general gastrointestinal system assessments

1. GIT Disorders
by :
Dr. Alshazaly abdoalghfar
BSN, RN, MSN, CNE PhD.
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2. Lecture 2
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Assessment of GIT System

3. Objectives
By the end of this lecture all of us well be able to
 Identify the assessment and diagnostic test used to
confirm GIT disorders.
 Formulate the nursing process as a framework for care
of patients with GIT disease.
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4. Assessment component
 History
 Physical examination
 Diagnostic test
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5. Assessment
History
 Personal data
 name ,age ,occupation ,residence , and education level
 Present medical history (chief complain):
 Such as abdominal pain, indigestion, belching, flatulence,
nausea, vomiting, hematemesis, constipation, diarrhea, heart
burn and abdominal distension
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6. Cont…
 Past medical history
 Social history
 Family history
 Drug history
 Diet history
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7. Physical examination
 Physical examination includes assessment of the mouth ,
abdomen and rectum
 Mouth examination:
 The tongue ,teeth ,mucosal membrane and gums are inspected
 Ulcers , nodules ,swelling , discoloration and inflammation are
noted
 Abdominal examination
 The patient lies supine with knee flexed slightly for
 Inspection
 Auscultation
 Palpation
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8. Abdominal examination
 Inspection :
 performs first , observe skin changes and scars from previous
surgery
 Auscultation :
 performs before percussion and palpation to avoid changes of
bowel sounds
 Bowel sound should be assessed in all four quadrants using
stethoscope may be normal or abnormal
 Normal sounds heard about every 5 to 20 seconds, hyperactive
5to 6 sounds heard in less than 30 seconds, hypoactive one or
two sounds in 2 minutes or may be absent (no sounds in 3 to 5
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9. Con
 Palpation:
 Use of light palpation for identifying areas of tenderness or
swelling
 Deep palpation to identify masses in the abdomen
 Percussion:
 During percussion notes dullness or music sound
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10. Diagnostic test
 Laboratory test
 Radiology and imaging studies
 Endoscopic procedure
 Liver biopsy
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11. Laboratory test
 Stool general(for consistency, color, and occult (not visible) blood. Additional
studies, including fecal urobilinogen, fecal fat, nitrogen, Clostridium difficile,fecal
leukocytes, calculation of stool osmolar gap, parasites, pathogens, food residues, and
other substances)
 LFT
 Stool for occult blood
 CBC - Breathe test.(H pylori).
 Wdial test
 Gastric analysis test
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12. Radiology and imaging studies
 Abdominal X ray
 Barium swallow
 Barium enema
 Abdominal ultra sound
 Abdominal CT scan and MRI(magnatic resonance
imaging)
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13. Endoscopic procedure
 Upper GIT endoscopy such as
esophagogastroduodenoscopy
 Lower GIT endoscopy such as colonoscopy ,
sigmoidoscopy ,
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14. Nursing preparation for barium enema
 Explain procedure to the patient
 Emptying and cleaning the bowel
 A low residue diet 1 to 2 days before the test
 A clear liquid diet and laxative at the evening before
 Nothing by mouth after mid night
 Cleaning enema until returns are clear at the morning
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15. Con
Post procedure:
 Administer an enema or laxative to facilitate barium removal
 Increase fluid intake
 Monitors the Pt for complete elimination of the barium
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16. Esophagogastroduodenoscopy
 Visual examination of the esophagus, stomach, and
duodenum
 NPO for 6 to 8 hr before the procedure
 After the test, assessment of vital signs every 30 min
 NPO until gag reflex returns
 Throat discomfort possible for several days
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17. Nursing role for Pt undergoing colonoscopy
 Explain procedure , obtain consent form
 Clear liquid diet 2 to 3 days pretest
 NPO 8 hours pretest
 Bowel cleaning using laxative like castor oil
 Warm water or saline enema in the morning of the test
 A sedative or narcotic may be used to promote relaxation
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18. Cont…
 Check HB , PT , PTT and platelets before test
 Patient in left side position and encourage relaxation and
deep breathing when colonoscopy is inserted
Post Procedure:
 monitor VS
 Assess Pt for following anal bleeding , sever crams , purulent
rectal drainage or fever and abdominal distention
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19. Endoscopic Retrograde
Cholangiopancreatography
 Visual and radiographic examination of the liver,
gallbladder, bile ducts, and pancreas
 NPO for 6 to 8 hr before test
 Access for intravenous sedation
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20. Cont…
After the test:
 Assessment of vital signs every 15 min
 Return of gag reflex checked
 Assessment for pain
 Colicky abdominal pain
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21. GIT DISORDERS
 Peptic ulcer
 Jaundice
 Liver cirrhosis
 Pancreatitis
 Gastritis
 Bowel disorders
 GIT bleeding
 Acute abdomen
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22. Nursing Process
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23. Nursing process:
 The nursing process is statement made by nurse that
addresses the focus of nursing care to be provide to pt
……..
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24. 1
ND:
 Pain R/T exacerbation of disease process evidence by pt
suffer from pain &facial expression .
GOAL:
 Reduce pain &provide comfortable .
INTERVENSION:
 Assess pain location , intensity & characteristic .
 Encourage pt to change position frequently to minimize
discomfort .
 Administer analgesia as order.
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25. 2
ND:
 Constipation R/TO immobility ,medication& decrease GIT
motility evidence by absent of stool .
GOAL:
 Promoting bowel elimination .
INTERVENTION
 Assess bowel sound
 Evaluate abdominal distension, nausea ,vomiting which may
indicate obstruction.
 Monitor stool for frequency ,amount and consistency.
 Encourage diet with adequate fiber and fluid.
 Administer laxative as order.
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26. 3
ND:
 Diarrhea related to acute infectious process , irritated bowel
and intestinal hyperactivity evidence by pt having diarrhea.
GOAL:
 Reducing diarrhea .
INTERVENTION:
 Assess diarrheal amount ,frequency and consistency and
color.
 Appropriate fluid intake, balance of food and avoidance food
that stimulate diarrhea.
 Administer antidiarrheal as order.
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27. 4
ND:
 Imbalance nutrition less than body requirement R/TO increase
out put and inadequate intake evidence by pt wt loss.
GOAL :
 Maintaining nutritional status
INTERVENTION :
 Review dietary habits with pt to determine pattern preferences
and bowel irritants .
 Advice pt to avoid food that stimulate elimination.
 Administer antidiarrheal as order.
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28. 5
ND:
 Risk for Impaired Skin Integrity related to contact with
diarrheal stools and inadequate perennial hygiene; related to
altered nutritional status; related to edema, ascites, and
purities
GOAL:
 Maintaining skin integrity
INTERVENTION:
 Encourage ambulation if pt able
 Clean ,dry ,and moisturize skin.
 Encourage adequate nutrition and hydration
 Teach pt the cause of pressure ulcer development(pressure
on skin , incontinence , poor nutrition)
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29. 6
ND:
 Risk for fluid volume deficit R/TO diarrhea ,vomiting or
inadequate intake & fever .
GOAL:
 Maintain fluid volume
INTERVENTION:
 Assess sign of dehydration (flushed dry skin , hypotension
……etc).
 Encourage oral intake if passable
 Administer IV fluid .
 Given drug as order…..
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30. 7
ND:
 Risk for infection R/To surgery & procedure (Iv line , feeding
tube)
GOAL :
 Preventing infection
INTERVENTION:
 Monitor V/S mainly temp
 Use aseptic technique .
 Change surgical dressing daily as indicate.
 Monitor S /S of infection(redness, swelling, hotness, odor and
pain)
 Administer antibiotics as order.
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31. Reference
 Bruner's medical surgical nursing
 Manual nursing practice
 Gastroenterology for nurses
 Clinical practice of gastroenterology
 www.nanda.org
 www.GIT.org
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32. Thank you
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