TLO 2.4 Gastrointestinal/Bowel Adult Flashcards
Barium enema, what is it?
X-ray exam where contrast medium is inserted rectally
Identified structural abnormalities of colon and rectum
Generally no sedation
Enemas not sterile
Barium enema nursing implications
Pre procedure: Signed consent Clear liquids 24 hr prior, NPO 8 hr prior Bowel prep Post procedure: Increase fluid intake Take laxative if ordered Stools white until barium expelled
Gastrointestinal diagnostic tests
Proctoscopy
Visualized rectum using proctoscope
Air inserted to expand rectum
Evaluate abnormal results from the barium enema
Looks at causes of bleeding and monitor polyp growth
Proctoscopy nursing implications
Enema day before or day of the cleanse bowel
Cramping and pressure common during procedure
Normal to feel and hear air escaping during procedure
If cramps continue post= ambulate
Knee chest or left lateral position
Signed consent
Sigmoidoscopy what is it?
Provides visualization of anal canal, rectum and sigmoid colon
Rigid metal scope or flexible scope
Usually no sedation
Sigmoidoscopy nursing implications
Signed consent Bowel prep pre policy/order Clear liquid diet 24-48 hr prior NPO after midnight prior May have cramping after If biopsy done may have some blood traces, avoid high fiber foods for 1-2 days, no heavy lifting for 7 days
Colonoscopy, what is it?
Visualization of entire colon to the ileocecal valve using a flexible endoscope
Identifies tumors, polyps and inflammatory bowel diseases
Can dilate strictures
Colonoscopy nursing implications
Bowel prep per orders
Diet per order, clear liquids, NPO, no red/purple liquids
Sedation usually given, need consent
if polyps removed: avoid high fiber foods 1-2 days, no heavy lifting for 7 days
Hernias, what is it?
A defect in the abdominal wall that allows its contents to protrude out of the abdominal cavity
Types of hernias?
Umbilical:
-located by the umbilicus
Inguinal:
- direct: defects and weakness of the posterior inguinal wall, usually affect older adults
- indirect: congenital
Femoral
Strangulated (blocks and obstructs blood flow to intestine). This is a common complication with umbilical hernias
Hernia surgical treatment
herniorrhaphy:
involves reinforcing the weakened area with a wire, fascia or mesh
Strangulated hernia
Requires exploratory surgery and infarcted bowel resected.
Post operative hernia care assessment
Assess: Bowel sounds Abdominal distention Pain Incision Lung sounds Coughing, deep breathing Ability to void
Factors affecting bowl elimination
Developmental age Diet Activity Psychologic factors Defecation habits Medications Diagnostic procedures Anesthesia and surgery Pathologic conditions Pain
Bowel assessment, history and assessment
Obtain history:
Normal bowel habits
Any changes
History of problems or use of aids
Assess:
Bowel sounds
Follow- inspect, auscultate, percuss, palpate
Bowel assessment sounds and color
Sounds:
Active- high pitched approx. 5-15 gurgles/min
Hypo- low pitched, infrequent, quiet
Hyper- very high pitched more frequent
Absent- no sounds after 3-5 min
Color:
Normal- brown r/t bile pigment
Light brown- r/t diet high in milk, low in meat
Pale- r/t malabsorption of fat
Black/tarry- r/t iron, upper GI bleed, diet high in red meat
