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Chapter 39

Nursing Assessment

Gastrointestinal System

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Assessment of theGastrointestinal System

Subjective data

Important health information

Past health history

Medications

Surgery or other treatments

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Assessment of theGastrointestinal System

Objective data

Physical examination

Mouth

Inspection

Palpation

Abdomen Supine, bend knees and raise head of bed, emptybladder, warm hands

Inspection- skin changes

Auscultation- do first because P&P may alter bowl sounds

Percussion- to determine if fluid, distension, or masses arepresent heard by dullness. Tympany (air) is what you wantto hear

Palpation- to detect tenderness, muscular resistance

Rectum and anus

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Fig. 39-7

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Diagnostic Studies of theGastrointestinal System

Radiologic studies

Upper gastrointestinal series/barium swallow- structuralabnormalities of the esophagus, stomach, and duodenumNPO 8-12 hrs, no smoking after 24:00, give fluids and lax

after to prevent impaction. White stool for 72hrs after Lower gastrointestinal series/barium enema- Colon

Contrast medium every 30 min until reaches ileum. Give laxand enema before. Clear liquid diet evening before. NPO 8hrs before test. Barium by enema. Cramping and urge todefecate may occur. Fluids and lax after

Ultrasounds- Gallbladder Pt: NPO 8-12 hrs before. Air/gasreduce quality, food can cause gallbladder contraction,

CTBiliary tract, liver, pancreatic disorders. Oral and IVcontrast medium. **Iodine**

MRIHepatic region and staging colon cancer. IV contastused. Contraindicated in pregnant or metal implants

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Fig. 39-10

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Fig. 39-11

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Diagnostic Studies of the

Gastrointestinal System (contd) Endoscopy mucosal lining of the esophagus, stomach, duodenum.

Visualize motility, inflammation, ulcers, tumors, tears. Biopsies can betaken. Varices can be treated. NPO 8 hrs, Signed consent, localanesthesia sprayed on throat, sedated during procedure. NPO until gagreflux returns. check temp every 15-20 min for 1-2 hrs to check for

proforation. Capsule endoscopyGI tract, small intestines, Crohns, small bowel

tumors, celiac, malabsorption, GI bleeding in areas other oscopys cantreach. * hrs after swallowing, pt returns to have capsule removed

Colonoscopy-

Sigmoidoscopy

ERCP Liver biopsy

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Fig. 39-12

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Fig. 39-13