Your SlideShare is downloading. ×
GI Linton Ch38 Powerpoint 2
Upcoming SlideShare
Loading in...5

Thanks for flagging this SlideShare!

Oops! An error has occurred.


Saving this for later?

Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime - even offline.

Text the download link to your phone

Standard text messaging rates apply

GI Linton Ch38 Powerpoint 2


Published on

  • Be the first to comment

  • Be the first to like this

No Downloads
Total Views
On Slideshare
From Embeds
Number of Embeds
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

No notes for slide


  • 1.
    • Learn to see things backwards, inside out and upside down
    • John Heider
  • 3. Nursing Assessment
    • Health History and Physical Examination
        • RN performs initial assessment, LPN contributes
        • Detailed description of present illness
    • What types of questions do we ask? ???
  • 4. Chief Complaint—Questions
    • Where it is
    • How it feels
    • Aggravating and alleviating factors
    • Timing
    • Severity
    • Useful data for associated symptoms
    • Perception by the patient of the problem
    • Pain
    • Nausea / Vomiting
    • Change in appetite
    • Change in bowel habits
    • Rectal bleeding
    • Jaundice
    • Abdominal distention
    • Mass
      • Onset and duration
        • Sudden, gradual, persistent, or intermittent
      • Character
        • Dull, sharp, burning, stabbing, aching
        • Location
        • Radiation, superficial, deep, changing
      • Associated symptoms
        • N/V/D, change in abdominal girth, belching
    • What makes the pain better?
      • Belching, eating, vomiting, change in position
    • What makes the pain worse?
  • 8. Health History (cont)
      • Chronic/serious illnesses/infections: diabetes, hepatitis, anemia
      • History of GI diseases i.e. peptic ulcers, CA, Crohn’s disease, colitis
      • Previous GI surgeries
    • Ask about medication use such as NSAIDs, aspirin, vitamins, laxatives, enemas, or antacids
      • Carefully note meds that can cause bleeding or irritation of the GI tract i.e. NSAID, aspirin
    • Assess pt knowledge of side effects to identify education needs
      • Regular use of laxatives can cause dependence
      • Educate on normal bowel patterns
    • OTC medications, herbal / natural products
    • Clostridium Dificile
      • Recent hospitalizations or antibiotic use -> risk factor for C. Dificile
      • Can cause diarrhea, colitis, dehydration, colonic perforation, death
      • S/S diarrhea, nausea, anorexia, abd tenderness, pain
      • Pts with + C. dificile require isolation
      • Hand washing
      • Can be carried on hands, nails, rings, shoes
  • 11. Health History (cont)
    • 3. FAMILY HISTORY—some conditions are hereditary
    • 4. Review of Systems
      • Pt general health state
      • S/S
      • Normal bowel pattern; changes in bowel habits
      • Unexplained weight loss/ gain
      • S/S of disease i.e. bloody/ tarry stools, rectal bleeding, stomach / abdominal pain
  • 12. HEALTH HISTORY (cont)
      • N/V, abdominal distention, gas
      • Work activities and work setting
      • Exposure to liver toxic substances
      • Use of alcohol
      • Recent blood transfusions/ products, dental procedures, body piercing, tattooing, IV injection with contaminated needle
      • Fatigue, stressors
    • Nutrition, activity, stressors
      • Diet History:
      • Usual foods and fluids
      • Allergies/ intolerance
      • Appetite patterns
      • Swallowing difficulty
      • Nutritional herbal supplements
    • Effect of chief complaint on usual functioning
  • 14. Cultural Influences
    • Many cultures have special dietary practices and restrictions
  • 15. Objective Data
    • Physical Exam
      • Height, Weight, Vital Signs, Body Mass Index
        • Should be normal
        • BMI should be 18.5-24.9
      • Oral Cavity
        • Moist, pink, teeth intact, proper fitting dentures
        • No lesions, inflammation, tenderness, discoloration,odor
      • Abdomen
        • Contour, shape, skin, bowel sounds
  • 16. Objective Data (cont’d)
    • Inspection
    • Auscultation
    • Percussion
    • Palpation
    • (goal is to prevent palpation from changing other assessment findings)
  • 17. Physical Assessment
    • Preparation
      • Gather equipment—examination gown, drape, examination light, gloves, stethoscope, skin-marking pen, ruler, tape measure
      • Wash your hands
      • Explain the procedure to the client
      • Ask the client to void--
      • Be sure the room is warm and draft free with proper lighting
  • 18. Physical Assessment
    • Ensure client privacy
    • Use universal precautions
    • Determine if abd pain is present before proceeding and examine painful area last
    • Inspection, auscultation, percussion, palpation
    • Visualize underlying structures before proceeding
    • Have client relax abd muscles by taking several deep breaths
    • Observe for nonverbal signs of pain or discomfort (facial grimacing, legs flexed at knees/hips, abd guarding w/ hands)
    • Stand on right side of client to conserve energy (liver, spleen, and right kidney assessed from clients right side)
  • 19. Inspection
    • Place client in supine position with arms at sides
    • Place small pillow under clients head and knees
    • Drape examination gown over chest, exposing abdomen
    • Place drape at symphisis pubis, covering pelvic area and legs
    • Map the abdomen-imaginary horizontal and vertical lines delineating abdominal quadrants
    • Visualize underlying structures
  • 20. Inspection (cont)
    • Note condition of skin and contour
    • Contour: Flat, rounded (convex), Sunken (concave), Distended (protuberant)
      • Distention, tumors, hernia, previous surgeries
    • Umbilicus—center of abdomen, clean and free of inflammation
    • Note abdominal pulsations and peristalsis—may be visible in thin persons or may indicate an abdominal aortic aneurysm
    • Wounds, tubes, ostomy device
  • 21. Inspection (cont)
    • Scars, striae (stretch marks), bruising, caput medusae (bluish purple swollen vein pattern extending from navel), spider angiomas, petechiae
    • Visible masses, movement, or peristalsis
    • Jaundice (icterus)—yellowing of skin and sclerae (liver and GB disease, or RBC disorders)—elevated bilirubin
  • 22.   Abdominal Auscultation
  • 23. Auscultation
    • Clockwise from RUQ
    • 2 minutes per quadrant
    • Press lightly, listen for soft clicks and gurgles every 5-15 seconds (5-30X per minute)
    • Peristalsis moves air and fluid through GI tract: normal, hyperactive, hypoactive, absent
  • 24. Bowel Sounds
    • Hyperactive—rapid, high pitched, and loud—may occur with hunger or gastroenteritis
    • Hypoactive—infrequent—may occur with paralytic ileus or after abd surgery
    • Absent—no sounds after listening for a full 5 minutes
    • Bowel obstruction—high pitched, tinkling sound proximal to obstruction and absent distal to obstruction
    • Vascular sounds or bruits (swooshing) over aorta normally not present
  • 25. Percussion/Palpation
    • Percussion: Produces sound that identifies density of organs beneath and is performed by the physician or advanced nurse practitioner
    • Palpation: Light palpation concludes the phys assessment. Painful areas palpated last.
      • Note muscle tension, rigidity, masses or expressions of pain
      • Deep palpation done only by physicians and highly skilled nurses (nurse practitioners)
    • Abdominal Girth-mark made so subsequent measurements taken at the same location
    • Rebound tenderness--? appendicitis
  • 26. Rectum and Anus
    • Inspect perianal skin for color, rashes, lesions, hemorrhoids
    • You may be asked to assist the examiner with the rectal exam
    • Use Standard precautions when obtaining specimens of body fluids, substances, or blood
  • 28. Radiographic Tests
    • Linton p. 736-737
    • Flat Plate o f t he Abdome n
      • organs, tumors, obstructions, strictures
      • Hospital gown with no metal
      • Avoid during pregnancy
    • Upper gastrointestinal series (barium swallow), small bowel series, barium enema
  • 29. Upper GI Series
      • Upper GI Series (Barium Swallow)
      • Radiographs of the esophagus, stomach, duodenum
      • oral liquid radiopaque constrast medium (barium) and x-rays
      • detect strictures, ulcers, tumors, polyps, hiatal hernias, motility problems
      • Clear liquid dinner, then NPO until test (no smoking, no gum—can stimulate gastric motility)
  • 30. Upper GI (cont)
    • Pt drinks barium and Xrays taken at specific intervals to visualize outline of organs and note passage of barium through GI tract
    • Procedure may take several hours
    • Laxative given afterward to help expel barium and prevent constipation or barium impaction
    • Drink 12 8-oz glasses of water per day for several days
    • Stool monitored, will look white X2-3 days
    • Complication: constipation with distention= barium impaction
  • 31.  
  • 32. Small Bowel Series
    • Detects abnormalities of small intestine
    • Pt drinks contrast; Films taken at 20-30 min intervals
    • Preparation same as UGI
  • 33. Lower GI Series
    • Visualize position, movements and filling of colon
    • Detects tumors, diverticula, stenosis, obstructions, inflammation, ulcerative colitis, and polyps
    • Low residue or clear liquid diet X2 days
  • 34. Lower GI (Barium enema)
    • Laxatives, bowel-cleansing solutions (GoLYTELY) and enemas evening before
    • GoLYTELY chilled and drunk full strength—8 oz every 10 min for a total of 4L
    • Watery diarrhea X5 hours
    • Clear liquids in am or NPO after midnight
    • Lower GI contraindicated if active inflammatory disease, suspected perforation or obstruction, active GI bleeding
  • 35. Barium enema (cont)
    • Barium instilled rectally and xrays taken
    • Cramping and urge to have a BM
    • Slow deep breaths and tighten anal sphincter
    • Stools monitored after to ensure barium is passed
    • Monitor for constipation
    • Increase fluids and laxative might be ordered
    • Instructions: report abd pain, bloating, absence of stool, or rectal bleeding
  • 36. Endoscopy
    • Tube and fiberoptic system
    • View structures, remove polyps, biopsy specimens, coagulate bleeding sites
    • Must have consent
      • Esophagoscopy
      • Gastroscopy
      • Gastroduodenoscopy
    • Esophagogastroduodenoscopy [EGD]
    • Endoscopic Retrograde Cholangiopancreatography (ERCP)
      • Lower Gastrointestinal Endoscopy
      • Colonoscopy
      • Proctoscopy
      • Sigmoidoscopy
  • 37.  
  • 38.  
  • 39. Esophagogastroduodenoscopy
    • EGD visualizes esophagus, stomach, and duodenum
    • Inflammation, cancer, bleeding, injury, infection
    • Consent, preop checklist
    • NPO 8-12 hrs (prevent aspiration)
    • Sedatives diazepam (Valium) and midazolam (Versed)
    • May be given atropine sulfate to dry oral secretions
    • Local anesthetic spray or gargle inhibits gag reflex
    • Placed on left side, tube passed orally down GI tract
  • 40. EGD (cont)
    • Photos or video
    • Specimens obtained
    • Afterward: VS, pt remains on side to prevent aspiration until sedation and anesthetic wear off
    • NPO until gag reflex returns (4hrs)
    • S/S perforation: bleeding, fever, dysphagia, pain—in various areas depending on site of perforation, cyanosis
    • Sore throat for a few days
  • 41.  
  • 42.  
  • 43.  
  • 44. G astroscopy
  • 45. Endoscopic Retrograde Cholangiopancreatography
    • ERCP visualize liver, GB, and pancreas
    • Direct viewing and use of contrast
    • Endoscope passed into duodenum and dye injected—outlines pancreatic and bile ducts
    • NPO night before, Iodine allergies
    • Lab studies i.e. Prothrombin time
    • Remove dentures
  • 46. Endoscopic Retrograde Cholangiopancreatography
  • 47. ERCP (cont)
    • Afterward note RUQ pain, fever, chills—infection
    • Hypotension, tachycardia, increasing RUQ pain, n/v—perforation or onset of pancreatitis
  • 48. Lower GI Endoscopy
    • Proctosigmoidoscopy—examination of distal sigmoid colon, rectum and colon using rigid or flexible endoscope
      • Detects ulcerations, punctures, lacerations, tumors, hemorrhoids, polyps, fissures, fistulas, abscesses
      • Annual exam for 40+
      • Lower bowel must be clean
  • 49. Proctosigmoidoscopy
    • Clear liquids X24hrs; laxative night before
    • Warm tap water enema or Fleet morning of
    • No bowel prep if bleeding, severe diarrhea
    • Position left lateral knee-to-chest (straightens sigmoid colon)
    • Rigid proctoscope for rectum
    • Flexible scope above rectosigmoid junction
  • 50. Proctosigmoidoscopy
    • Biopsy specimens, polyps removed
    • Cauterization to prevent/stop bleeding
    • After procedure rest in supine position to avoid orthostatic hypotension
    • Pain and flatus from instilled air
    • Observe for signs of perforation
  • 51. Colonoscopy
    • Visualization of lining of large intestine w/ flexible endoscope
    • Biopsy, polyps removed
    • Liquid diet 24hrs before; NPO after midnight
    • Bowel Prep i.e. GoLYTELY night before
    • Laxative, suppository (Dulcolax) or enema may be needed
  • 52. Colonoscopy (cont)
    • Conscious sedation i.e. Versed—relax and ease pain
    • Left side with knees bent
    • Air instilled into colon to help visualize (pressure/discomfort)
    • Encourage relaxation/deep breathing
    • VS; Watch for vasovagal response (Hypotension and bradycardia)
    • Monitor until stable; hemorrhage or severe pain
    • Flatus and cramping for several hours
    • Blood may be present in stool if biopsy
  • 53.  
  • 54.  
  • 55.  
  • 56.  
  • 57. Gastric Analysis
    • Measures stomach secretions
    • Duodenal ulcer, gastric carcinoma, pyloric or duodenal obstruction, pernicious anemia
    • Basal cell secretion test
      • Avoid drugs that interfere w/ acid secretion
      • NPO after midnight
      • NG tube inserted and syringe used to suction
      • Wall suction; contents q15min X1 hr
      • pH and amount of gastric acid
      • Too much HCL—peptic ulcer; too little—CA or pernicious anemia
  • 58. Gastric Analysis (cont)
    • Gastric Acid stimulation test
      • Measures amount of gastric acid for 1 hr after SQ injection of histamine drug
      • If abnormal results radiographic tests or endoscopy done
    • Tubeless gastric analysis detects presence of HCL
      • Stimulant and dye administered
      • Dye reacts if HCL present and appears in urine in 2 hrs
  • 59. Occult Blood Test
    • Detects blood not visible with naked eye in vomitus, gastric secretions, and stool
    • Small sample placed on special paper and treated with a chemical
    • Observe for specific color change
    • False positive results can occur with bleeding gums following a dental procedure; ingestion of red meat within 3 days before testing; ingestion of fish, turnips, or horseradish; certain medications (anticoagulants, NSAIDS, steroids, aspirin, large doses of iron)
  • 60. Stool Tests
    • Blood
    • Bile
    • Pathogenic organisms
    • Parasite ova (eggs)
    • Fecal fat
    • White blood cell count