Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
41 Cards in this Set
- Front
- Back
|
Gastritis 1/7
|
Pathophysiology:
-Inflammation of gastric mucosa (stomach lining) -Prostaglandins = protective mucosal barrier. A break in the protective barrier = mucosal injury. -Pathologic changes – vascular congestion, edema, acute inflammatory cell infiltration, degenerative changes in superficial epithelium causing edema, hemorrhage, & erosion |
|
|
Gastritis 2/7
|
Types:
Acute gastritis -bacterial (H. pylori, staphylococci, streptococci, E. Coli, salmonella) onset within 5 hours of food poisoning/gastric hemorrhage is life-threatening emergency -Risk factors (NSAIDS inhibit prostaglandin production; alcohol; caffeine; corticosteroids, radiation therapy; accidental or intentional ingestion of corrosive substances – acids/alkalis; emotional stress/acute anxiety Chronic gastritis Risk factors: alcohol, radiation therapy, smoking, Crohn’s Disease, graft-versus-host disease, uremia -Type A (nonerosive) Parietal cell antibodies (Probable autoimmune) found in pt. with pernicious anemia(B12); autosomal dominant inheritance -Type B caused by H. Pylori (most common form of gastritis) -Atrophic gastritis – seen most often with older adults; exposure to toxic substances in the workplace (benzene, lead, nickel) or H. Pylori, or related to autoimmune factors. |
|
|
Gastritis 3/7
|
Clinical Manifestations:
Acute Gastritis: -rapid onset of epigastric pain or discomfort -N/V, cramping -Hematemesis -Gastric hemorrhage -Dyspepsia (heartburn) -Anorexia - abdominal tenderness & bloating, Melena (traces of blood in stool) Chronic Gastritis: -Vague report of epigastric pain that is relieved by food -Anorexia -N/V -Intolerance of fatty & spicy Foods -Pernicious Anemia - Upper abdominal discomfort |
|
|
Gastritis 4/7
|
Assessment & Diagnostic Findings:
Serologic Testing: IgG anti-H. pylori antibody; IgA & IgM anti-H. pylori antibody; enzyme-linked immunosorbent assay (ELISA) following treatment. A negative result = successful treatment. Diagnostic: Esophagogastroduodenoscopy (EGD) with biopsy Rapid urease testing for H. pylori (need to discontinue antacids for at least 1 week prior to testing) |
|
|
Gastritis 5/7
|
Medical Management:
Acute: -Symptomatical care - Blood transfusions if bleeding severe -Fluid replacement if severe fluid loss Surgery: Partial gastrectomy Pyloroplasty- opening between stomach & small intestine is enlarged to increase the rate of gastric emptying Vagotomy- branches of the vagus nerve that supply the stomach are cut to disrupt acid production Chronic: -elimination of causative agents -treatment of underlying disease (Crohn’s disease, uremia) -avoidance of toxic substances (alcohol, tobacco) Drugs: -H2-receptor antagonists (Pepcid, Tagamet, Zantac)- blocks gastric secretions by blocking histamine receptors -Give single dose at bedtime -IV form to prevent surgical stress ulcers -Sucralfate (Carafate) a mucosal barrier fortifier -Give 1 hr. before & 2 hr. after meals & at bedtime -Do not give within 30 minutes of antacids or other drugs -Antacids – buffering Agent by increasing pH of gastric;Maalox (aluminum hydroxide/magnesium hydroxide), Alternagel (aluminum hydroxide), Mylanta (simethicone/ magnesium hydroxide) Give antacids 2 hours after meals & at bedtime. Do not give other drugs within 1-2 hours of antacids Assess for renal disease; can interfere with effectiveness of Dilantin, tetracycline, Teach patient with heart failure to avoid antacids with high sodium content -Proton pump Inhibitors (PPI)- antisecretory agents: omeprazole (Prilosec), pantoprazole (Protonix) -Vitamin B12 injection for treatment or prevention of pernicious anemia -PPI Triple therapy (PPI + 2 antibiotics) for H. pylori. (Prevacid, flagyl, tetracycline, or Biaxin & amoxicillin for 7-14 days. 7 day therapy is effective when a PPI + levaquin & amoxicillin or Biaxin |
|
|
Gastritis 6/7
|
Nursing Management:
Health Promotion: balanced diet (limiting intake of foods & spices that cause gastric distress- caffeine, chocolate, mustard, pepper, alcohol, tobacco, tomato products, citrus juices, bell peppers, onions); regular exercise (regular peristalsis helps prevent contents from irritating the gastric mucosa); stress-reduction techniques; avoid excessive use of aspirin/NSAIDS/ corticosteroids Protect against exposure of toxic substances (lead/nickel) Chart 58-1 Provide supportive care: relief of symptoms & removing or reducing the cause of the discomfort. Teach patient to monitor for symptoms of relief & side effects of drugs & to notify HCP of any adverse effects or worsening of gastric distress. Remind patients not to take additional over-the-counter drugs if taking similar prescribed drugs Preoperative teaching & postoperative care: place patient in semi-Fowler’s position to facilitate respiratory movements; monitor NG output (scant amount of blood expected); notify provider prior to repositioning or irrigating NG (disruption of sutures); assess bowel sounds; educate on need for vitamin/mineral supplementation after gastrectomy (Vit. B12, Vit. D, calcium, iron, folate) |
|
|
Gastritis 7/7
|
Dumping syndrome is a complication of gastric surgery that consists of vasomotor symptoms occurring in response to food ingestion. Symptoms result with rapid emptying of gastric contents into the small intestine. In response to sudden hypertonic fluid, the small intestines pulls fluids from extracellular space-decreasing circulating volume, resulting in vasomotor symptoms(syncope, pallor, palpitations, dizziness, headache); limit amount of fluid ingested at one time; eliminate liquids with meals for 1 hr prior & following a meal; Instruct client to lie down after meal to slow movement of food within intestines; Consume a high protein, high fat , high fiber, & low to moderate carb diet; avoid milk, sweets, or sugars; sm. frequent meals
|
|
|
PUD 1/5
|
Pathophysiology:
Mucosal defenses become impaired & no longer protect the epithelium from the effects of acid & pepsin. Types: Gastric ulcers & Duodenal ulcers are caused by H. pylori, which is transmitted via the fecal-oral route & thought to be acquired in childhood Stress ulcers (less common) Acute gastric mucosal lesions occurring after an acute medical crisis or trauma (head injury, sepsis) Risk Factors: H. Pylori, NSAIDS, corticosteroids, Theophylline, caffeine, radiation therapy, increased risk in families that have history of PUD, Type O blood; chronic pulmonary/renal disease; |
|
|
PUD 2/5
|
Clinical Manifestations:
-Bleeding caused by gastric erosion is the main manifestation of acute stress ulcer -Epigastric tenderness, located at midline between umbilicus & xyphoid, s/s of peritonitis; initially hyperactive bowel sounds but may diminish with progression of the disorder; Dyspepsia (most common described as sharp, burning, gnawing); abdominal pressure, fullness or hunger; N/V Duodenal: pain located to the right of epigastrium & occurs 90 minutes to 3 hrs. after eating & often wakens patient at night -Complications: hemorrhage (bright red or coffee-ground emesis, tarry stools or frank blood in stools, Melena-occult, decreased blood pressure, increased weak/thread pulse, decreased H & H, Vertigo, acute confusion, dizziness, syncope), perforation (sudden, sharp pain begins in the mid- epigastric region & spreads over the entire abdomen, peritonitis, surgical emergency), pyloric obstruction (N/V, abdominal bloating, hypochloremic when vomiting persists leading to metabolic alkalosis, hypokalemia) & intractable |
|
|
PUD 3/5
|
Assessment & Diagnostic Findings:
Serologic Testing: IgG anti-H. pylori antibody; IgA & IgM anti-H. pylori antibody, enzyme-linked immunosorbent assay (ELISA) following treatment. A negative result = successful treatment. Diagnostic: Esophagogastroduodenoscopy (EGD) with biopsy (most reliable for diagnosis) Upper GI series with barium follow through ( not the most reliable way to visualize lesions) Chest & abdominal x-ray series Rapid urease testing for H. pylori (need to discontinue antacids for at least 1 week prior to testing) |
|
|
PUD 4/5
|
Medical Management:
Drugs: -H2-receptor antagonists (Pepcid, Tagamet, Zantac)- blocks gastric secretions by blocking histamine receptors -Give single dose at bedtime -IV form to prevent surgical stress ulcers -Sucralfate (Carafate) a mucosal barrier fortifier -Give 1 hr. before & 2 hr. after meals & at bedtime -Do not give within 30 minutes of antacids or other drugs -Antacids – buffering Agent by increasing pH of gastric;Maalox (aluminum hydroxide/magnesium hydroxide), Alternagel (aluminum hydroxide), Mylanta (simethicone/ magnesium hydroxide) -Give antacids 2 hours after meals & at bedtime. Do not give other drugs within 1-2 hours of antacids Assess for renal disease -Proton pump Inhibitors (PPI)- antisecretory agents: omeprazole (Prilosec), pantoprazole (Protonix) -Vitamin B12 injection for treatment or prevention of pernicious anemia -PPI Triple therapy (PPI + 2 antibiotics) for H. pylori. (Prevacid, flagyl, tetracycline, or Biaxin & amoxicillin for 7-14 days. 7 day therapy is effective when a PPI + levaquin & amoxicillin or Biaxin Prostaglandin Analogs: -Decreases gastric secretions & enhances resistance to mucosal injury Misoprostol (cytotec) -Take with food -Avoid magnesium containing Antacids -use contraceptives or not take if chance of PG NGT/Saline Lavage Endoscopic Therapy: via EGD isolate bleeding artery to embolize (clot) it Surgery: Minimally invasive surgery (MIS) laparoscopy; Partial gastrectomy |
|
|
PUD 5/5
|
Nursing Management:
Health promotion & maintenance same as gastritis Psychosocial Assessment: impact of disease on lifestyle, occupation, family, social & leisure activities. Assess fluid volume deficit(orthostatic B/P) & monitor for s/s of dehydration related to bleeding Intervention to manage pain include drug (provide pain relief, elimination of H. Pylori, heal ulcerations, prevent recurrence) & dietary therapy, CAM Avoid nighttime snacks (stimulates gastric acid secretion) Manage Upper GI bleed: Monitor for electrolyte imbalances, dehydration, bleeding, perforation, gastric outlet obstruction -First priority with upper GI bleed is airway, breathing, circulation; Provide oxygen as needed; Start 2 large-bore IV for replacing fluids/blood; Monitor vital signs, H & H, coagulation studies, oxygen sats. Mild bleeding (<500 ml); weakness, perspiration ; > 1 L/24 hrs = hypotension, chills, palpitations, diaphoresis, weak/thread pulse (shock) Nasogastric tube / Lavage (instill room temperature solution in volumes of 200-300 ml/solution & blood withdrawn until clear or light pink & without clots)– Chart 58-5 (Levin=intermittent; Salem sump = continuous suction) care & safety Monitor electrolytes for depletion from vomiting or NG suctioning Preoperative teaching & postoperative care: same as Gastritis Chart 58-6 Home care ***** |
|
|
Appendicitis 1/5
|
Pathophysiology:
Most often in people between 10-30 years. Most common cause of RLQ pain Lumen of appendix is obstructed leading to infection (fecaliths- very hard pieces of feces composed of calcium phosphate-rich mucus & inorganic salts). May result in peritonitis from perforation may develop within 24 hrs.-risk rising rapidly after 48 hrs. (gangrene within 24-36 hrs). Risk factors: age, familial tendency, intra-abdominal tumors |
|
|
Appendicitis 2/5
|
Clinical Manifestations:
N/V prior to pain may indicate gastroenteritis; N/V after onset of pain indicates appendicitis. May have anorexia with N/V. Pain becomes more severe & steady shifting to RLQ between anterior iliac crst & umbilicus (McBurney’s point). -Abdominal pain that increases with cough or movement & is relieved by bending the right hip or knees suggests perforation & peritonitis Rebound tenderness |
|
|
Appendicitis 3/5
|
Assessment & Diagnostic Findings:
Labs do not diagnose, but moderate elevation in WBC to 10-18,000/mm3 with a shift to the left (increased number of immature WBCs) WBCs > 20,000 may indicate perforation Ultrasound may show enlarged appendix CT: may reveal the presence of a fecalith for diagnosis |
|
|
Appendicitis 4/5
|
Medical Management:
Surgical: appendectomy If peritonitis or abscesses are found, wound drains are inserted & NGT may be places to decompress the stomach & prevent abdominal distention. Administer antibiotics (IV) & analgesics Surgical consult |
|
|
Appendicitis 5/5
|
Nursing Management:
Keep patient suspected or confirmed NPO to prepare for possible surgery Administer IV fluids as ordered to prevent fluid/electrolyte imbalance & replace fluid volume. Administer opioid analgesics & antibiotics as prescribed Advise patient to maintain a semi-Fowler’s position to contain abdominal drainage to lower abdomen. |
|
|
Peritonitis 1/5
|
Pathophysiology:
Inflammation of peritoneum due to contamination of peritoneal cavity by bacteria or chemicals Life-threatening Risk factors: appendicitis, diverticulitis, PUD, or external penetrating cavity, gangrenous gallbladder, bowel obstruction,or ascending infection through genital tract, perforating tumors, peritoneal dialysis, surgery E. Coli, Streptococcus, Staphlococcus, pneumococcus, leakage of bile, pancreatic enzymes, gastric acid |
|
|
Peritonitis 2/5
|
Clinical Manifestations:
Abdomen is tender/rigid/ boardlike, rebound tenderness & pain (localized, poorly localized, or referred to shoulder or chest); distended abd. N/V/ anorexia; diminished bowel sounds due to decreased peristalsis; inability to pass flatus or feces; high fever; tachycardia; dehydration; decreased urine output; hiccups (diaphragmatic irritation) Patient assumes a fetal position (knee-chest) Leading to bacterial septicemia & hypovolemic shock Septicemia Respiratory problems: resulting from increased abd. pressure against diaphragm from intestinal distention & fluid shifts. Pain may interfere with respirations at a time of increased oxygen demand |
|
|
Peritonitis 3/5
|
Assessment & Diagnostic Findings:
Labs: WBCs often > 20,000 with a high neutrophil count; Blood cultures Chem panel (electrolytes, BUN, creatinine, H & H Abdominal sonogram Abdominal x-rays to assess for free air or fluid in abdominal cavity, indication perforation- may also show dilation, edema, inflammation of small & large intestines |
|
|
Peritonitis 4/5
|
Medical Management:
Nonsurgical: IV fluids, antibiotics; monitor daily weight; I & O; NGT, NPO, Surgical consult Surgery: laparotomy to remove or repair inflamed or perforated organ; irrigate the peritoneum with antibiotic solutions prior to closure, wound drains. May heal by second or third intention (wet to dry dressing) |
|
|
Peritonitis 5/5
|
Nursing Management:
Monitor oxygen sats if respiratory compromised IV fluids, antibiotics; monitor daily weight; I & O; NGT; NPO; administer analgesics Monitor & document pain control Monitor LOC, vital signs, respiratory status, Maintain in semi-Fowler’s position to promote drainage into lower region & increase lung expansion Educate patient/family to report unusual or foul-smelling drainage; swelling, redness, or warmth or bleeding for incision; a temperature > 101 degrees; abdominal pain; signs of wound dehiscence or ileus Instruct on care of wound (second or third intention healing) Review information about antibiotics & analgesics Teach to refrain from lifting for 6 weeks. |
|
|
Hernia 1/5
|
Hernia- patho- weakness in the abdominal muscle wall through which a segment of the bowel or other abdominal structure protrudes. They can also penetrate any other defect in the abdominal wall, through the diaphragm or through other structures in the abdominal cavity
|
|
|
Hernia 2/5
|
* Indirect- sac formed from peritoneum that contains a portion of the intestines or omentum. Hernia pushes downward in to the inguinal canal. In males it can become large enough to descend in to the scrotum
* Direct inguinal hernia- passes through a weak point in abdominal wall * Femoral hernia- protrudes the femoral ring. A plug of fat in the femoral canal enlarges and eventually pulls the peritoneum and often the urinary bladder in to the sac * Umbilical hernia- congenital or acquired- congenital appears at infancy and acquired are directly result from increased abdominal pressure- most commonly in obese people. * Incisional hernia- occurs at the site of a previous surgical incision. The result is from inadequate healing from a surgical incision which is usually caused by post-operative wound infections , inadequate nutrition and obesity. |
|
|
Hernia 3/5
|
Hernias can be classified as reducable, ireducable, strangulated
* Reducable- contents of hernia sac can be placed back in to the abdominal wall with gentle pressure * Ireducable- also called incarcerated- cannot be reduced or placed back in to abdominal cavity – Requires immediate surgical consultation. * Strangulated- when the blood supply to the herniated segment of the bowel is cut off by pressure from the hernial ring – there is then ischemia and obstruction of the bowel loop which can lead to necrosis and possible bowel perforation |
|
|
Hernia 4/5
|
Most significant factors contributing to increased intra-abdominal pressure, obesity, pregnancy and lifting heavy objects; Indirect inguinal hernias are the most common and are most common in men; Direct hernias often occur in older adults; Umbilical hernias are most common in pregnant and obese people
Clinical manifestations- Strangulation- abdominal distention, NV, pain, fever, tachycardia Health Promotion- enc exercise to strength muscles, don’t get fat (wt management), don’t strain, avoid heavy lifting Assessment- a lump of protrusion at involved site, development associated with straining or lifting, abd assessment-visually inspect while lying or standing; if hernia is reducible may disappear while pt is lying down; only by provider- strain, vasovalvo test; absence of bowel sounds- can indicate obstruction; palpate look for changes with cough- don’t reduce forcibly= may cause strangulation to rupture; reduce means hernia goes back in; |
|
|
Hernia 5/5
|
Interventions-non surgical: for pt is that is old or has multiple health problems- tross (firm pad/belt over hernia, applied only after MD has reduced hernia; pain management; surgical (outpatient care)- laparoscopic (minimally invasive inguinal hernia repair), most important pre op is to inform pt to remain NPO for a # of hours; hemiplasty- reinforcement of weakened abd muscle with mesh patch; post op- avoid coughing-enc deep breathing and amb; suggest scrotal
support and ice bags to prevent swelling; monitor urinary output- atleast 30ml/hr; enc fluid intake of 1500-2500ml/day; may need to straight cath if pt void; educate- report s/s of infection and use of antibacterial soap to clean incisional site |
|
|
Diverticulitis
|
Diverticulitis- labs- inc WBC, dec H&H, OCB and urinalysis for RBCs; medical management- antibiotics, surgery- double barrel (may be temporary), colostomy, ileostomy, diet; nursing interventions- after dx tests-monitor for s/s of bowel perforation (rectal bleeding, firm abd, tachycardia, hypotension; may be treated at home; meds- antibiotics, analgesics, antispasmodics and rest; oral intake limited to clear liquids- high fiber diet, low fat diet; hospitalization upon severe symptoms-severe pain, high fever; NPO, NG suctioning, IV fluids, IV antibiotics, TPN, opioids for pain; clinical manifestations- tenderness on palpation of abd, often pain in LLQ (sigmoid colon), when have peritonitis- generalize abd pain (infection of peritoneum), N/V, constipation/diarrhea, low grade fever with chills (possible), tachycardia
|
|
|
Bowel Obstruction 1/3
|
Bowel obstructions- patho- mechanical- physically blocked- strangulated: low blood flow, inc periotonitis leading to septic shock; paralytic ileus- dec peristalsis, r/t neuro disruption; intestinal contents accumulate at and above obstruction- distention r/t inc secretions- compensatory mechanism- inc peristalsis to move obstruction; dec blood flow (hypovolemia) and electrolyte imbalances; high in small intestine- dec acid- metabolic alkalosis; low in duodenal- inc bowel- nochange in balance- loss of acid- loss of base; lower in small intestine- dec alkalosis- metabolic acidosis
|
|
|
Bowel Obstruction 2/3
|
Etiology- most common in ileum (narrowest part)- adhesions, tumors, hernias, fecal impaction- most common cause in elderly in addition to diverticulitis, strictures r/t chrone’s disease or previous radiation
Assessement- history- colorectal cancer, abd surgery, trauma, recent N/V, singultus (hiccups); s/s- strangulated-elevation in pulse, (fever, in HR, dec BP, inc pain= notify MD), constipation- no passage of stool, borborygmi- high pitched bowel sounds- document BS- absent in late obstruction; labs- inc BUN, inc creatnine, inc H&H- mimicks signs of dehydration, SBO- ABSs resemble metabolic alkalosis; |
|
|
Bowel Obsruction 3/3
|
interventions- goal to determine cause and relieve obstruction; non-surgical- NPO with NG tube to decompress bowel by draining fluid and air, NG tube on low continuous suction, IV fluid replacement; surgical: exploratory laparotomy, colon resection required for tumors/diverticulitis
|
|
|
DRUGS (peptic ulcer disease and gastritis)
|
Magnesium hydroxide with Aluminum Hydroxide (Milk of Mag)- inc pH of gastric conents via deactivating pepsin, assess for heart failure, renal disease, 2 hr after meals
Ranitidine (Zantac)- dec gastric acid secretion (H2blocker); give single dose at HS for ulcer but can give IV to prevent surgical stress ulcers Famotidine (Pepcid)-same action as Ranitidine Sucralfate (Carafate)- binds with bile acids and Pepcid to protect stomach- 1hr before and 2hr after meals, and hour of sleep (Prilosec) Omeprazole- dec H, K-ATPase enzyme system; do not crush, give single dose at HS; proton pump inhibitor Misoprostol (Cytotec)- dec gastric secretions; take with food, avoid mag containing antacids, helps build protective barrier so not eroding the stomach, a prostaglandin Antimicrobials- eradicated H. pylori infection- clarithromycin, amoxicillin, tetracycline, metronidazole (Flagyl) Tagamet (Peptol): H2Blocker Vitamin B12- weekly injection cause not absorbing cause of irritation and inflammation of GI tract Have one proton pump inhibitor and 2 antibiotics- |
|
|
Diagnostic Tests-general to GI 1/9
|
People 50yrs and older there are options- double contrast barium enema q5yr, flexible sigmoidoscopy q5yrs, CT colonography-q5yrs (also called the virtual colonoscopy), colonoscopy q10yrs (recommendations are by national cancer society); informed consent if invasive
|
|
|
Diagnostic Tests-general to GI 2/9
|
Lower GI (Barium Enema)- xray of the large intestine Done by instilling a radiopaque liquid into the clients rectum and colon; purpose and identify colorectal cancer and polyps in older adults; if pt has positive results they are scheduled for colonoscopy; xray of large intestines after enema instilled; nursing actions- teach to fully drink cleaning solution, and be NPO for 6-8 hr before procedure, check allergies (shellfish, iodine), expect white chalky stools for 24-72 hrs, take off jewelry/piercings for xray; may be given laxative after to rid body of barium, drink plenty of fluids (will constipate you HYDRATION-chalky stool are constipating); compliance issues
Contraindications- acute cholitis or diverticulitis, recent polypectomy or cholonic biopsy, pt older than 70 yrs old, pregnancy (cause of xray) Complications- colonic perforation- hemorrhage, over sedation, cardiac arrhythmias are major issues and constipation, abd discomfort, rectal bleeding, and flatus are minor |
|
|
Diagnostic Tests-general to GI 3/9
|
Upper GI series-used to detect disorders of the esophagus, stomach or duodenum; barium Swallow/upper GI-look into esophagus to see GERD- as swallow; also for aspiration precautions to see if things are misformed; informed consent; 1.5 cups of barium prep- chalky, gross milkshake; low fiber diet 2-3 days before (don’t want bulk); NPO 8hr prior, no smoking- avoid opioid/anticholinergic 24hr prior (don’t want dec motility); procedure=30 min-several hours; post procedure: stool; softener (makes you constipated, dehydrated), chalky white stool (do not be alarmed)- barium is usually excreted 24-72hours later; report to MD if abd fullness, pain or delay in return of brown stools; procedure identifies: GERD, hiatal hernia, diverticulum, tumors, polyps, dysphasia;
|
|
|
Diagnostic Tests-general to GI 4/9
|
Endoscopy: Direct visualization of the Gi tract using flexible fiberoptic endoscope. Used to evaluate bleeding, ulceration, inflammation, tumors and cancer of the esophagus, stomach, biliary system, or bowel. Obtain specimens for biopsy and cell studies like H pylori through endoscope, needs informed consent
Esophagogastroduodenoscopy (EGD): looks at esophagus, stomach, and duodenum. needs to be NPO for 6-8 hrs prior to procedure. Drug therapy for hypertension and other diseases need to be taken morning of test. Diabetic need to consult PCP for special instructions, avoid anticoagulants, aspirin or NSAIDS for several days, uses mod. sedations (versed, fentanyl, propofol) Spray used to inactivate gag reflex (swallowing may be difficult), remove dentures, bite block is used to protect endoscopy, takes 20-30 mins. priority for care- prevent aspiration, monitor for signs of perforation (pain, bleeding, fever) |
|
|
Diagnostic Tests-general to GI 5/9
|
Endoscopic Retrograde Cholangiopancreatography (ERCP): visual and radiographic examination of the liver, gallbladder, bile ducts, and pancreas to locate obstruction. More for Therapy than diagnosis. Radiopaque dye is instilled and Xrays are taken. Prep test same as EGD, Avoid same drugs as EGD. Ask about pacemaker. Similar to EGD but advanced further
into duodenum. lasts 30min-2 hrs. Monitor for Bleeding, complications, sepsis, pancreatitis, may not occur immediately but 2hrs- 2 days later. |
|
|
Diagnostic Tests-general to GI 6/9
|
Small Bowel Capsule Endoscopy (Enteroscopy): view of small intestine, entire small bowel and distal ileum. used to find GI bleeds, explain procedure, fast from food, water only 8-10hr and NPO for 1st 2 hrs of the testing. Mark Abd, 8 lead sensors, a capsule taken w/ water, normal activity, normal diet 4hrs after capsule. 8 hrs later return to get the capsule to retrieve images (capsule is in poo)
|
|
|
Diagnostic Tests-general to GI 7/9
|
Colonoscopy- endoscopic examination of the entire large bowel; patient prep- teach NPO except water 4-6hr prior, avoid aspirin, anticoagulants, antiplatelets for several days before procedure; diabetic pt need to be instructed to check with physician about direct therapy requirements on day of test due to NPO status (blood sugars can dec); drink e.g. Sodium Phosphate, GoLytely (does not taste good-key) day before (cleans bowel) and may repeat morning of- should be avoided in elderly to prevent fluid and electrolyte loss; in some cases pt may require laxatives, suppositories, or one or more enemas (extra cleansing); intra- IV access, prescribed Versed, Diprivan, or Fentanyl, complementary therapies (REIKI- reduced amount of sedation needed-energy hold therapeutic touch), laid on left side with knees drawn up, lasts about 30-60 min, air may be instilled, atropine sulfate is kept available incase of bradycardia from vasovagal response; follow up care- VS q15min until pt stable, side rails up until alert, maintain NPO status, observe s/s of proliferation- including severe abd pain and guarding-fever may occur later, severe pain, and hemorrhage such as rapid drop in BP; hypovolemic shock- s/s- dizziness, light-headedness, dec BP, tachycardia, pallor, and altered mental status (which may be first sign); reassure pt that a feeling of fullness, cramping and flatus is expected several hr after test and pt can start fluid as soon as pass gas; if polypectomy or tissue biopsy was performed there could be a small amount of bleeding but immediately report large amount or severe pain; outpatient procedure- but shouldn’t drive for 12hrs- until after sedation- need driver;
|
|
|
Diagnostic Tests-general to GI 8/9
|
Sigmoidoscopy: endoscopic exam of rectum and sigmoid, screens for colon cancer, investigate source of GI bleed, or diagnose inflammatory bowel disease. 50 years of age, every 5 yrs later. clear liq diet 24 hr prior to test, cleansing enema (Fleet’s) morning of the procedure, laxative may also be used. left side, knee to chest for procedure, no mod. sedation is required, tissue biopsy may be performed, 30 mins long. Mild gas pain, farts, small amount of bleeding may occur and should be reported.
|
|
|
Diagnostic Tests-general to GI 9/9
|
Virtual colonoscopy- a noninvasive procedure to obtain multi-dimensional imaging views entire colon; bowel prep and dietary restrictions similar to traditional colonoscopy; if anything detected may need follow up invasive colonoscopy; therefore diagnostic testing and minor surgical procedures can be done at the same time
|
