assessment of digestive and gi function connie k. cupples, ms, msn, rn union university
TRANSCRIPT
Assessment of Digestive and GI Function
Connie K. Cupples, MS, MSN, RN
Union University
Outcome 1
• Review the structure and function of the organs of the GI tract.
• A. Draw abdomen depicting organs in the four quadrants.
• B. Identify function of each of the organs of digestion.
Abdomen
Function of Organs
• Mouth
• Stomach
• Small Intestine
• Colon
Outcome 2
• Explain the processes involved in the digestion, absorption, and elimination of
food products.
A. Identify major digestive enzymes, sources, and digestive actions.
refer to pg. 943 table 34-1
Action of enzymes that digest CHO,
protein, and fat
Outcome 3
• Describe assessment paramaters and techniques used when evaluating the GI tract.
• A. Draw a torso and shade common sites
of referred abdominal pain.
• B. Discuss the order of the examination of the abdomen and give the rationale.
Sites of Referred Abdominal Pain
Health History
• Focus on symptoms common to GI dysfunction:
Pain
Indigestion
Intestinal gas
Change in bowel habits
Change in stool characteristics
Physical Assessment
• Inspect mouth and contents• Supine with knees flexed slightly• Order of assessment:
inspectionauscultationpalpationpercussion
Rationale for order of GI Assessment?
Abdomen - Ascites
Abdomen-Obese
Abdomen - Hernia
Outcome 4
• Describe preparation, education, and follow-up care for patients undergoing the following diagnostic testing of the GI tract.
• A. Discuss how the nurse would prepare and educate patients for GI tests, including post procedure interventions.
Stool Tests
• Collect on random basis except specimen where quantitative study is performed (fecal fat and urobilinogen)
• Refrigerate quantitative specimen (24-72 hr. collections)
• Special diet required for some tests
• Fecal occult blood tests (foods & meds
may alter results.
Abdominal Ultrasonography
• Noninvasive means of imaging abdominal organs and structures.
• NPO for 8-12 hrs.
• Fat-free meal at supper if GB studies are done
• Schedule barium studies after test if ordered as well
Upper GI X-ray Studies
X-ray imaging after contrast media injested.Low residue diet X several days priorNPO after MNLaxative prepDiscourage smoking day of testHold all meds on day of testMonitor post test for 3 days to get rid of
barium (fluids, laxatives, enemas)
Lower GI X-ray Studies
• Visualization of lower GI tract after instillation of barium
• Bowel prep to cleanse lower bowel
• Low-residue diet 1-2 days prior
• C/L diet for supper, laxative HS, NPO after MN
• Cleansing enemas until clear in a.m.
• Post procedure elimination of barium
CT
• Cross-sectional images of abdominal organs and structures
• NPO 6-8 hrs. before test
• Question about contrast dye allergies
• Schedule barium studies after CT scan if ordered
MRI
• Noninvasive technique to supplement ultrasonography and CT scanning
• NPO 6-8 hrs. prior to test
• Remove all jewelry & other metals
• Explain that procedure lasts 30-90 minutes
• Explain type of equipment used (pt. may experience claustrophobia & hear knocking sound)
Esophagogastroduodenoscopy
• Visualization of upper GI tract with fiberoptic lenses.
• NPO 6-12 hrs.
• Pt. may gargle with local anesthetic
• Versed given IV – monitor pt. per conscious sedation protocol
• Atropine may be given to dry secretions
• Position on left side during procedure
Nursing Interventions Post EGD
• Keep NPO until return of gag reflex
• Simms position until awake, then semi-fowlers
• Observe for s/s of perforation (pain, bleeding, unusual difficulty swallowing, temp)
• Monitor for changes in P & BP
• Instruct not to drive for 10-12 hrs. post
EGD
Colonsocopy
• Direct visual inspection of the colon using flexible fiberoptic colonoscope.
• Colon preparation a must
• C/L diet at noon day before
• Laxatives the night before
• Use of preparation such as Golytely to lavage the bowel over 3-4 hrs. until returns are clear
Nursing Interventions post Colonoscopy
• Monitor according to conscious sedation guidelines
• Observe for s/s of bowel perforation (abdominal pain, distention, rectal bleeding, temp)
• Provide written instructions due to amnesic effect of meds
Colonoscopy
Gastic Analysis, Gastic Acid Stimulation test & pH Monitoring
• Determines secretory activity of gastic mucosa and gastric retention.
• NPO 8-12 hrs.
• Hold meds that affect gastic secretion
• Smoking not allowed day of test
• Insert small NG tube
• Aspirate entire contents of stomach q 15 minutes for 1 hr.
Gastic Acid Stimulation
• Med given to stimulate gastric secretion
• Inform pt. that flushing may occur
• Monitor P & BP q 15 min.
• Collect gastic specimen q 15 minutes for 1 hr.
pH Monitoring
• NPO 6 hrs. before test
• Hold meds 24-36 hrs.
• Probe inserted through nose
• Connected to external recording device