Git Part 1- Run

GIT part 1 Ruby Ruth Roces, R.N., M.D.

Common laboratory Procedures

COMMON LABORATORY PROCEDURES FECALYSIS Examination of stool consistency, color and the presence of occult blood.  Special tests for fat, nitrogen, parasites, ova, pathogens and others 

COMMON LABORATORY PROCEDURES FECALYSIS: Occult Blood Testing 3-day meatless diet  No intake of NSAIDS, aspirin, iron,steroids & anti-coagulant 48 Hrs prior  3 stool specimen  Screening test for colonic 

Test for ova- fresh stool  Test for lipids- inc fat diet, no alcohol 3 days prior 72 hr stool specimen- store in ice no mineral oil, no neomycin SO4 

COMMON LABORATORY PROCEDURES

Upper GIT study: barium swallow Pre-test: NPO post-midnight  Post-test: Laxative is ordered, increase pt fluid intake, instruct that stools will turn white, monitor for obstruction 

COMMON LABORATORY PROCEDURES

Lower GIT study: barium enema Pre-test: low residue diet x 12 days, Clear liquid diet and laxatives, NPO post-midnight, cleansing enema prior to the test  Post-test: Laxative is ordered, increase patient fluid intake, 

COMMON LABORATORY PROCEDURES

Gastric analysis 

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Aspiration of gastric juice to measure pH, appearance, volume and contents- NGT is inserted, connected to suction & contents collected q 15 mins to 1 hr. Pre-test: NPO 8-12 hours, avoidance of stimulants& drugs for 24-48 hrs, cigarette and chewing gum for 6 hrs before test

COMMON LABORATORY PROCEDURES

Lower GI- scopy (anoscopy, proctoscopy, sigmoidoscopy, colonoscopy) Pre-test: consent, clear liquids 24 hrs,NPO 8 hours, cleansing enema until return is clear  Intra-test: position is LEFT lateral, right leg is bent and placed anteriorly 

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Post-test: supine for few minutes to prevent orthostatic hypotensionbed rest, monitor for complications like bleeding and perforation

COMMON LABORATORY PROCEDURES Paracentesis

Pre-test: ensure consent, instruct to VOID and empty bladder, measure abdominal girth  Intra-test: Upright on the edge of the bed, back supported and feet resting on a foot stool 

postprocedure:  monitor vs, hypovolemia, elecstrolyte loss, hematuria  instruct to notify if urine become s bloody, pink, red  apply a dry sterile dressing  measure fluid collected, describe and record 

Conditions of the GIT

UPPER GI system

CONDITION OF THE ESOPHAGUS HIATAL HERNIA 

Protrusion of the esophagus into the diaphragm thru an opening

CONDITION OF THE ESOPHAGUS ASSESSMENT  1. Heartburn  2. Regurgitation  3. Dysphagia  4. 50%- without symptoms

CONDITION OF THE ESOPHAGUS

DIAGNOSTIC TEST Barium swallow and fluoroscopy

CONDITION OF THE ESOPHAGUS

NURSING INTERVENTIONS small frequent feedings  AVOID supine position for 1 hour after eating  Elevate the head of the bed on 8inch block  avoid anticholinergic wch delays emptying 

CONDITION OF THE ESOPHAGUS Esophageal Varices Dilation and tortuosity of the submucosal veins in the distal esophagus  ETIOLOGY: commonly caused by PORTAL hypertension secondary to liver cirrhosis  This is an Emergency condition! 

CONDITION OF THE ESOPHAGUS ASSESSMENT    

Hematemesis Melena Ascites jaundice

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hepatomegaly/splenomegaly 

Signs of Shock

CONDITION OF THE ESOPHAGUS

DIAGNOSTIC PROCEDURE Esophagoscopy

COMMON LABORATORY PROCEDURES

EGD (esophagogastroduodenosco py) 

Pre-test: ensure consent, NPO 8 hours, pre-medications like atropine and anxiolytics, remove dentures, local spray to post. Pharynx-advise not to swallow

COMMON LABORATORY PROCEDURES

EGD 

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Intra-test: position : LEFT lateral to facilitate salivary drainage and easy access Post-test: NPO until gag reflex returns, place patient in SIMS position until he awakens, monitor for complications, saline gargles for mild oral discomfort

CONDITION OF THE ESOPHAGUS NURSING INTERVENTIONS 1. Monitor VS strictly.  2. Monitor for LOC  3. Maintain NPO  4. Monitor blood studies  5. Administer O2  6. prepare for blood transfusion 

CONDITION OF THE ESOPHAGUS 

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7. prepare to administer Vasopressin and Nitroglycerin 8. Assist in NGT and SengstakenBlakemore tube insertion for balloon tamponade 9. Prepare to assist in surgical management: – Endoscopic sclerotherapy – Variceal ligation – Shunt procedures

Conditions of the Stomach Gastro-esophageal reflux due to incompetent lower esophageal sphincter , pyloric stenosis or motility disorder  Symptoms may mimic ANGINA or MI 

Conditions of the Stomach ASSESSMENT ( for GERD)  Heartburn  Dyspepsia  Regurgitation  Epigastric pain  Difficulty swallowing  Ptyalism

Diagnostic test  Endoscopy or barium swallow  Gastric ambulatory pH analysis – Note for the pH of the esophagus, usually done for 24 hours – The pH probe is located 5 inches above the lower esophageal sphincter – The machine registers the different pH of the refluxed

Conditions of the Stomach NURSING INTERVENTIONS  AVOID stimulus that increases stomach pressure and decreases LES pressure ( spices, coffee, tobacco and carbonated drinks)  LOW-FAT, HIGH-FIBER diet

Conditions of the Stomach NURSING INTERVENTIONS

Avoid foods and drinks TWO hours before bedtime  Elevate the head of the bed with an approximately 8-inch block  Administer prescribed meds  Advise proper weight reduction 

Conditions of the Stomach GASTRITIS  Inflammation of the gastric mucosa  May be Acute or Chronic  Etiology: Acute- bacteria, irritating foods, NSAIDS, alcohol, bile and radiation, Autoimmune disease, diet, smoking

Conditions of the Stomach DIAGNOSTIC PROCEDURE EGD- to visualize the gastric mucosa for inflammation  Low levels of HCl  Biopsy to establish correct diagnosis whether acute or chronic 

Conditions of the Stomach NURSING INTERVENTIONS Give BLAND diet  Monitor for signs of complications like bleeding, obstruction and pernicious anemia  Instruct to avoid spicy foods, irritating foods, alcohol and caffeine 

Conditions of the Stomach NURSING INTERVENTIONS Administer prescribed medications- H2 blockers, antibiotics, mucosal protectants  Inform the need for Vitamin B12 injection if deficiency is present 

Conditions of the Stomach PEPTIC ULCER DISEASE An ulceration of the gastric and duodenal linin  Most common Peptic ulceration: anterior part of the upper duodenumg 

Condition of the Duodenum

DIAGNOSTIC TESTS EGD and Biopsy

Drugs:   

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Histamine H2 receptors antagonists (po/iv) Axn: ↓ HCl production Taken with meals or at h.s., cigarettes reduces the axn. SE: headache, skin rash, bleeding and dizziness 8 weeks medication (if s/sx will not improve start antibiotics) Cimetidine (Tagamet) Ranitidine (Zantac) Famotidine (Pepcid)

Drugs: Antibiotics  Amoxil  Tetracycline  Can be combined with other drugs 

Drugs: Mucosal Barrier  Axn: adheres to ulcer surface  30 min interval before taking antacids  SE: constipation, diarrhea and n/v  Give 1-2 hour after meal or during bedtime on an empty stomach  5 hours duration  Sucralfate (Carafate) 

Drugs:

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Antacids (non absorbable)

Axn: ↓ gastric acidity Chew thoroughly then swallow Taken 1 hour after meals or at bedtime Aluminum Hydroxide SE: constipation Don’t give other drugs within 1-2 hour after taking antacids Magnesium Oxide SE: diarrhea Taken in between meals or at bedtime May increase serum Magnesium level in RF client Chew follow with water Calcium Carbonate SE: ↑ uric acid Taken in between meals or at bedtime with milk NaHCO3 SE: metabolic alkalosis and tetani

Drugs: Proton Pump Inhibitor  Axn: block HCl release from parietal cell  4-8 weeks medications  Omeprazole (Prilosec)  Lansoprazole (Prevacid) 

Surgery Vagotomy (complication is diarrhea) give KAOPECTATE  Antrectomy 

Complications: Hemorrhage (anemia, hematemesis, hematochezia, melena)  Perforation  Pyloric obstruction 

Nursing Considerations: Avoid spicy foods  Milk stimulates HCl secretion  Avoid coffee, chocolate, cola, caffeine  No snacks at bedtime (↑ HCL secretions) 

Gastric Cancer     

Most common Key Test GASTROSCOPY Surgery: Billroth I gastroduodenostomy Billroth II gastrojejunostomy

Post op         

Observe NGT drainage: -NaCl irrigating solution -bloody for the first 12 hours -attached to continuous suction machine -don’t give cold give warm weak tea -color, amount and consistency IVF with KCl Early ambulation Listen for bowel sounds (1

Post op Observe for dumping syndrome  -subsides in 6 months  -s/sx are related to FVD  -palpitations  -perspirations  -faintness  -weakness 

Dumping Syndrome avoid CHO  ↑ CHON, ↓ CHO  no fluids after meal  lie supine after meal  avoid fowlers position after meal 

Inflammatory Bowel Diseases  

Crohns Disease Ulcerative Colitis

Assessment chronic diarrhea  cramplike pain after meals  fever  mucus bloody stool  dehydration and anemia ( more sever in ulcerative colitis) 15-20x BM 

Management:        

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↑calories and CHON, ↓ residue bland diet with iron All foods must be cooked rehydrate vitamin B12( crohn”s) steroids and antibiotics antidiarrheal (lomotil) sedatives and narcotics to decrease apprehension and pain immunosuppressive drugs to prevent another attack TPN

Appendicitis 

Inflammation of the appendix due to obstruction from fecalith, lymphoid hyperplasia, helminth, foreign body

Assessment:

Key Test – IPPA, Lab results (↑ WBC)pain- epigastric---periumbilical---RLQ  Rovsings  Psoas  Obturator  Mcburneys  CBC- inc WBC  Urinalysis- +/-RBC 

Management: Semi fowler’s to relieve pain and discomfort  NPO til bowel sounds present (postop)  No laxatives and enemas as it may rupture  No warm compress or heat application  NGT insertion 

CONDITIONS OF THE LARGE INTESTINE Post-operative care  POSITION post-op: RIGHT sidelying, SEMI- FOWLER’S to decrease tension on incision, and legs flexed to promote drainage

Intestinal Obstructions Partial or complete stoppage of forward flow of intestinal contents  Key Test – UTZ, don’t use contrast media if obstruction is suspected 

Abdominal UTZ

Mechanical Type: 

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Adhesions-fibrous band of scar tissue from surgery Hernias-incarcerated or strangulated Volvulus-twisting of bowel Intussusception-telescoping of the bowel upon itself Tumors Hematoma Fecal impaction Intraluminal obstruction

Neurogenic Type: Paralytic ileus  Adynamic ileus 

Vascular Type: Occlusion of arterial blood supply  Mesenteric thrombosis  Abdominal angina 

What will happen? Fluids and air are collected proximal to the obstruction  peristalsis ↑’s as the bowel attempts to force-out the collected material  peristalsis ends and the bowel becomes blocked  pressure increases and the absorption ability is decreased  this will lead to vomiting and decreased absorption resulting to shock 

Assessment:     

Constipation vomiting Cramplike or diffused pain in the abdomen gaseous distention no flatus

Management: intestinal tube insertion (miller abott, cantor tube) for decompression  fluid and electrolyte replacement  prophylactic antibiotic  v/s, I&O  stool exam  surgery 

Hemorrhoids 

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Dilated varicose veins of the anal canal (internal and external may be affected) Due to: Portal HPN Straining from constipation Irritation and diarrhea, CHF Increased abdominal pressure, pregnancy

Assessment:  Itchiness  Pain ( external)  Bleeding  Complications:  Hemorrhage  Strangulation  Prolapse and Thrombosis 

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Management: Stool softeners Laxative for constipation Analgesic Hot sitz bath Infrared photocoagulation and laser therapy Surgery: Hemorrhoidectomy Cryosurgery

CONDITIONS OF THE LARGE INTESTINE Post-operative care for hemorrhoidectomy  1. Position: Prone or Sidelying  2. Maintain dressing & Monitor for bleeding  4. Administer analgesics and stool softeners  5. Advise SITZ bath 3-4x a day