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Git Procedures


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GIT Procedures

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Git Procedures

  1. 1. GASTROINTESTINAL PROCEDURES Gastrointestinal (GI) Series GASTROINTESTINAL PROCEDURES The introduction of barium, an opaque medium, into the upper GI tract via the mouth, gastrostomy tube, or nasogastric tube to visualize the area by x-ray methods Nursing care 1. Explain procedure to client 2. Maintain the client NPO after midnight 3. Inform client that the stool will be white or pink for NIO C. NOVENO, RN, MAN 24 to 72 hours after procedure 4. Encourage fluids and administer cathartics as ordered 5. Evaluate client's response to procedure nionoveno@yc GI PROCEDURES 2 Barium Enema Barium Enema Nursing care Explain procedure to the client 1. Prepare the client for the procedure by: 2. Administering cathartics and/or enemas as The introduction of a. A. ordered to evacuate the bowel barium, an opaque medium, into the Maintaining the client NPO for 8 to 10 hours prior b. to the test intestines for the purpose of x-ray Inspect stool after the procedure for the 3. visualization for presence of barium pathologic changes Administer enemas and/or cathartics as 4. ordered if the stool does not return to normal Encourage fluid intake 5. Evaluate client's response to procedure 6. nionoveno@yc GI PROCEDURES 3 nionoveno@yc GI PROCEDURES 4 DEAN NIO C. NOVENO, RN, MAN 1
  2. 2. GASTROINTESTINAL PROCEDURES Colostomy Irrigation and Care Colostomy irrigation Instillation of fluid into the lower colon 1. via a stoma on the abdominal wall to stimulate peristalsis and facilitate the expulsion of feces Cleansing the colostomy stoma and 2. collection of feces sigmoid colon will tend to produce formed o stools transverse or ascending colostomy will o produce less formed stools nionoveno@yc GI PROCEDURES 5 nionoveno@yc GI PROCEDURES 6 Colostomy Irrigation and Care Colostomy Irrigation and Care Nursing care Nursing care Secure a physician's order 1. Provide privacy while waiting for fecal returns or 6. Irrigate the stoma at the same time each day to 2. permit the client to ambulate with the collection bag approximate normal bowel habits in place to further stimulate peristalsis Insert a well-lubricated catheter tip into the 3. Clean the stoma 7. stoma if excoriation occurs, a soothing ointment may be o 7 to 10 cm in the direction of the remaining bowel ordered o as the solution is allowed to flow, the catheter may be Apply a colostomy bag or gauze dressing o 8. advanced Teach the client to control odor when necessary 9. Hold the irrigating container 4. place two aspirin tablets (or commercially available o height: 30.5 to 45.7 cm (12 to 18 inches) deodorizers) in the colostomy bag o temperature: 105oF (40.5oC) take bismuth subcarbonate tablets orally to control o o odor Clamp tubing or temporarily lower the container 5. Evaluate client's response to procedure if the client complains of cramping 10. nionoveno@yc GI PROCEDURES 7 nionoveno@yc GI PROCEDURES 8 DEAN NIO C. NOVENO, RN, MAN 2
  3. 3. GASTROINTESTINAL PROCEDURES Colostomy bag Endoscopy The visualization of the esophagus, stomach, gallbladder, pancreas, colon, or rectum using a hollow tube with a lighted end Gastroscopy: stomach 1. Esophagoscopy: esophagus 2. Sigmoidoscopy: sigmoid colon 3. Proctoscopy: rectum 4. Endoscopic retrograde 5. cholangiopancreatography (ERCP) One-piece Two-piece nionoveno@yc GI PROCEDURES 9 nionoveno@yc GI PROCEDURES 10 Gastric endoscopy Endoscopy nionoveno@yc GI PROCEDURES 11 nionoveno@yc GI PROCEDURES 12 DEAN NIO C. NOVENO, RN, MAN 3
  4. 4. GASTROINTESTINAL PROCEDURES Sigmoidoscopy Colonoscopy nionoveno@yc GI PROCEDURES 13 nionoveno@yc GI PROCEDURES 14 Endoscopic retrograde Endoscopy cholangiopancreatography (ERCP) Nursing care Obtain an informed consent for the procedure 1. If rectal examination is indicated, administer 2. cleansing enemas prior to the test Restrict diet (NPO) prior to procedure 3. Following the procedure, observe for bleeding, 4. changes in vital signs, or nausea If the throat is anesthetized (as for a 5. gastroscopy or esophagoscopy), check for the return of gag reflex before offering oral fluids Evaluate client's response to procedure 6. nionoveno@yc GI PROCEDURES 15 nionoveno@yc GI PROCEDURES 16 DEAN NIO C. NOVENO, RN, MAN 4
  5. 5. GASTROINTESTINAL PROCEDURES Enemas Enemas Tap-water enema (TWE): introduction of 1. water into the colon to stimulate evacuation Soapsuds enema (SSE): introduction of 2. soapy water into the colon to stimulate peristalsis by bowel irritation contraindicated as a preparation for an o endoscopic procedure • may alter the appearance of the mucosa Hypertonic enema: commercially 3. prepared small-volume enema that works on the principle of osmosis nionoveno@yc GI PROCEDURES 17 nionoveno@yc GI PROCEDURES 18 Enemas Enemas Nursing care Harris flush or drip: introduction of water Explain procedure to client 4. 1. into the colon as tolerated and subsequent Provide privacy 2. repeated drainage of that water through the place in side-lying position o same tubing to facilitate passage of flatus Obtain the correct solution High colonic irrigation: introduction of 3. 5. water into the upper portion of the colon to Lubricate the tip of a rectal catheter 4. facilitate complete fecal evacuation with water-soluble jelly Instillation: introduction of a liquid (usually 6. Insert the catheter 10 to 15 cm (4 to 5. mineral oil) into the colon to facilitate fecal 6 inches) into the rectum activity through lubricating effect nionoveno@yc GI PROCEDURES 19 nionoveno@yc GI PROCEDURES 20 DEAN NIO C. NOVENO, RN, MAN 5
  6. 6. GASTROINTESTINAL PROCEDURES Enemas Gastric Analysis Nursing care Allow the solution to enter slowly Analysis of stomach contents for the 6. 1. presence of abnormal constituents or keep it no more than 30.5 to 45.7 cm (12 to o 18 inches) above the rectum lack of normal constituents such as temporarily interrupt flow if cramps occur hydrochloric acid, blood, acid-fast o bacteria, and lactic acid Allow ample time for the client to expel 7. the enema Acid content is elevated in ulcers, 2. Observe and record the amount and decreased in malignant conditions of 8. consistency of returns the stomach, and absent in pernicious anemia Evaluate client's response to procedure 9. nionoveno@yc GI PROCEDURES 21 nionoveno@yc GI PROCEDURES 22 Gastric Analysis Gavage (Tube Feeding) Nursing care Explain procedure to client Nasogastric 1. 1. Maintain the client NPO prior to the test and Placement of a tube through the nose into the 2. a. have a nasogastric tube passed at time of stomach, securing it in place with tape procedure Prepared nutritional supplements are b. Administer histamine or caffeine to stimulate 3. introduced through this tube hydrochloric acid secretion prior to the Intestinal 2. procedure if ordered Placement of a tube through the nose into the a. Obtain stomach contents, secure in an 4. small intestine, securing it in place with tape appropriate container, and send to laboratory There is less likelihood of aspiration because b. Evaluate client's response to procedure 5. the pyloric sphincter inhibits backflow nionoveno@yc GI PROCEDURES 23 nionoveno@yc GI PROCEDURES 24 DEAN NIO C. NOVENO, RN, MAN 6
  7. 7. GASTROINTESTINAL PROCEDURES Gavage (Tube Feeding) Gavage (Tube Feeding) Surgically placed feeding tubes Percutaneous endoscopic gastrostomy 3. 4. Cervical esophagostomy: tube is sutured directly a. (PEG) into the esophagus for clients who have had head and neck surgery Stomach is punctured during endoscopy a. procedure Gastrostomy: tube is placed directly into stomach b. Does not require general anesthesia or b. through the abdominal wall and sutured in place laparotomy • used for clients who require tube feeding on a long-term basis Dressing should be changed daily c. Although associated with reduced risks, d. Jejunostomy: tube is inserted directly into the c. accidental removal and aspiration still jejunum for clients with pathologic conditions of the upper GI tract may occur nionoveno@yc GI PROCEDURES 25 nionoveno@yc GI PROCEDURES 26 Gavage (Tube Feeding) Gavage (Tube Feeding) Nursing care Nursing care Verify placement of tube prior to feeding Aspirate contents of stomach prior to 1. 2. Inject a small amount of air into the tube and, feeding to determine residual a. with a stethoscope placed over the epigastric reinstill to avoid electrolyte imbalance • area, listen for the passage of air into the withhold feeding if the residual is greater stomach • than 150 ml Aspirate for presence of stomach contents; b. reinstill to avoid electrolyte imbalance Test aspirate for acid pH c. Small-bore tube placement must be verified by d. x-ray examination nionoveno@yc GI PROCEDURES 27 nionoveno@yc GI PROCEDURES 28 DEAN NIO C. NOVENO, RN, MAN 7
  8. 8. GASTROINTESTINAL PROCEDURES Gavage (Tube Feeding) Gavage (Tube Feeding) Intermittent feeding cont… 3. Intermittent feeding 3. Slowly administer the feeding at room or body d. Position the client so that the head is elevated temperature a. during and for 1 hour after the feeding observe and question the client to determine – tolerance the higher the feeding container and the – Appropriately verify placement of tube b. larger the lumen of the feeding tube, the more rapid the flow Administer a small amount of water to clear the Introduce a small amount of water (30 ml) first to e. c. tube at the completion of the feeding verify the patency of the tube Clamp the tubing and clean the equipment f. – the tube should not be allowed to empty during Place client in sitting position for 1 hour after g. feeding so that excess air is not forced into the feeding stomach place infant in right side-lying position – nionoveno@yc GI PROCEDURES 29 nionoveno@yc GI PROCEDURES 30 Gavage (Tube Feeding) Gavage (Tube Feeding) Continuous feeding cont… 4. Continuous feeding 4. Appropriately verify placement of tube when adding d. Place prescribed feeding in gavage bag and prime a. additional fluid to a continuous feeding tubing to prevent excess air from entering stomach Flush tube intermittently with water to prevent occlusion e. of tube with feeding Set rate of flow b. – rate of flow can be manually regulated by setting Monitor for gastric distention and aspiration f. drops per minute or mechanically regulated by gastric distention and subsequent aspiration are less – using an electric pump frequent Discard unused fluid that has been in gavage Position the client to keep the head elevated g. c. administration bag at room temperature for longer than 4 throughout the feeding hours nionoveno@yc GI PROCEDURES 31 nionoveno@yc GI PROCEDURES 32 DEAN NIO C. NOVENO, RN, MAN 8
  9. 9. GASTROINTESTINAL PROCEDURES Gavage (Tube Feeding) Gavage (Tube Feeding) Care common for all clients receiving tube feedings cont… 5. Care common for all clients receiving 5. When appropriate, encourage the client to chew foods d. that will stimulate gastric secretions while providing tube feedings psychologic comfort chewed food may not be swallowed Monitor for abdominal distention – a. changes in bowel sounds or diarrhea – Provide special skin care e. if the client has a gastrostomy tube sutured in place, – the skin may become irritated from gastrointestinal enzymes Discontinue feeding if nausea and/or b. if the client has a nasogastric tube, the skin may – vomiting occur become excoriated at point of entry because of irritation Evaluate client's response to the procedure f. Provide oral hygiene c. nionoveno@yc GI PROCEDURES 33 nionoveno@yc GI PROCEDURES 34 Ileostomy Care Ileostomy The physical care of the ileostomy stoma and surrounding skin Nursing care Protect the skin from irritation, since the feces will be 1. liquid because of the anatomic location of the stoma Explain procedure to the client and family and encourage 2. selfcare Do not irrigate the stoma 3. Affix an appliance with an adequate seal (e.g., karaya) to 4. prevent accidental leakage around the stoma; the appliance is generally changed every 2 to 4 days but emptied every 6 hours Evaluate client's response to procedure 5. nionoveno@yc GI PROCEDURES 35 nionoveno@yc GI PROCEDURES 36 DEAN NIO C. NOVENO, RN, MAN 9
  10. 10. GASTROINTESTINAL PROCEDURES Irrigation of Nasogastric Gastric decompression: Levin (Levin) Tube The Levin tube is commonly used for gastric 1. decompression Purposes of insertion of a nasogastric tube 2. include emptying the stomach, obtaining a specimen for diagnostic purposes, or providing a means for nourishment Irrigation is the insertion and then removal of 3. fluid (usually normal saline) to maintain patency nionoveno@yc GI PROCEDURES 37 nionoveno@yc GI PROCEDURES 38 Irrigation of Nasogastric Irrigation of Nasogastric (Levin) Tube (Levin) Tube Nursing Care Instill approximately 30 ml of fluid into the Check that the order for irrigations has 5. 1. tube been written by the physician Gently withdraw the same volume of fluid as 6. Ascertain the patency of the Levin tube 2. was instilled attached to intermittent suction by o if the client has undergone gastric surgery, the observing for drainage physician will generally order instillations nausea or abdominal discomfort may indicate o irrigation fluid is instilled but not withdrawn that the tube is occluded o the amount instilled must be subtracted from total gastric output Assemble equipment: 30-ml syringe or 3. Chart the amount, color, and consistency of 7. bulb syringe, irrigating solution, and drainage basin for returning fluid Evaluate client's response to procedure 8. Verify placement 4. nionoveno@yc GI PROCEDURES 39 nionoveno@yc GI PROCEDURES 40 DEAN NIO C. NOVENO, RN, MAN 10
  11. 11. GASTROINTESTINAL PROCEDURES Paracentesis Paracentesis Nursing care The surgical puncture of the peritoneal Explain the procedure; obtain consent 1. membrane of the abdominal cavity for Have the client void prior to procedure 2. the purpose of removing fluid to avoid accidental trauma to the bladder Assist the client to a sitting position 3. Observe for signs of shock 4. sudden fluid shifts can result in • hypotension nionoveno@yc GI PROCEDURES 41 nionoveno@yc GI PROCEDURES 42 Paracentesis Paracentesis Nursing care Chart the amount and characteristics 5. of fluid withdrawn Apply a dry sterile dressing to the 6. puncture site Properly label the specimen if required 7. and send to the laboratory Evaluate client's response to the 8. procedure nionoveno@yc GI PROCEDURES 43 nionoveno@yc GI PROCEDURES 44 DEAN NIO C. NOVENO, RN, MAN 11
  12. 12. GASTROINTESTINAL PROCEDURES Parenteral Replacement Therapy Parenteral Replacement Therapy Total Parenteral Nutrition (TPN) Peripheral parenteral nutrition (PPN) Administration of carbohydrates, amino 1. Administration of isotonic lipid and 1. acids, vitamins, and minerals via a central amino acid solutions through a vein (usually the superior vena cava) peripheral vein High osmolality solutions (25% dextrose) 2. 2. Amino acid content should not exceed are administered in conjunction with 5% to 4%; dextrose content should not be 10% amino acids, electrolytes, minerals, greater than 10% and vitamins 3. Assists in maintaining a positive Assists in maintaining a positive nitrogen 3. balance nitrogen balance nionoveno@yc GI PROCEDURES 45 nionoveno@yc GI PROCEDURES 46 Parenteral Replacement Therapy Parenteral Replacement Therapy Intralipid therapy Total nutrient admixture (TNA or quot;3 in 1quot;) 1. Infusion of 10% to 20% fat emulsion 1. Combination of dextrose, amino acids that provides essential fatty acids and lipids in one container; vitamins and minerals may be added 2. Administered through a central line Provides increased caloric intake to 2. over 24 hours maintain positive nitrogen balance nionoveno@yc GI PROCEDURES 47 nionoveno@yc GI PROCEDURES 48 DEAN NIO C. NOVENO, RN, MAN 12
  13. 13. GASTROINTESTINAL PROCEDURES Parenteral Replacement Therapy Parenteral Replacement Therapy Nursing care Precisely regulate the fluid infusion rate; an Infuse fluid through a large vein such 3. 1. intravenous pump should be used if available as the subclavian because of the high Rapid infusion may result in movement of the a. osmolarity of the solution used in TPN fluid into the intravascular compartment dehydration, circulatory overload, and Ensure proper placement of the tube • 2. hyperglycemia can occur by chest x-ray examination after insertion of a catheter; accidental Slow infusion may result in hypoglycemia, b. since the body adapts to the high osmolarity of pneumothorax can occur during this fluid by secreting more insulin insertion therapy is never terminated abruptly but is • gradually discontinued nionoveno@yc GI PROCEDURES 49 nionoveno@yc GI PROCEDURES 50 Parenteral Replacement Therapy Parenteral Replacement Therapy Use aseptic technique when handling Utilize a filter for TPN; filters cannot 4. 6. the infusion or changing the dressing be used for lipids (in many institutions, only nurses Use surgically aseptic technique when 7. specially prepared are allowed to changing tubing change the dressing because of the Record daily weights, and monitor 8. high risk of infection) urinary sugar and acetone or blood Consult manufacturer's instructions 5. glucose levels frequently about tubing when administering lipids nionoveno@yc GI PROCEDURES 51 nionoveno@yc GI PROCEDURES 52 DEAN NIO C. NOVENO, RN, MAN 13
  14. 14. GASTROINTESTINAL PROCEDURES Parenteral Replacement Therapy Stool Specimens Stool for guaiac (occult blood): specimen or smear of Check laboratory reports daily, especially 1. 8. stool on a commercially prepared card is analyzed for glucose, creatine, BUN, and electrolytes the presence of blood serum lipids and liver function studies if lipids are positive results indicate the presence of blood in the • • stool administered peptic ulcer, gastritis, gastric or colonic carcinoma, • Monitor temperature every four hours since 9. colitis, or diverticulitis infection is the most common complication of TPN Stools for O and P (ova and parasites): must be sent to 2. the laboratory while still warm for microscopic if the client has a temperature elevation, order • examination unless a preservative is available cultures of blood, urine, and sputum to rule out other sources of infection Stool culture: specimen or swab of stool is sent in a 3. Evaluate client's response to procedure 10. sterile container for identification of abnormal bacterial growth nionoveno@yc GI PROCEDURES 53 nionoveno@yc GI PROCEDURES 54 Stool Specimens Guaic’s test Nursing care Explain procedure to the client 1. Collect specimen in an appropriate 2. container Label the container with the client's 3. name, identification number, physician, and room number Chart that the specimen was sent and 4. any unusual assessment of the stool nionoveno@yc GI PROCEDURES 55 nionoveno@yc GI PROCEDURES 56 DEAN NIO C. NOVENO, RN, MAN 14