Power Point Adult Nursing Iv

Adult Nursing IV

Anatomy and Physiology

Basic Functional Anatomy of the Digestive System

An atomy and Ph ysio lo g y The digestive system is composed of the digestive or alimentary tube and accessory digestive organs.

An atomy a nd Ph ysio lo g y

An atomy a nd Ph ysio lo g y

Upper GI En dosc opy Upper GI endoscopy, sometimes called EGD (esophagogastroduodenoscopy), is a visual examination of the upper intestinal tract using a lighted, flexible fiberoptic or video endoscope.

Upper GI En dosc opy

Equipment ...flexible endoscope

Two types 1.

The original pure fiberoptic instrument has a flexible bundle of glass fibers that collect the lighted image at one end and transfer the image to the eye piece. 2. The newer video endoscopes have a tiny, optically sensitive computer chip at the end.

EN DOSC OPY

Upper GI Endosc opy

Reasons for the Exam ulcers intestinal bleeding esophagitis and heartburn gastritis

UG I EN DOS COPY  Preparation:  1. Obtain written consent 2. NPO 3. Medication 4. Remove dentures, bridges 5. Anesthesia

UG I EN DOS COPY  During the procedure > the throat is anesthesized > IV sedation is given > the endoscope is gently inserted into the upper esophagus

Upper GI Endosc opy       

After the procedure 1. positioning 2. NPO 3. NSS gargle 4. V/S monitoring 5. Assess 6. Advise the pt. Not to drive for 12hours.

Lower GI Endoscopy Lower GI endoscopy Purpose: > helps diagnose inflammation of the colon  > remove abnormal cell growth  > take sample of tissue for later study  > help detect colon or rectal cancer   

Lower GI END OSCO PY    

Preprocedure: > Clear liquid diet for 24hours > Administered cathartic as ordered > Administer enema until the returns are clear

Lower GI En dosc ope

Lower GI END OSCO PY         

During Procedure: > Knee chest position > endoscope is inserted into the rectum > you may feel pressure and cramping After the procedure: > Supine position for few minutes. > Assess for signs of perforation e.g bleeding,pain,fever > Hot sitz bath for discomfort in the anorectal area

Lower GI En dosc opy

Colonoscopy Colonoscopy is the visual examination of the large intestine (colon) using a lighted, flexible fiberoptic or video endoscope.

Co lonosc opy

The flexible colonoscope is a remarkable piece of equipment that can be directed and moved around the many bends in the colon.

Co lonosc opy  Colonoscopy is used for: > Colon CA  > Polyps  > Colitis  > Diverticulosis and diverticulitis  > Bleeding lessions  > Abdominal symptoms

Co lo noscopy  Used for(cont.)  > Chronic diarrhea, constipation, or a change in bowel habits  > Anemia

Co lonosc opy Preprocedure: > cleansing enema > clear liquid diet before the test > Midazolam is adminestered through IV to provide sedation  > position patient on left side;knees flexed    

Co lonosc opy After procedure: > Monitor V/S especially heart rate > Assess for signs and symptoms of perforation  > Instruct the client to report any bleeding to the physician.   

Colonosc opy  The procedure takes 15 to 30 minutes and is seldom remembered by the sedated patient.  Side Effects and Risks > Bloating and distension  > excessive bleeding

Barium swallow and barium meal tests > barium swallow and a barium meal test involve swallowing a liquid suspension of barium sulphate before a series of X-rays. > In a barium swallow test, X-ray images are taken of your pharynx and your oesophagus > X-ray images are taken of your stomach at the beginning of your duodenum > Barium is a naturally occurring element that appears white on X-ray. > the barium is given as a cup of flavoured drink

Barium swallow and barium meal tests      

Why is a barium swallow or barium meal done? difficulty swallowing, chest pain reflux (backflow of stomach juices into the lower part of the oesophagus). unexplained vomiting pain in your abdomen, severe indigestion or blood in your stool (which may be coming from your stomach or duodenum or elsewhere in your digestive system). Help to diagnose inflammation, ulcers or tumours in the oesophagus, stomach or duodenum.

Barium swallow and barium meal tests  Preparation NPO for several hours before the test. If you have diabetes, contact the centre performing the test, or about how to prepare for the test.

Barium swallow and barium meal tests  No smoking for several hours before the test  Not to take your regular oral medicines on the day of the test, that is, until after the test

Barium swallow and barium meal tests During Barium Swallow or Barium Meal 

In the X-ray room you will be told when and how fast to drink the barium solution, usually about one cup in total. If X-rays are to be taken of your stomach (a barium meal test), you may also be asked to drink a small amount of one or 2 other liquids. These liquids combine to produce a gas that expands your stomach, making it easier to detect any abnormalities in its lining. This can make you feel a little ‘gassy’, but you will be asked to resist the urge to burp so that the gas remains in your stomach until after the X-rays have been taken. Doctors call this type of barium meal a ‘double contrast study’.

Barium swallow and barium meal tests  After the Test > resume eating normal food > eat high-fibre foods > your stools will be a whitish colour for 2 or 3 days after consuming the barium

Sigmoidoscopy

A sigmoidoscope is a small tube with an attached light source about the thickness of your finger. A doctor or nurse inserts the sigmoidoscope into the anus and pushes it slowly into the rectum and sigmoid colon. This allows the doctor or nurse to see the lining of the rectum and sigmoid colon.

Sigmoidoscopy Bowel preparation  laxatives for a day or two, or by using one or two enemas prior to the procedure. A commonly used laxative to clear the bowel is called Picolax. A common plan is:  For three days before the procedure - eat a light diet.

Sigmoidoscopy  For 12 hours before the procedure - have fluids only (no solids in your diet), but you can eat a normal light breakfast on the morning just before the procedure.  AFTER CARE:  > May experience flatulence or gas pain bec. air was used to distend the intestines for better visibility  > Observe for signs of bowel perforation  > If biopsy is performed, patient should be informed that slight rectal bleeding may occur

Endos copic R Cholangiopancr

etr og rade ea tog r aphy

 Direct visualization with radiographic examination of the liver, gallbladder, and pancreas.  Contrast medium is introduced via the endoscope  Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x rays.

Endoscopi c Retr og r ade Cho langi opancr ea tog r aph y Preparation      

Secure written consent NPO 10-12hours Check for allergy to iodine/seafoods Take initial V/S AtSO4; valium as ordered Local anesthetic spray into the throat

Endoscopi c Retr og r ade Cho langi opancr ea tog r aph y Procedure  Lie on the left side on an examining table in an x-ray room. Patient will be given medication to help numb the back of the throat and a sedative to help you relax during the exam. You will swallow the endoscope, and the physician will then guide the scope through your esophagus, stomach, and duodenum until it reaches the spot where the ducts of the biliary tree and pancreas open into the duodenum. At this time, the pt. will be turned to lie flat on his stomach, and the physician will pass a small plastic tube through the scope.  Through the tube, the physician will inject a dye into the ducts to make them show up clearly on x rays.  X rays are taken as soon as the dye is injected. An ERCP can take 30 minutes to 2 hours to complete

Endoscopi c Retr og r ade Cho langi opancr ea tog r aph y Purpose

 An ERCP may be necessary to find the cause of jaundice, upper abdominal pain, or unexplained weight loss.

Endoscopi c Retr og r ade Cho langi opancr ea tog r aph y  Care after ERCP    

> NPO until gag reflex returns > turn to side to prevent aspiration > Monitor V/S > Monitor signs and symptoms of sepsis, perforation, pancreatitis

Liver Biopsy  Definition A biopsy is a tiny sample of body tissue -- in this case, liver tissue. A needle is inserted through the abdominal wall to the liver to obtain a tissue sample for biopsy and microscopic exam.

Liv er Bi opsy  Preparation Obtained informed consent NPO 2-4hours Vit.K injection Monitor Prothrombin time; initial V/S  Administered a sedative as ordered  Position in the left side or supine position with the pillow under the right shoulder  Instruct to exhale deeply; hold breath for 5-10sec during needle insertion to prevent trauma to the diaphragm    

Liv er Bi opsy

Liv er Bi opsy

Liv er Biopsy  Care after liver biopsy  Turn to the right side for 4hours to apply pressure and prevent bleeding  Maintain bedrest for several hours  Monitor VS every 30minsevery hour for the first 24hours  Monitor biopsy site for bleeding  Monitor for peritonitis  Avoid heavy lifting &

Esophagogastroduodenoscopy Definition  is a diagnostic endoscopic procedure that visualises the upper part of the gastrointestinal tract up to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure (unless sedation or anesthesia has been used). A sore throat is also common.

EG D

Esophagogastroduodenos copy  Diagnostic Indication * Unexplained anemia (usually along with a colonoscopy) * Upper gastrointestinal bleeding as evidenced by hematemesis or melena * Persistent dyspepsia in patients over the age of 40-45 years * Heartburn and chronic acid reflux - this can lead to a precancerous lesion called Barrett's esophagus * Persistent vomiting * Dysphagia - difficulty in swallowing * Odynophagia - painful swallowing * Surveillance of gastric ulcer or duodenal ulcer * Occasionally after gastric surgery * Abnormal barium swallow or barium meal

Esophagogastroduodenos copy  Therapeutic

* Treatment (banding/sclerotherapy) of esophageal varices * Injection of liquids through a needle (e.g. adrenalin in bleeding lesions) * Cutting off of larger pieces of tissue with a snare device (e.g. polyps, endoscopic mucosal resection) * Application of cautery to tissues * Retrieval of foreign bodies that have been ingested * Tamponade of bleeding esophageal varices with a balloon * Application of photodynamic therapy for treatment of esophageal malignancies

Esophagogastroduodenoscopy  Procedure The patient is told not to eat for at least 4-6 hours before the procedure. Most patients tolerate the procedure with only topical anaesthesia of the oropharynx using lignocaine spray. However, some patients may need sedation and the very anxious/agitated patient may even need a general anaesthetic. Informed consent is obtained before the procedure. The main risks are bleeding and perforation. The risk is increased when a biopsy or other intervention is performed.

EG D  The patient lies on his/her left side with the head resting comfortably on a pillow. A mouth-guard is placed between the teeth, partly to protect the patient's teeth but more importantly to prevent the patient from biting on the very expensive endoscope.  The endoscope is then passed over the tongue and into the oropharynx.