Unit 3: Chp 55: Diagnostic Studies for Gastrointestinal Assessment Flashcards
Laboratory Studies
- Complete Blood Count (CBC)
- Serum chemistry panel
- Prothrombin Time (PT)
- Liver Function Tests (LFTs)
- Urine analysis
- Stool samples
Laboratory Studies: Complete Blood Count (CBC)
- provides information about potential blood loss through assessment of the red blood cell count (RBC), hemoglobin, and hematocrit
- white blood cell count (WBC) indicated for evaluation of inflammatory or infectious processes
Laboratory Studies: Serum Chemistry Panel
- obtained to assess for electrolyte imbalances associated w/ impaired absorption or excretion
- serum albumin, prealbumin, and transferrin levels provide data regarding nutritional status
Laboratory Studies: Prothrombin Time
- w/ suspected liver disease
- important to assess clotting b/c this test measures the time required for prothrombin to be converted to thrombin and may be prolonged b/c of impaired synthesis of clotting factors in the liver
Laboratory Studies: Liver Function Tests (LFTs)
evaluated w/ suspected hepatic (liver) dysfunction
- ALT
- AST
- Albumin
- Bilirubin
Laboratory Studies: Urine Analysis
indicated in patients w/ suspected pancreatitis b/c urine amylase is elevated in this disorder
Laboratory Studies: Stool samples
in patients w/ complaints of changes in bowel pattern; collected for occult blood
Connection Check: The nurse correlates an increase in which laboratory value w/ the diagnosis of pancreatitis? A. Serum sodium B. Serum amylase C. Serum potassium D. Serum creatinine
B. Serum amylase
Patients presenting w/ complaints of abdominal pain typically undergo what diagnostic test?
Plain X-ray of the abdomen
Diagnostic Test: Plain x-ray of abdomen
- patients w/ complaints of abdominal pain undergo a routine plain x-ray of the abdomen
- reveals abnormal masses, obstruction, or strictures
- requires no preparation; just an explanation
Presence of air in the abdomen
consistent with an obstruction and requires further assessment b/c perforation can occur w/ increasing pressure behind the obstruction
Diagnostic Tests
- Plain x-ray of abdomen (routine)
- Ultrasonography
- Barium Studies
- Endoscopy
Ultrasonography
- uses a doppler
- soundwaves are transmitted to a particular organ
- sound waves are converted to an electronic image to provide a real-time depiction of the soft tissue structure
- can detect any size and structural abnormalities of the underlying abdominal cavity organs and vessels
- preferred method of visualization of abdominal structures in patients who cannot tolerate contrast dye
Ultrasonography: Abdominal Cavity
evaluated for presence of ascites
Ultrasonography: of Liver and Pancreas
visualized to detect cysts, tumors, or masses
Ultrasonography: Gallbladder and Kidneys
further visualized for stones
Ultrasonography: As a therapeutic intervention
can be utilized to place stents in obstructed areas
Barium Studies
- consists of a series of x-rays
- ordered to examine integrity and patency of the GI tract; can be diagnostic or therapeutic
Barium Studies
- consists of a series of x-rays
- ordered to examine integrity and patency of the GI tract; can be diagnostic or therapeutic
- with the use of fluoroscopy, patients are taken through a series of time-sensitive x-rays
- several studies that can be performed: upper gastrointestinal series, small bowel series, or barium enema
Barium Studies: Upper GI Series
visualizes the esophagus, stomach, and duodenum
Barium Studies: Small bowel series
visualizes small intestine
Barium Studies: Barium Enema
visualizes the colon
Preparation for Barium Studies
- special diet (clear liquids) before the test
- NPO after midnight (8-12 hours prior to study)
- laxative or enema may also be prescribed for the night before the study
- patients typically given barium, a radiographic opaque liquid, to drink
- if concern for possible perforations anywhere along the GI tract, a water-soluble liquid, gastrografin, is administered
Safety Alert: Post-procedure care for Barium Studies
increased fluid intake and/or enemas are necessary to prevent constipation and impaction in patients who undergo barium studies
Connection Check: The nurse monitors for which complication in the patient who has undergone a barium enema? A. Fluid overload B. Dehydration C. Diarrhea D. Constipation
D. Constipation
Endoscopy
general term used to describe the procedure in which a fiberoptic scope is used to visualize the GI tract
- endoscopic studies serve 3 purposes: diagnostic, curative, or palliative
- patients are sedated with a narcotic and a sedative
After an upper endoscopy
nurse monitors for the return of swallow before providing oral intake to decrease risk of aspiration
After a lower endoscopy
anticoagulation and aspirin are usually held temporarily d/t risk of bleeding
Gastric Analysis
after a period of fasting, gastric fluid is obtained through a nasogastric (NG) tube or during endoscopic procedure
- measures gastric acidity
- assess for presence of: blood, bacteria, medications
Teachings for Gastric Analysis
- NPO from 8-12 hours
- refrain from caffeine and alcohol intake at 24 hours prior to test
Gastric Analysis: Pre/Intra/Posttest
> Pretest:
- patient education
- remove loose dentures
- assess medication intake
> Intratest:
-monitor for patient distress during NG insertion
> Posttest:
- monitor vital signs
- patient education on reporting symptoms associated w/ postprocedural complications, further treatment, or lifestyle changes
Stool Analysis
collected to assess presence of:
- Blood (gross and occult)
- Fecal leukocytes
- Bacteria (C.diff)
- Parasites
- Fat
Patient Teaching regarding stool analysis
education on rationale for test and specimen collection methods
Stool Analysis: Pre/Intra/Post
> Pretest:
- analysis and studies should be done prior to the administration of antibiotics, antidiarrheal medications, and laxatives
- stool specimen should not be collected from toilet
- patient education on specimen collection
> Posttest:
-patient education on contact isolation if C.diff cultures are positive
Liver Function Test: ALT
Male: 13-40 units/L
Female: 24-36 units/L
Liver Function Test: Albumin
3.4 to 5.1 g/dL
Liver Function Test: AST
Male: 20 to 40 units/L
Female: 15-35 nits/L
(both 20 point difference)
Bilirubin
> Total Bilirubin: 0.3-1 mg/dL
Indirect Bilirubin: 0.2-0.8 mg/dL
Direct Bilirubin: 0.1-0.3 mg/dL
Liver Function Tests: Pre/Intra/Post Test
- collected in a red-top tube
- previous intramuscular injections may cause increased levels
- collected in gold-, gray, or red top tube
