Med-Surg-Gastrointestinal Flashcards
Gastrointestinal diagnostic procedures often involve ________ and __________ to visualize parts of the gastrointestinal system and to evaluate gastrointestinal contents.
scopes and x-rays
common gastrointestinal diagnostic procedures are:
liver function tests and other blood tests urine bilinogen fecal occult blood test (FOBT) endoscopy gastrointestinal (GI) series
aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), bilirubin, and albumin are all:
liver function tests
Blood tests that provide info on the functioning of the GI system include:
amylase, lipase, alpha-fetoprotein, and ammonia
expected reference range from aspartate aminotransferase (AST)
5 - 40 units/L
if the level of aspartate aminotransferase (AST) is elevated what condition is likely?
hepatitis or cirrhosis
expected reference range from alanine aminotransferase (ALT)
8 - 20 units/L
if the level of alanine aminotransferase (ALT) is elevated what condition is likely?
hepatitis or cirrhosis
expected reference range from Alkaline phosphatase (ALP)
30 - 120 units/L
30 - 85 IU/L
if the level of alkaline phosphatase is elevated what condition is likely?
this indicates liver damage
expected reference range of amylase
56 to 90 IU/L
expected reference range of lipase
0 - 110 units/L
elevation of amylase and lipase is indicative of
pancreatitis
expected reference range of total bilirubin
0.1 to 1.0 mg/dL
expected reference range of direct (conjugated) bilirubin
0.1 to 0.3 mg/dL
elevations of these indicate altered liver function, bile duct obstruction, or other hepatobiliary disorder
total bilirubin, direct (conjugated) bilirubin, indirect (unconjugated) bilirubin
expected reference range of indirect (unconjugated) bilirubin
0.2 to 0.8 mg/dL
expected reference range of albumin
3.5 to 5.0 g/dL
what does a decrease in albumin indicate
decrease can indicate hepatic disease
expected range of alpha-fetoprotein
less than 40 mcg/L
what is expected of alpha-fetoprotein levels with liver cancer?
elevation occurs with liver cancer
expected range of ammonia levels
15 to 110 mcg/dL
what is indicative of an elevated ammonia level in the blood?
elevation occurs with hepatic encephalopathy, cirrhosis, liver cancer or liver disease
urine bilirubin aka
urobilinogen
a urine test to determine the presence of bilirubin in the urine.
urobilinogen
interpretation of findings of a urobilinogen test
positive or elevated finding indicates possible liver disorder (cirrhosis or hepatitis) or biliary obstruction.
pre-procedure nursing actions for a urine bilirubin or urobilinogen
use a dipstick for urine bilirubin or a 24-hr urine collection for urobilinogen.
pre-procedure client education for urine bilirubin or urobilinogen
show the client how to collect urine and provide proper collection container
post-procedure nursing actions for urine bilirubin or urobilinogen
inform the client when and how results are provided
a stool sample is collected and tested for:
blood, ova and parasites (giardia lamblia) and bacteria (clostridium difficile). also to test for DNA changes in the vimentin gene.
indications for administering urine bilirubin diagnostic procedure
suspected liver or biliary tract disorder
indications for administering liver function and other blood tests
suspected liver, pancreatic or biliary tract disorder
indications for administering fecal occult blood test or taking a stool sample.
gastrointestinal bleeding, unexplained diarrhea, foul-smelling stools, abdominal pain, mucus in stool
a change in the vimentin gene can be an indicator or
colorectal cancer
Pre-procedure nursing actions for an occult blood test are
provide the client with cards impregnated with guaiac to mail to the provider or with a specimen collection cup.
how many samples are needed if the cards impregnated with guaiac are used
3
pre-procedure nursing actions for a stool sample to test for parasites and bacteria
provide the client with a specimen or collection cup
pre-procedure client education for an occult blood test
instruct the client about proper collection technique. also the client may need instructions about dietary and medication restrictions to follow prior to obtaining samples (red meat, anticoagulants)
pre-procedure client education for stool samples to test for ova and parasites and bacteria
instruct the client about proper collection technique (time frame for submission to laboratory, need for refrigeration)
post-procedure nursing actions for fecal occult blood test or stool samples
inform the client when and how the results are provided.
These procedures allow direct visualization of body cavities, tissues, and organs through the use of a flexible, lighted tube.
Endoscopic procedures
why are endoscopic procedures used?
for diagnostic and therapeutic purposes. biopsies, removal of abnormal tissue, perform minor surgery such as cauterizing a bleeding ulcer. contrast medium can be inject to allow visualization of structures beyond the capabilities of the scope.
names of gastrointestinal scope procedures
colonoscopy, esophagogastroduodenoscopy (EGD), endoscopic retrograde cholangiopancreatography (ERCP), sigmoidoscopy
what are the potential diagnoses indicated by gastrointestinal scope procedures?
gastrointestinal bleeding, ulcerations or inflammation, polyps, malignant tumors
what client presentation will indicate the need for a gastrointestinal scope procedure?
anemia (secondary to bleeding), abdominal discomfort, abdominal distention or mass
interpretation of findings from a gastrointestinal scope procedure may indicate a need for:
medication or surgical removal of a lesion
pre-procedure nursing actions for a gastrointestinal scope procedure:
Evaluate clients understanding of procedure
verify that the client has signed a consent form
vital signs and ask about allergies
evaluate baseline lab tests and report unexpected findings to the provider.
evaluate chest xray, ecg and abgs
evaluate medical history for increased risk of complications
what information obtained from a medical history can indicate risk of complications?
Age recent food or fluid intake medications previous radiographic examinations electrolyte and fluid status ensure client has been NPO ensure client has followed proper bowel preparation
