidity test and manometry done for?
To diagnose problem of lower oesophageal sphincter/achalasia 食道底下肌肉無法有效contract, 所以推唔到啲食物去胃度 and chronic reflux esophagitis 因為胃酸倒流刺激到食道所以發炎
What should we do before the Oesophageal Acidity Test and Manometry
Keep fasting 8-12hrs before, Avoid drugs that alter the pH(antacids, H2 inhibitors); weaken (anticholinergics, adrenergic blockers) or strengthen (cholinergics) smooth muscle ;Alcohol & corticosteroids that worsen the gastroesophageal reflux
What kinds of patient are not suitable to have the Magnetic Resonance Imaging? [Contraindications]
Patients with metal implant or other metal fragments
What can MRI do?
Identify the sources of bleeding, identify lesions and staging of cancers/tumors, evaluate the organs
What should we do if contrast media is needed for MRI?
1.Ensure fasting for 6-8hrs
2.IV assess
What should always ensure for MRI?
1.Remove all metallic objects and dental appliances
2.Make sure the patient is able to communicate–>so the patient can talk with the technician even suffer from claustrophobic 幽閉恐懼症