MEDSURG PRELIM

• Hydrogen Breath Test


  Helps diagnose intolerance to sugars or small intestinal bacterial overgrowth (SIBO) by measuring hydrogen levels, indicating sugar tolerance issues or bacterial growth in the small intestine
• Upper GI and Small Bowel Series


  Set of x-rays to examine the esophagus, stomach, and small intestine. Barium enema is a related test that examines the large intestine
• Guaiac Test


  Occult (hidden) blood test on stool involving placing a fecal sample on guaiac paper and applying hydrogen peroxide, resulting in a quick blue color change in the presence of blood
• Barium enema


  Test that examines the large intestine
• Ultrasonography


  Procedure that uses high-energy sound waves to look at tissues and organs inside the body
• Upper GI and Small Bowel Series


  Set of x-rays taken to examine the esophagus, stomach, and small intestine
• Barium enema


  An X-ray exam that can detect changes or abnormalities in the large intestine (colon)
• Magnetic Resonance Imaging (MRI)


  Test that uses powerful magnets, radio waves, and a computer to make detailed pictures of the inside of the body
• Endoscopy


  Nonsurgical procedure used to examine a person’s digestive tract using an endoscope, a flexible tube with a light and camera attached
• Ultrasound


  Procedure that uses high-energy sound waves to look at tissues and organs inside the body
• Upper GI endoscopy

  1. Withhold food and fluids for 6 to 8 hours before the procedure

  2. Remove dentures and eyewear

  3. Provide mouth care
• Accidental perforation of the esophagus or colon may occur during endoscopy
• During an upper endoscopy or EGD, an image of the esophagus, stomach, and duodenum is transmitted through a thin, flexible, lighted tube called an endoscope
• Pre-procedure for EGD

  1. Avoid eating all solid foods 8 hours before the procedure

  2. Do not allow the patient to take oral diabetes medicine the morning of the test

  3. Do not allow the patient to chew gums and/or drink clear liquids 2 hours before the procedure

  4. Ensure informed consent is signed prior to premedication

  5. Encourage questions, provide answers and support

  6. Remove dentures and eyewear

  7. Provide mouth care
• Pre-procedure for Proctosigmoidoscopy/Colonoscopy

  1. Do not eat solid food the day before the exam

  2. Limit drinks to clear liquids

  3. Take laxative the night before or both the night before and the morning of the procedure

  4. Encourage the use of an enema kit

  5. Secure informed consent

  6. Provide information about the procedure

  7. Ensure compliance with bowel preparation

  8. Establish an IV line

  9. Explain the introduction of air through the colonoscopy
• Proctosigmoidoscopy/Colonoscopy is an exam used to detect changes or abnormalities in the large intestine (colon) and rectum
• Colon endoscopy (proctoscopy, sigmoidoscopy, and colonoscopy)

  1. Bowel must be free of stool to enhance visualization

  2. Accomplished with laxatives and cleansing enemas
• Upper endoscopy or EGD can be used to diagnose upper GI conditions
• Post-procedure for EGD

  1. Patient may experience a sore throat after the procedure

  2. Physician will discuss preliminary findings once discharge criteria are met

  3. Diet and/or medication restrictions may be given depending on exam findings
• Post-procedure instructions

  1. Withhold foods, fluids, and P.O. medications until the patient is fully alert and gag reflex has returned

  2. Take vital signs per SOP
• A long, flexible tube with a tiny video camera at the tip is inserted into the rectum during Proctosigmoidoscopy/Colonoscopy
• Fecalysis


  1. Assess the patient's level of comfort

  2. Encourage the patient to urinate before to avoid contamination

  3. Advise patient to avoid laxatives, enemas, or suppositories before collection

  4. Instruct a red-meat free and high residue diet before the test

  5. Instruct patient to do hand washing post-procedure

  6. Recommend regular screening
• Post-colonoscopy care

  1. If a polyp was removed, advise a special diet temporarily

  2. Inform the patient about feeling bloated or passing gas after the exam

  3. Inform about the possibility of a small amount of blood in the first bowel movement after the exam
• There's a risk of bruising or infection at the site of a blood test. Moderate pain or a sharp sensation may be felt when the needle is inserted
• CEA test measures the CEA in the blood, which is a protein found in the tissues of a developing baby. High CEA levels can indicate certain types of cancers or noncancerous conditions
• After a colonoscopy, it takes about an hour to begin to recover from the sedative. The patient will need a family member to take them home because the full effects of the sedative can take up to a day to wear off. The patient should not drive, make important decisions, or go back to work for the rest of the day
• Gastric analysis is performed to evaluate gastric
• Fecalysis is a series of tests done on a stool sample to help diagnose conditions affecting the digestive tract such as infection, poor nutrient absorption, or cancer
• CEA blood test

  1. No special preparations needed

  2. High CEA levels can indicate certain types of cancers or noncancerous conditions
• Enema administration

  1. Secure an informed consent

  2. Provide information about the procedure

  3. Ensure that the patient has complied with the bowel preparation

  4. Establish an IV line

  5. Explain to the patient that air may be introduced through the colonoscopy

  6. Instruct the patient to remove all metallic objects from the area to be examined
• Nursing Responsibilities

  • Pre-procedure: Educate patient about the procedure and preparation, obtain informed consent, instruct NPO for 8-10 hours, implement care for gastric intubation, withdraw stomach contents if ordered, allow patient to rest after tube insertion. Post-procedure: Monitor vital signs, observe for throat irritation or bleeding, resume diet and medication as per physician's orders
• Refluxed material in GERD has a pH of 1.5-2, whereas the esophagus normally has a pH of 6-8, causing erosive esophagitis
• For sore throat post-procedure, soothing lozenges may be given and the patient can resume the usual diet and medications
• Predisposing Factors for GERD

  • Food, alcohol, cigarettes, hiatal hernia, increased abdominal pressure, certain medications, prolonged NGT placement
• Diagnosis of GERD includes endoscopy and 24-hour ambulatory pH monitoring
• Complications such as nausea, vomiting, abdominal distention, or pain are possible following removal of the gastric tube
• Gastric Analysis


  Performed to evaluate gastric function by measuring the contents of a fasting patient’s stomach for acidity, appearance, and volume
• Gastroesophageal Reflux Disease (GERD) causes esophageal mucosa irritation by gastric and duodenal contents, leading to inflammation
• Physical Manifestations of GERD

  • Dyspepsia, regurgitation, hypersalivation, dysphagia, odynophagia
• Interventions for GERD

  • Avoid factors decreasing LES pressure or causing esophageal irritation, follow a low-fat high-fiber diet, avoid specific triggers, elevate head of bed, avoid anticholinergics, and follow specific eating instructions