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MED SURG EXAM 2 - Review of the gastrointestinal disorders (including upper and lower GI disorders)

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MED SURG EXAM 2 UPPER GI DISORDERS (Ingestion & Digestion Disorders) CH. 46 + 47 GI SERIES • Radiographic studies done with or without contrast that define anatomic or functional abnormalities o ... Upper GI Series  an upper fluoroscopy delineates entire GI tract after introduction of a contrast agent  Enables examiner to detect/exclude anatomic or functional disorders of the upper GI organs or sphincters  Aids in DX of ulcers, varices, tumors, regional enteritis, and malabsorption syndromes  Procedure could be extended to examine the duodenum and small bowel o Barium Enema  for visualization of the lower GI tract  Can be used to detect presence of polyps, tumors, or other lesions of the large intestine + demonstrate any anatomic abnormalities or malfxning of the bowel  Contraindicated if: • Pt has active inflammatory disease of colon (enemas contra) • Signs of perforation or obstruction (a water-soluble contrast study would be done instead) • Active GI bleeding (prohibits enemas + laxatives) • Indications o Gastric ulcers, peristaltic disorders, tumors, varices, and intestinal enlargements or constrictions o C/O abdominal pain, altered elimination habits, or GI bleeding • Nursing Actions o Pre procedure  Upper GI Series: • Dietary changes prior to study include: clear liquid diet, with NPO from midnight the night before the study • Polyethylene glycol = most effective bowel cleansing prep agent • No smoking, chewing gum, or mints b/c stimulates gastric motility • Oral meds withheld the morning of the study, resumed that evening  Barium Enema: • Patient prep includes emptying + cleansing lower bowel • Low-residue diet 1-2 days before the test • Clear liquid diet and a laxative the night before the test • NPO after midnight • Cleansing enemas until returns are clear the morning of the test o Post procedure  Upper GI series: • Follow up to ensure the patient has eliminated most of the ingested barium • Fluids may be increased to facilitate the elimination of stool + barium  Barium Enema: • Pt education  increase fluid intake, evaluate BMs for elimination of barium, note any increase in BMs (b/c barium has high osmolarity that may draw fluid into bowel, resulting in greater output) ENDOSCOPY • Allows direct visualization of body cavities, tissues, and organs for diagnostic and therapeutic purposes • Different Procedures o Esophagogastroduodenoscopy (EGD)  an be used to evaluate esophageal and gastric motility and to collect secretions and tissue specimens for further analysis  Valuable when esophageal, gastric, or duodenal disorders or inflammatory, neoplastic, or infectious processes are suspected o Endoscopic Retrograde Cholangiopancreatography (ERCP)  uses the endoscope in combination with x-rays to view the ductal structures of the biliary tract  Helpful in evaluating jaundice, pancreatitis, pancreatic tumors, common bile duct stones, and biliary tract disease o Colonoscopy  direct visualization of the large intestine (anus, rectum, sigmoid, transcending + ascending colon)  Most frequently used for cancer screening + surveillance for those w/ previous colon cancer or polyps  Also used in evaluation of pts with diarrhea of unknown cause, occult bleeding, or anemia, further study of abnormalities found w/ barium enemas, and DX/clarification of extent of inflammatory or other bowel disease  Therapeutically – can be used to remove visible polyps, TX areas of bleeding or stricture  Performed while pt is lying on the left side with legs drawn up toward chest o Sigmoidoscopy  used to evaluate chronic diarrhea, fecal incontinence, ischemic colitis, lower GI hemorrhage, + to observe for ulceration, fissures, abscesses, polyps, tumors • Indications o Potential Diagnoses o Client Presentation ENDOSCOPIC NURSING ACTIONS • Pre procedure o Verify informed consent is obtained for proper procedure o Assess vital signs and verify allergies o Evaluate baseline laboratory values and report unexpected or abnormal results o Assess history for risks of complications o Colonoscopy  Pt must cleanse the colon (diff ways):  may prescribe a laxative for 2 nights before exam and a fleet’s or saline enema until the return is clear the morning of the test, but more commonly: polyethylene glycol electrolyte lavage solutions for effective bowel cleansing.  Patient maintains clear liquid diet starting @ noon the day before the procedure, then patient ingests the solution at intervals over 3-4 hours.  Informed consent is obtained before patient is sedated. o Sigmoidoscopy  only limited bowel prep – including warm tap water or fleet’s enema until returns are clear.  Dietary restrictions usually not necessary  sedation not required [Show More]

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