Med-Surg GI ATI Unit 7 Flashcards
what are the types of liver function tests and their values/implications
1) aspartate aminotransferase (AST) - 5-40units/L
- elevation occurs with hepatitis or cirrhosis
2) alanine aminotransferase (ALT) - 8-20 units/L; 3-35 IU/L
- elevation occurs with hepatitis or cirrhosis
3) alkaline phophatase (ALP) - 30-120 units/L; 30-85 IU/L
- elevation indicates liver damage
4) total bilirubin - 0.1 to 1.0 mg/dL
con jugated 0.1 to 0.3 mg/dL
- elevations indicate altered liver function, bile duct obstruction, or other hepatobiliary disorder
5) albumin - 3.5 - 5.0 g/dL
- decrease may indicate hepatic disease
blood tests that have information on GI system
- amylase - 56-90 IU/L
- elevation occurs with pancreatitis - lipase: 0-110
- same as amylase - less than 40 mcg/L
- elevated in liver cancer
4) ammonia 15-110 mcg/dL
- elevated in liver disease
urine bilirubin
- also known as urobilinogen, tests bilirubin in urin
- for suspected liver or biliary tract disorder
FOBT and stool samples for
1) C diff
2) parasites/ova
3) blood for GI bleeding (ulver, colitis, cancer)
4) vimentin gene - indicator of colorectal cancer
FOBT/stool sample to know
NAs
1) occult blood: card with guaiac; 3 samples required
2) for ova/parasites provide with collection cup
Education
- red meat/anticoag restriction
- for collection cup, need for refrigeration and time to lab
what do clients usually present with for endoscopy needed
1) anemia secondary to bleeding
2) ab discomfort
3) ab distention or mass
procedure for endoscopy
Pre NAs: a) consent form b) vita sign/allergies c) labs/hx
note. ..
- fluid/food restriction before
- meds don’t do NSAIDs, warfarin, aspiring
- previous barium admin
- proper laxatives, flushes
- electrolyte/fluid status
endoscopic procedures
1) Colonoscopy: flexible fiber-optic scope throiugh anus to see rectum, sigmoid, and colon
- moderate sedation with midazolam (Versed) and opiate analgesics
- left-side with knees to chest
- bowel prep like bisacodyl (Dulcolax) and polyethylene glycol (GOLYTELY) laxitives; clear liquid diet (no red/purple/orange); NPO after midnight
Post: a) severe pain could be perforation or sign of hemorrhage 2) recetal bleeding 3) vital signs/rr 4) resume normal diet 5) increase fluid intake 6) possible flatulence b/c of air instillation during procedure
2) EGD (esophagogastroduedenoscopy): endoscope through mouth into esophagus, stomach, duodenum
- moderate sedation - top anesthetic
- left-side lying
- NPO 6-8 hr prep, remove dentures prior to procedure
- Postprocedure: monitor vital sign/rr; notify of bleeding or pain; WITHHOLD fluids until return of gag reflex
3) ERCP (endoscopic retrograde cholangiopancreatography): insertion of endoscope through mouth into biliary tree via duodenum, allows visualization of biliary ducts, gall bladder, liver, pancrea
- conscious sedation - topical anesthetic
- initially semi-prone with repositioning
- NPO 6-8 hr prior, removes dentures
- Post: vitals/RR; bleeding pain infection; withouhold fluids until return of gag reflex
4) sigmoidoscopy: scope shorter than colonscope, anus rectum sigmoid of colon
- no anesthesia required
- positioned on the left side
- Prep: bowel prep like laxatives; clear liquid diet; npo after midnight; avoid certain meds
- post: vitals/rr; rectal bleeding; resume diet normal; fluid intake; flatulence from air
Complications of endoscopic procedures
1) oversedation (difficult to arouse, poor rr, hypoxemia, tachycardia, elevated or low bp) - don’t drive
2) hemorrhage: bleeding, cool/clammy skin, hypotension, tachycardia, dizziness, tachypnea
3) aspiration (dyspnea, tachypnea, tachycardia, advent breath sounds, fever)
4) perforation of GI tract: chest/ab pain, fever, nausea, vomitting, ab distention
GI series
- for assessing anatomic or funcitonal abnormalities
- drink barium or done with enema (makes stools white 24-72 hours after until clears)
what are GI therapeutic procedures
1) enteral feedings
2) total parenteral nutrition (TPN)
3) paracentesis
4) nasogastric decompression
5) bariatric surgeries
6) ostomies
Infor on enteral feedings
- can no longer take nutrition orally
Indications: intubated clients, pathologies that cause dysphagia or risk of aspiration, need supplementation
Presentation: malnutrition, aspiration pneumonia
Complications:
1)overfeeding and client can’t digest fast enough resulting in ab distention, N/V
NAs
a) check residual q 4-6 hours
b) follow protocol for witholding excess residual volumes as directed (typically 100-200 mL)
c) withhold feeding as prescribed and resume at reduced rate per rx
2) diarrhea NAs a) slow rate of feeding/notify provider b) confer with dietitian c) provide skin care and protection
3) aspiration pneumonia
- can be secondary to aspiration of feeding: tube displacement primary cause of aspiration of feeding
NAs
a) stop feeding
b) turn client to side and suciton airway, O2
c) monitor vitals/temp
d) auscultate breath sound
e) notify provider/obtain chest xray prn
TPN overview
total parenteral nutrition
- hypertonic iv bolus solution, purpose of admin is to prevent or correct nutritional deficiencies and minimize AEs of malnourishment
a) usually through central line like tunneled triple lumen catheter or single/double lumen PICC line
b) standar iv bolus is less than or equal to 700 calories/day
c) partial pn or PPN is less hypertonic and for short-term admin in larger peripheral vein, usual dextrose concentration is less than 10% RISK INCLUDES PHLEBITIS
what are the basic guidelines when to initiate TPN
- weight loss of 7% body weight and NPO for 5 days or more
- hypermetabolic state
flow rate of TPN
usually adjusted up or down by 10% increments; NEVER abruptly stop TPN
what should you keep by the bedside when admin TPN via IV
- 10% dextrose solution in case it’s unexpectedly ruined or next bag isn’t available, will minimize risk of hypoglycemia
if an air bolus while admin TPN occurs what should you do?
clamp catheter immediately, put patient on left side to trap air, admin O2 and call provider
what’s big with TPN?
infection risk, don’t use anything else in this tube
