Unit 3: Chp 55: Diagnostic Studies for Gastrointestinal Assessment

Question 1

Laboratory Studies

Answer 1

• Complete Blood Count (CBC)
• Serum chemistry panel
• Prothrombin Time (PT)
• Liver Function Tests (LFTs)
• Urine analysis
• Stool samples

Question 2

Laboratory Studies: Complete Blood Count (CBC)

Answer 2

• 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

Question 3

Laboratory Studies: Serum Chemistry Panel

Answer 3

• obtained to assess for electrolyte imbalances associated w/ impaired absorption or excretion
• serum albumin, prealbumin, and transferrin levels provide data regarding nutritional status

Question 4

Laboratory Studies: Prothrombin Time

Answer 4

• 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

Question 5

Laboratory Studies: Liver Function Tests (LFTs)

Answer 5

evaluated w/ suspected hepatic (liver) dysfunction

• ALT
• AST
• Albumin
• Bilirubin

Question 6

Laboratory Studies: Urine Analysis

Answer 6

indicated in patients w/ suspected pancreatitis b/c urine amylase is elevated in this disorder

Question 7

Laboratory Studies: Stool samples

Answer 7

in patients w/ complaints of changes in bowel pattern; collected for occult blood

Question 8

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

Answer 8

B. Serum amylase

Question 9

Patients presenting w/ complaints of abdominal pain typically undergo what diagnostic test?

Answer 9

Plain X-ray of the abdomen

Question 10

Diagnostic Test: Plain x-ray of abdomen

Answer 10

• 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

Question 11

Presence of air in the abdomen

Answer 11

consistent with an obstruction and requires further assessment b/c perforation can occur w/ increasing pressure behind the obstruction

Question 12

Diagnostic Tests

Answer 12

• Plain x-ray of abdomen (routine)
• Ultrasonography
• Barium Studies
• Endoscopy

Question 13

Ultrasonography

Answer 13

• 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

Question 14

Ultrasonography: Abdominal Cavity

Answer 14

evaluated for presence of ascites

Question 15

Ultrasonography: of Liver and Pancreas

Answer 15

visualized to detect cysts, tumors, or masses

Question 16

Ultrasonography: Gallbladder and Kidneys

Answer 16

further visualized for stones

Question 17

Ultrasonography: As a therapeutic intervention

Answer 17

can be utilized to place stents in obstructed areas

Question 18

Barium Studies

Answer 18

• consists of a series of x-rays

- ordered to examine integrity and patency of the GI tract; can be diagnostic or therapeutic

Question 18

Barium Studies

Answer 18

• 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

Question 19

Barium Studies: Upper GI Series

Answer 19

visualizes the esophagus, stomach, and duodenum

Question 20

Barium Studies: Small bowel series

Answer 20

visualizes small intestine

Question 21

Barium Studies: Barium Enema

Answer 21

visualizes the colon

Question 22

Preparation for Barium Studies

Answer 22

• 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

Question 23

Safety Alert: Post-procedure care for Barium Studies

Answer 23

increased fluid intake and/or enemas are necessary to prevent constipation and impaction in patients who undergo barium studies

Question 24

``` 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 ```

Answer 24

D. Constipation

Question 25

Endoscopy

Answer 25

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

Question 26

After an upper endoscopy

Answer 26

nurse monitors for the return of swallow before providing oral intake to decrease risk of aspiration

Question 27

After a lower endoscopy

Answer 27

anticoagulation and aspirin are usually held temporarily d/t risk of bleeding

Question 28

Gastric Analysis

Answer 28

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

Question 29

Teachings for Gastric Analysis

Answer 29

- NPO from 8-12 hours | - refrain from caffeine and alcohol intake at 24 hours prior to test

Question 30

Gastric Analysis: Pre/Intra/Posttest

Answer 30

>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

Question 31

Stool Analysis

Answer 31

collected to assess presence of: - Blood (gross and occult) - Fecal leukocytes - Bacteria (C.diff) - Parasites - Fat

Question 32

Patient Teaching regarding stool analysis

Answer 32

education on rationale for test and specimen collection methods

Question 33

Stool Analysis: Pre/Intra/Post

Answer 33

>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

Question 34

Liver Function Test: ALT

Answer 34

Male: 13-40 units/L Female: 24-36 units/L

Question 35

Liver Function Test: Albumin

Answer 35

3.4 to 5.1 g/dL

Question 36

Liver Function Test: AST

Answer 36

Male: 20 to 40 units/L Female: 15-35 nits/L (both 20 point difference)

Question 37

Bilirubin

Answer 37

>Total Bilirubin: 0.3-1 mg/dL >Indirect Bilirubin: 0.2-0.8 mg/dL >Direct Bilirubin: 0.1-0.3 mg/dL

Question 38

Liver Function Tests: Pre/Intra/Post Test

Answer 38

- collected in a red-top tube - previous intramuscular injections may cause increased levels - collected in gold-, gray, or red top tube