disturbance in metabolism

7/27/2019 Disturbance in Metabolism

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Prepared by:

Hazel Jane M. Tan, RN, MAN


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The major system assessed in the abdominal examinationis the GI or digestive system.

The digestive system is responsible for the ingestion anddigestion of food, absorption of nutrients, and eliminationof waste products.

The primary structures of the digestive system include themouth, pharynx, esophagus, stomach, small intestines(duodenum, jejunum, and ileum), large intestines (cecum,colon [ascending, transverse, descending, and sigmoid]),and rectum.

These main structures of the digestive system form ahollow tube that is actually outside the internalenvironment of the body even though it is located insidethe body.

This tube, referred to as the alimentary canal or the

gastrointestinal tract, begins at the mouth and ends atthe anus.

The digestive system also contains accessory organs thataid in the digestion of food. The accessory organs of thedigestive system include the salivary glands (parotid,submandibular, and sublingual), liver, gallbladder, and

pancreas.


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Primary Digestive Organs/Structures and Functions

Organs

Structure

Function

Mouth Masticating (chewing) food particles and mixing them with saliva.

Primarily mechanical digestion and the beginning of chemical digestion.

Pharynx Swallowing food particles into esophagus.

Esophagus Propelling food downward into stomach

Stomach Storing food until it can be moved farther along GI tract.

Parietal cells secrete hydrochloric acid to aid in digestion.Mucus cells secrete substances to coat the stomach.

Chief cells secrete pepsinogen, which is converted to pepsin, which in

turn digests protein.

Churns food and breaks it down into small particles, then mixes them

with gastric juices.

Secretes gastrin, which stimulates secretion of acid and pepsinogen andincreases gastric motility.

Secretes intrinsic factor that protects vitamin B12 from stomach acids

and facilitates absorption of B12 across the membranes of the small

intestines (parietal cells).

Absorbs some water, alcohol, and certain drugs.

Destroys some bacteria found in foods.Site for both mechanical and chemical digestion.


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Small Intestine

Duodenum: 25

cm (10

inches) long

Jejunum: 2.5 m

(8 ft)long

Ileum: 3.5 m (12

ft) long

Bile and pancreatic juices facilitate absorption of nutrients in

small intestines.

Primary site for digestion, especially chemical digestion.

Enzymes include:

Enterokinase: Converts trypsinogen to active trypsin.

Peptidases: Help break down proteins. Maltase, lactase, and sucrase: Break down carbohydrates.

Hormones include:

Cholecystokinin: Secreted from duodenal wall; stimulates

gallbladder to secrete pancreatic enzymes.

Gastric inhibitory peptide: Inhibits gastric motility.

Secretin: Secreted by duodenal wall; stimulates pancreaticsecretions to neutralize gastric acid.

Appendix Function is unknown.

Narrowest part of intestines and a frequent site for bacteria and

indigestible matter to become trapped leading to inflammation(appendicitis).

May serve as a breeding ground for intestinal bacteria because it

contains large amounts of lymphatic tissue.

Large Intestine

1.5

1.8 m (5

6 ft)long

Absorbs salt and water and excretes waste products of digestive

process (feces) from the rectum (defecation).Helps synthesize vitamins B12 and K.


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Accessory Digestive Organs/Structures and Functions

Organ/Structure Function

Salivary Glands

Parotid,

submandibular,sublingual

Produce saliva that moistens and lubricates food.

Secrete amylase, which converts starches to maltose.

Liver Produces and secretes bile to emulsify fats.

Metabolizes protein, carbohydrates, and fats.

Converts glucose to glycogen, which is stored in the liver.

Produces clotting factors and fibrinogen.Produces plasma proteins such as albumin

Detoxifies a variety of substances such as drugs and alcohol

Stores vitamins A, D, E, K, and B12 and minerals iron and copper

Converts conjugated bilirubin from blood to unconjugated bilirubin

Pancreas 1215 cm (69

inches)

long

As an endocrine gland, the pancreas secretes: Beta cells, which secrete insulin to regulate blood sugar levels.

Alpha cells, which secrete glucagons that store carbohydrates.

Delta cells, which secrete somatostatin, the hypothalamic growth-

inhibiting hormone that inhibits insulin and glucagon secretion.

F cells, which secrete pancreatic polypeptide that regulates the

release of pancreatic enzymes.


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As an exocrine gland, the pancreas secretes the

following digestive enzymes and alkaline materials:

Acinar units, which secrete digestive enzymes.

Amylase, which digests starches into maltose.

Lipase, which breaks down lipids into fatty acids and

glycerol. Pancreatic proteolytic enzymes (trypsinogen,

chymotrypsinogen, and procarboxypeptidase), which

are secreted in inactive form and activated in small

intestine.

Gallbladder

710 cm (3

4 inches)

long and 3 cm

wide.

Stores and concentrates bile.


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Assessment The nurse begins by taking a complete history, focusing on symptoms

common to GI dysfunction. These symptoms include: pain

Indigestion

intestinal gas

nausea and vomiting

hematemesis,

changes in bowel habits and stool characteristics

Information about any previous GI disease is important. Note past and current medication use and any previous treatment or

surgery. Information pertaining to medications is of particular interestbecause medications are a frequent cause of GI symptoms.

The nurse takes a dietary history to assess nutritional status.

Questioning about the use of tobacco and alcohol includes detailsabout type and amount.

Changes in appetite or eating patterns and any examples ofunexplained weight gain or loss over the past year.

assess the stool characteristics.

records all abnormal findings and reports them to the physician.

It is important to include in the history questions about psychosocial,spiritual, or cultural factors that may be affecting the patient.


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Nutritional Problems

Characteristics: What is your typical 24-hour food intake?

What is your usual weight?

Has there been a recent weight gain or loss?

If a recent weight change, how many pounds? How isyour appetite?

Associated factors: Explore other factors that may influence weight changes:

food preferences; family/individual routines associatedwith eating; cultural and religious values; psychologicalfactors, such as depression, anxiety, stress; physicalfactors, such as activity level, health status, dentalproblems, allergies; access/transportation to grocerystores; eating habits, self-imposed dietary restrictions;body image; nutritional knowledge; finances.

History: Any history of eating disorders?

Any family history of ulcer disease, GI cancer,inflammatory bowel disease, obesity?


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Abdominal Pain

Characteristics:

Can you describe the pain (sharp, dull, superficial, ordeep)? Is the pain intermittent or continuous?

Was the onset sudden or gradual?

Can you point to where the pain is located?

What makes the pain better, worse?

Associated factors: Are there other symptoms associated with the

pain:fever, nausea, vomiting, diarrhea, constipation,anorexia, weight loss, dyspepsia?

History:

Any family history of GI cancer, ulcer disease,inflammatory bowel disease?

Any previous history of tumors, malignancy, orulcers?


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Indigestion (Dyspepsia)

Characteristics:

Have you experienced any of the following symptoms:a feelingof fullness, heartburn, excessive belching, flatus, nausea, a badtaste, mild or severe pain?

How is your appetite?

If pain or tenderness, where is it located?

Does the pain radiate to any other areas?

What precipitating factors are associated with the pain?

What makes the symptoms better, worse?

Are the symptoms associated with food intake? If associatedwith food, the amount and type?

Associated factors: Is there nausea, vomiting, blood in bowel movements, or

diarrhea? Is there a history of alcohol, nonsteroidal anti-

inflammatory drug (NSAID), or aspirin use? History:

Any family history of cancer, inflammatory bowel disease?

Any history of bowel obstruction?

Any previous abdominal surgeries?


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Nausea and Vomiting

Characteristics: Is the nausea or vomiting associated with certain stimuli,

such as specific foods, odors, activity, or a certain time ofday?

Does it occur before or after food intake?

How many times per day does vomiting occur?

What specific fluids/foods can be tolerated when vomitingoccurs?

What is the amount, color, odor, and consistency of thevomitus?

Associated factors: Is there fever, headache, dizziness, weakness, or

diarrhea? Missed menstrual period?

Any weight loss?

History: Any history of gallbladder disease? Ulcer disease? GI

cancer? Unprotected intercourse?


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Diarrhea

Characteristics: How long has the diarrhea been present?

Determine the frequency, consistency, color, quantity, and odor of stools.

Is there blood, mucus, pus, or food particles in the stools?

Does this represent a change in bowel habits?

Any nocturnal diarrhea?

What makes the diarrhea worse, better?

Any associated weight loss?

Associated factors: Any fever, nausea, vomiting, abdominal pain, abdominal distention,

flatus, cramping, urgency with straining?

Is the patient taking antibiotics?

Has there been any recent travel to foreign countries? (Mexico, SouthAmerica, Africa, and Asia are countries with the highest risk of traveler'sdiarrhea.)

Is the patient experiencing emotional stress or anxiety?

History: Is there a history of colon cancer, ulcerative colitis, Crohn's disease,

malabsorption syndrome?


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Constipation

Characteristics: What is the frequency, consistency, color of the stools?

Is this a change in bowel habits? If a change, has this been gradual or sudden?

What is the size of the stools?

Have there been dietary changes?

Is there blood or mucus in the stools?

Any laxative use? Associated factors:

Are there periods of diarrhea?

Is there abdominal pain or distention? Is the patientexperiencing stress?

Is there a change in activity level?

Does the patient have a regular time for defecation?

Does the patient use antacids containing calcium or ananticholinergic?

History: Any family history of colorectal cancer? Any history of

depression or metabolic disorders, such ashypothyroidism or hypercalcemia?


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Dysphagia

Characteristics: Is the onset acute or gradual?

Is the problem with swallowing intermittent orcontinuous?

Is this associated with solid foods, liquids, orboth?

Associated factors: Is there any regurgitation, heartburn, chest or

back pain, weight loss?

Any hoarseness, voice change, or sore throat?

History:

Is there a family history of esophageal cancer? Is there a history of stroke, palsy, or any other

neurologic conditions?

Is there a history of alcohol or tobacco intake?


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Physical Examination

When performing a physical

examination of the abdomen, include the

following:

inspection of the abdomen

auscultation of all four abdominal quadrants

percussion for tympany or dullness

light and deep palpation.


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Key findings during physical

examinations: Tenting of the skin when skin is rolled between thumb and index

finger. Tenting may indicate dehydration.

Mouth lesions, missing teeth, swollen or bleeding gums maycontribute to weight loss and nutritional deficiencies.

Body weight may indicate obesity or such problems as anorexianervosa or malignancy.

Palpable mass may indicate an enlarged organ, inflammation,malignancy, hernia.

Rebound tenderness, guarding, and rigidity may indicateappendicitis, cholecystitis, peritonitis, pancreatitis, duodenalulcer.

Protuberant or bulging abdomen or flanks can indicate ascites.

Two physical assessment skills that may help to confirm thepresence of ascites are testing for shifting dullness and testingfor a fluid wave.

Distention and absence of bowel sounds may indicate intestinalobstruction.


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Characteristics of Stool

The appearance of blood in stool may becharacteristic of its source.

Upper GI bleeding - tarry black (melena) Lower GI bleeding - bright red blood

Lower rectal or anal bleeding - blood streaking onsurface of stool or on toilet paper

Other characteristics of stool may indicate a

particular GI problem. Bulky, greasy, foamy, foul smelling, gray with silvery

sheen - steatorrhea (fatty stool)

Light gray clay-colored(due to absence of bilepigments, acholic) - biliary obstruction

Mucus or pus visible - chronic ulcerative colitis,shigellosis

Small, dry, rocky-hard masses - constipation,obstruction

Marble-sized stool pellets - spastic colon syndrome


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Diagnostic Tests:

Hemoccult Guaiac Tests (Hemoccult,Hemoccult Sensa) Commercially available guaiac-impregnated slides or

wipes present a simple, inexpensive, andaesthetically acceptable method of testing feces forblood

Nursing Consideration: (3 days prior) Diet should have a high-fiber content.

Avoid red meat in the diet.

Avoid foods with a high peroxidase content, such asturnips, cauliflower, broccoli, horseradish, and melon.

Avoid iron preparations, iodides, bromides, aspirin,NSAIDs, or vitamin C supplements greater than 250mg/day.

Avoid enemas or laxatives before the stool specimencollection.

Avoid aspirin and NSAIDs for 1 week

Vit. C can cause false-negative results


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Stool Specimen The stool is examined for its amount, consistency,

and color. Normal color varies from light to dark

brown, but various foods and medications may affectstool color. Meat protein Dark brown

Spinach Green

Carrots and beets Red

Cocoa Dark red or brown

Senna Yellow Bismuth, iron, licorice, and charcoal Black

Barium Milky white

Special tests may be made for fecal urobilinogen,

fat nitrogen, food residue, and other substances.Fecal leukocytes are tested by Wright's stain, andstool cultures are obtained to identify bacteria, virus,or ova and parasites.


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Nursing Considerations: Use a tongue blade to place a small amount of stool in a

disposable waxed container.

Save a sample of fecal material if unusual in appearance,contains worms or blood, blood streaked, unusual color, orexcess mucus; show to health care provider.

Specimens for parasitology must be collected in vialscontaining special preservatives. For accurate specimenresults, the vials must be sent to the laboratory as soon aspossible. The vials should be refrigerated if unable to

submit quickly to the laboratory. Send specimens to be examined for parasites to the

laboratory immediately so the parasites may be observedunder microscope while viable, fresh, and warm.

Test for occult blood or to confirm grossly visible melenaor blood - Hemoccult guaiac test.

Consider that barium, bismuth, mineral oil, and antibioticsmay alter the results.


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Hydrogen Breath Test

The hydrogen breath test is used to evaluate carbohydrateabsorption.

A radioactive substance is ingested, and, after a certain time

period, exhaled gases are measured. The test measures the amount of hydrogen produced in the

colon, absorbed in the blood, and then exhaled in the breath.

This test is used as a diagnostic test for short bowel syndrome,lactose intolerance, and bacterial overgrowth of the intestine(blind loop syndrome, Crohn's disease, distal ileal disease).

Nursing and Patient Care Considerations

The patient should be nothing-by-mouth (NPO) for 12 hoursbefore the procedure.

The patient should not smoke after midnight before the test.

Antibiotics and laxative/enemas should not be used for 1 week

before the test. These products may alter the laboratory results. Appropriate diet instructions should be given before discharge if

the test is positive.


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Helicobacter pylori Testing

Laboratory tests for H. pylori include a serum immunoglobulin Gantibody test and an H. pylori breath test.

A positive antibody test may not differentiate between active

and inactive disease. A negative test can be interpreted to mean no antibodies or

antibodies present at a lower level than detectable.

Nursing and Patient Care Considerations

Symptomatic patients and patients with an active or past history

of ulcer disease should be tested for H. pylori. Endoscopy maybe necessary for patients with symptoms of weight loss,anemia, occult blood loss, and patients older than age 50.

It is recommended that negative H. pylori test results in apatient with ulcer-related complications be confirmed by asecond test.

Contact laboratory for the type of serologic test being performedfor H. pylori and the appropriate tube for blood.

Due to the potential for false-negative H. pylori breath test,preparation includes stopping treatment 2 weeks before testing.

False-positive results from H. pylori breath testing may becaused by achlorhydria or urease production associated withother GI disorders.


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Radiology and Imaging Studies

Upper GI Series and small-bowel series are fluoroscopic X-ray examinations of the

esophagus, stomach, and small intestine afterthe patient ingests barium sulfate.

As the barium passes through the GI tract,fluoroscopy outlines the GI mucosa and organs.

Spot films record significant findings.

Double-contrast studies administer barium first

followed by a radiolucent substance, such as air,to produce a thin layer of barium to coat themucosa. This allows for better visualization ofany type of lesion.


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Nursing Consideration

Explain procedure to patient.

Instruct patient to maintain low-residue diet for 2 to 3 daysbefore test and a clear liquid dinner the night before the

procedure. Emphasize nothing by mouth after midnight before the test.

Encourage patient to avoid smoking before the test.

Explain that the health care provider may prescribe all opioidsand anticholinergics to be withheld 24 hours before the testbecause they interfere with small intestine motility. Othermedications may be taken with sips of water, if ordered.

Tell the patient that he will be instructed at various timesthroughout the procedure to drink the barium (480 to 600 mL).

Explain that a cathartic will be prescribed after the procedure tofacilitate expulsion of barium.

Instruct the patient that stool will be light in color for the next 2to 3 days from the barium.

Instruct patient to notify health care provider if he has notpassed the barium in 2 to 3 days because retention of thebarium may cause obstruction or fecal impaction.

Note that water-soluble iodinated contrast agent (such asGastrografin) may be used for a patient with a suspectedperforation or colonic obstruction. Barium is toxic to the body if it

leaks into the peritoneum with perforation. It can also worsen anobstruction, thus is not used if an obstruction is suspected.


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Barium Enema

Fluoroscopic X-ray examination

visualizing the entire large intestine isadministered after the patient is given an

enema of barium sulfate.

Can visualize structural changes, suchas tumors, polyps, diverticula, fistulas,

obstructions, and ulcerative colitis.

Air may be introduced after the barium

to provide a double-contrast study.


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Nursing Considerations:

Explain to the patient: What the X-ray procedure involves.

That proper preparation provides a more accurate view of thetract and that preparations may vary.

That it is important to retain the barium so all surfaces of thetract are coated with opaque solution.

Instruct the patient on the objective of having the largeintestine as clear of fecal material as possible: The patient may be given a low-fiber, low-fat diet 1 to 3 days

before the examination. The day before examination, intake may be limited to clear

liquids (no drinks with red dye).

The day before the examination, a oral laxative, suppository,and/or cleansing enema may be prescribed.

The patient will be NPO after midnight the day of

procedure. An enema or cathartic may be ordered after the barium

enema to cleanse bowel of barium and prevent impaction.

Inform the patient that barium may cause light-coloredstools for several days after the procedure.


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Ultrasonography

A noninvasive test focuses high-frequency soundwaves over an abdominal organ to obtain an image

of the structure. Ultrasound can detect small abdominal masses,

fluid-filled cysts, gallstones, dilated bile ducts,ascites, and vascular abnormalities.

Ultrasound with Doppler may be ordered for vascularassessment.

Nursing Consideration: If indicated, prepare the patient before the procedure with

a special diet, laxative, or other medication to cleanse thebowel and decrease gas.

Abdominal ultrasound usually requires the patient to beNPO for at least 6 hours before the procedure.

Change position of patient, as indicated, for bettervisualization of certain organs.


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Computed Tomography Scan

This is an X-ray technique that provides excellentanatomic definition and is used to detect tumors, cysts,

and abscesses. The computed tomography (CT) scan can also detect

dilated bile ducts, pancreatic inflammation, and somegallstones.

It identifies changes in intestinal wall thickness andmesenteric abnormalities.

Ultrasound and CT can be used to perform guided needleaspiration of fluid or cells from lesions anywhere in theabdomen. The fluid or cells are then sent for laboratorytests (such as cytology or culture).

A newer technique of focused appendiceal CT can beused to diagnose appendicitis. Rectal contrast media is given so the colon is opacified

quickly without waiting for oral contrast to reach theappendix.

The right lower quadrant is focused on to visualize theappendix, so the procedure is quick.


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Nursing Consideration: Instruct the patient that fasting for 4 hours

before the procedure and an enema or cathartic

may be necessary. This is to clean the bowel forbetter visualization.

Ask the patient if she is pregnant. If yes, do notproceed with scan and notify health careprovider.

Ask if there are known allergies to iodine orcontrast media. A contrast medium may begiven I.V. to provide better visualization of bodyparts. If allergic, notify the technician and health

care provider immediately. Instruct the patient to report symptoms of itching

or shortness of breath if receiving contrastmedia, and observe patient closely.


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ENDOSCOPIC PROCEDURES

Endoscopy is the use of a flexible tube (the fiber-opticendoscope) to visualize the GI tract and to perform certaindiagnostic and therapeutic procedures.

Images are produced through a video screen or telescopiceyepiece. The tip of the endoscope moves in four directions,allowing for wide-angle visualization. The endoscope can beinserted through the rectum or mouth, depending on whichportion of the GI tract is to be viewed.

Capsule endoscopy utilizes an ingestible camera device ratherthan an endoscope. Images are transmitted to sensor array

abdominal leads, which are attached to a Walkman-likerecording device belted to the patient's waist.Afterapproximately 8 hours, the recording device is removed and isconnected to a computer to download the images for review.The capsule will be excreted naturally through the digestivetract

Endoscopes contain multipurpose channels that allow for airinsufflation, irrigation, fluid aspiration, and the passage ofspecial instruments. These instruments include biopsy forceps,cytology brushes, needles, wire baskets, laser probes, andelectrocautery snares.

Endoscopic functions other than visualization include biopsy orcytology of lesions, removal of foreign objects or polyps, control

of internal bleeding, and opening of strictures.

`Nursing Consideration


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The patient begins a clear liquid diet at lunch the day before theprocedure and is NPO after 10 P.M. that night (should be NPO at least10 hours before the test).

Oral medications are discontinued 2 hours before the study.Antispasmodics, Pepto-Bismol, and antidiarrheal medications shouldbe held for 24 hours before the study.

Iron preparations and Carafate should be held 5 days before the studyto prevent mucosal staining.

Instruct the patient not to smoke 24 hours before the procedure toprevent mucosal staining.

Male patients will need their abdomen shaved below and above theumbilicus before attaching the sensor array leads.

Sensory array leads will be placed on the abdomen and attached to adata recorder on a belt.

Instruct the patient to avoid strenuous activity, heavy lifting, bending orstooping, or immersion in water while wearing the leads and recorder.This is to prevent detachment of the leads or damage of the recorder.

After ingesting the capsule, the patient is instructed not to eat or drinkfor at least 2 hours, then can advance to clear liquids. After 4 hours, thepatient can have a light snack. When the procedure is completed, the

patient can resume a normal diet. During the capsule endoscopy procedure, instruct the patient to check

the blinking light on the top of the data recorder every 15 minutes.Avoid radio equipment (ham radio or broadcasting towers), which mayinterfere with the capsule's signal.

The capsule is naturally excreted within 1 to 3 days. The patient shouldbe instructed to call the physician for the following symptoms:

abdominal pain or chest pain, nausea or vomiting, a sticking sensation,or fever. These symptoms may indicate that the capsule has obstructed


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The patient should verify excretion of thecapsule before undergoing magneticresonance imaging (MRI).

Capsule endoscopy is contraindicated for

patients with small bowel obstruction,dysphagia, fistulas, severe delayed gastricemptying, gastrectomy with gastrojejunostomy,or GI stricture. There is a risk of trapping the

capsule, delayed passage, or impairedperistalsis. Pacemakers or implanteddefibrillators may alter the quality and quantityof study information.


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Esophagogastroduodenoscopy

This allows for visualization of theesophagus, stomach, and duodenum.

Esophagogastroduodenoscopy can beused to diagnose acute or chronic upper GIbleeding, esophageal or gastric varices,polyps, malignancy, ulcers, gastritis,esophagitis, esophageal stenosis, andgastroesophageal reflux.

Instruments passed through the scope canbe used to perform a biopsy or cytologicstudy, remove polyps or foreign bodies,control bleeding, or open strictures.


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Explain the following to the patient: The type of procedure to be performed on the patient. As an outpatient, advise that someone

must accompany the patient to drive home due to the patient being sedated.

NPO for 8 to 12 hours before the procedure to prevent aspiration and allow for completevisualization of the stomach.

Remove dentures and partial plates to facilitate passing the scope and preventing injury.

Inform the health care provider of any known allergies and current medications.

Medications may be held until after the test is completed. Obtain prior X-rays, and send with the patient.

Describe what will occur during and after the procedure: The throat will be anesthetized with a spray or gargle.

An I.V. sedative will be administered.

The patient will be positioned on the left side with a towel or basin at the mouth to catchsecretions.

A plastic mouthpiece will be used to help relax the jaw and protect the endoscope. Emphasizethat this will not interfere with breathing.

The patient may be asked to swallow once while the endoscope is being advanced. Then thepatient should not swallow, talk, or move tongue. Secretions should drain from the side of themouth, and the mouth may be suctioned.

Air is inserted during the procedure to permit better visualization of the GI tract. Most of the air isremoved at the end of the procedure. The patient may feel bloated, burp, or pass flatus fromremaining air.

Keep patient NPO according to protocol until patient is alert and gag reflex has returned.

May resume regular diet after gag reflex returns and tolerating fluids.

May experience a sore throat for 24 to 36 hours after the procedure. When the gag reflex hasreturned, throat lozenges or warm saline gargles may be prescribed for comfort.

Monitor vital signs every 30 minutes for 3 to 4 hours, and keep the side rails up until thepatient is fully alert.

Monitor the patient for abdominal or chest pain, cervical pain, dyspnea, fever,hematemesis, melena, dysphagia, lightheadedness, or a firm distended abdomen.These may indicate complications.

Instruct the patient on the above listed signs and symptoms, and advise to reportimmediately should any occur, even after discharge.

Possible complications include perforation of the esophagus or stomach, pulmonary

aspiration, hemorrhage, respiratory depression or arrest, infection, cardiac arrhythmiasor arrest.

P t i id d C l


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Proctosigmoidoscopy and Colonoscopy

Proctosigmoidoscopy (rectosigmoidoscopy) is the visualizationof the anal canal, rectum, and sigmoid colon through a fiber-optic sigmoidoscope.

Colonoscopy is the visualization of the entire large intestine,

sigmoid colon, rectum, and anal canal. Sigmoidoscopy or colonoscopy can be used to diagnose

malignancy, polyps, inflammation, or strictures.

Colonoscopy is used for surveillance in patients with a history ofchronic ulcerative colitis, previous colon cancer, or colon polyps.

Lower GI endoscopy can be used to perform biopsy, remove

foreign objects, or obtain diagnostic specimens. Colonoscopy, a more extensive procedure than

proctosigmoidoscopy, requires several days of bowelpreparation and use of conscious sedation during theprocedure. The bowel preparation includes approximately 1gallon or less isoosmolar electrolyte solution to consume over a3- to 4-hour period the day before the procedure, clear liquid

diet the day before, and an oral laxative the night before(protocols vary). See Patient Education Guidelines for samplepreparation. If unable to tolerate CoLyte, GoLYTELY, orNuLytely, an alternate prep of Fleet Phospho-Soda may beused.

CT colonography, also known as virual colonoscopy, is evolvingas a noninvasive screening method.


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Nursing Consideration:

prepare bowel before the procedure by drinking a substance calledCoLyte, GoLYTELY, or NuLytely. It is not absorbed by your body, butrinses solid matter from your colon. expect to empty your bowel frequently.

During the procedure you will receive medication to keep youcomfortable. You will be ready to leave the facility in 1 to 3 hours. Themedication you will receive may affect your memory. You must bring acompetent adult driver with you. Your driver will be responsible forsigning you out and must receive the discharge instructions.

Do not take aspirin, aspirin-containing products, or iron supplements for7 days before your exam. If you take a blood-thinning medication, suchas coumadin, call the health care provider who prescribed it for you for

further instructions.The day before your procedure

Begin clear liquid diet for the entire day (see below). NO SOLID FOOD.

At 8 a.m., drink one 10-oz. bottle of citrate of magnesia (available atany drugstore).

At 3 p.m., start drinking one gallon of bowel prep (CoLyte, GoLYTELY,or NuLytely). You may have it on ice or refrigerated. You may add onepackage of lemon-lime Crystal Light to the entire gallon. Drink oneglass every 10 to 15 minutes, completing the entire gallon in 2 hours.Slow down if you begin to feel bloated or nauseated (sick to yourstomach). It is normal to feel chills while drinking the prep. Warmclothing may help. If you cannot drink the prep, call your health careprovider for instructions.

You may continue to take clear liquids until midnight.

Do not eat or drink anything after midnight.


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The day of your procedure

If you have an advance directive or livingwill, please bring a copy with you.

Take your heart and blood pressuremedications with a small sip of water.

Insulin doses should be cut in half. If youare on a sliding scale, please bring your

insulin with you. Do not forget to bring an adult driver with

you.


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Endoscopic Ultrasound

This procedure is a combination ofendoscopy and ultrasonography tovisualize the GI tract.

An ultrasonic transducer is built into thedistal end of the endoscope.

This procedure allows for high-quality

resolution and imaging of the walls of theesophagus, stomach, duodenum, smallintestines, and colon. Adjacent abdominalstructures can also be studied.

Endoscopic ultrasound (EUS) is alsoindicated to evaluate and stage lesions ofthe GI tract.


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Nursing Consideration

Verify the patient's compliance with the pretest bowelpreparation the day before the procedure, usually an

oral laxative (such as magnesium citrate) and a clearliquid diet.

The patient must be NPO after midnight.

Explain to the patient that a feeling of fullness willoccur when water is introduced into the GI tract. Thiseliminates air space and provides for high resolution.

If an upper EUS is performed, maintain the NPOstatus until the gag reflex returns. A lower EUS canbe performed using a rectal approach.

Observe the patient for a change in vital signs,bleeding, pain, vomiting, abdominal distention or

rigidity. Make sure that patients who have had endoscopic

procedures requiring sedation have a caregiver todrive home after the procedure.

disturbance in metabolism

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