GI diagnostics

liver function tests

urine bilinogen

fecal occult blood test(FOBT) and stool samples

endoscopy

GI series

Aspartate aminotransferase (AST)

5-40 units

elevation occurs with hep or cirrhosis

Alanine aminotransferase (ALT)

8-20 units/L 3-35 IU/L

elevation occurs with hep or cirrhosis

Alkaline phosphatase (ALP)

30-120 units/L 30-85 IU/L

elevation indicates liver damage

amylase

56-90 IU/L

elevation occurs with pancreatitis

Lipase

0-110 units/L

elevation occurs with pancreatitis

total bilirubin

0.1 to 1.0 mg/dL

elevations indicate altered liver function, bile duct obstruction, or other hepatobiliary disorder

direct (conjugated) bilirubin

0.1-0.3 mg/dL

elevations indicate altered liver function, bile duct obstruction, or other hepatobiliary disorder

indirect (unconjugated) bilirubin

0.2-0.8 mg/dL

elevations indicate altered liver function, bile duct obstruction, or other hepatobiliary disorder

albumin

3.5-5.0 g/dL

decrease may indicate hepatic disease

alpha-fetoprotein

less than 40 mcg/L

elevated in liver cancer

ammonia

15-110 mcg/dL

elevated in liver disease

fecal occult blood test

collected and tested for blood, ova, and parasites (Giardia lamblia), and bacteria (c.diff) stool may also be collected to assess for DNA changes in the vimentin gene.

GI bleeding

ulcer, colitis, cancer

what does a change in the vimentin gene indicate

colorectal cancer

GI scope procedures

colonoscopy

EGD

ERCP

sigmoidoscopy

indications for scopes

GI bleeding

ulcerations

inflammation

polyps

malignant tumors

general endoscopic preprocedures

evaluate client's understanding

verify consent

assess VS and allergies

evaluate CBC, electrolyte panel, BUN, Cr, PT, aPTT, and liver function studies

evaluate chest XRay, ECG, and ABG

increased risks of complications for scopes

age

current health status

cognitive status

support system

colonoscopy

moderate sedation-midazolam (Versed) usually with an opiate analgesic

positioning-left sided with knees to chest

bowel prep dulcolax/golytely

clear liq diet(avoid red, purple, orange fluids)

NPO after midnight

colonoscopy post procedure

notify of severe pain

monitor for rectal bleeding

monitor VS and resp status

resume normal diet

encourage increased fluid

may be increased flatulence d/t air intillation

EGD

insertion through mouth into esophagus, stomach, and duodenum

moderate sedation-topical anesthetic

left side lying

NPO 6-8 hours, remove dentures

EGD postprocedure

monitor VS and Resp

notify provider of bleeding, abd/chest pain, and any evidence of infection

withhold fluids until gag reflex returns

ERCP

through the mouth into the biliary tree via the duodenum, allows visualization of the biliary ducts, gall bladder, liver, and pancreas

conscious sedation-topical anesthetic

initially semi prone with repositioning throughout procedure

NPO 6-8 hr, remove dentures

ERCP postprocedure

VS and Resp

notify if bleeding, abd/chest pain, infection

withhold fluids until return of gag reflex

sigmoidoscopy

anus, rectum, and sigmoid colon

left side

bowel prep dulcolax, and golytely

clear liq diet

NPO after midnight

sigmoidoscopy postprocedure

VS and resp

rectal bleeding

resume normal diet

encourage increased fluids

may be increased flatulence

oversedation manifestations

difficult to arouse, poor resp effort, evidence of hypoxemia, tachycardia, elevated/low BP

nursing actions for oversedation

antidotes

maintain open airway

administer oxygen

notify provider immediately

hemorrhage manifestations

bleeding

cool and clammy skin

hypotension

tachycardia, dizziness, and tachypnea

nursing actions hemorrhage

assess for hemorrhage from the site, monitor VS, and monitor diagnostic test results(Hgb and Hct)

notify provider immediately

client ed-report fever, pain and bleeding to provider

aspiration manifestations

dyspnea

tachypnea

adventitious breath sounds

tachycardia

fever

nursing actions aspiration

keep client NPO until gag reflex returns

ensure client is awake and alert prior to consuming food or fluid

deep breathe and cough

notify provider if there is delay in gag reflex

client ed-report any resp congestion or compromise to provider

perforation of GI tract

chest/abd pain

fever

n/v

abd distention

nursing actions perforation

monitor diagnostic tests for evidence of infection, elevated WBC, notify provider of findings

client ed-report fever, pain, and bleeding to the provider

preprocedure barium

clear liq diet and/or low residue

NPO after midnight

avoid smoking or chewing gum(increases peristalsis)

barium enema studies must be scheduled prior to upper GI studies

contraindications to bowel preparation

possible bowel perforation or obstruction, inflammatory disease

client education barium

restrict food and fluids for bowel preparation

inform client that if the sm intestine is to be visualized additional radiographs will be done over the next 24 hr

post procedure barium

monitor elimination of contrast material and administer a laxative if prescribed

increase fluid intake

client ed barium

instruct client to monitor elimination of contrast and to report retention of contrast(constipation or diarrhea accompanied by weakness

discuss the possible need for an over the counter med to prevent constipation resulting from barium

instruct the client that stools will be white for 24-72 hours until barium clears. the client should report abdominal fullness, pain or delay in return to brown stool.

enteral feedings

instituted when a client can no longer take adequate nutrition orally

clients who are intubated

pathologies that cause difficulty swallowing(stroke, advanced parkinsons, and MS)

clients who cannot maintain adequate oral nutrition

client presentation

malnutrition

aspiration pneumonia

complications of enteral feedings

overfeeding results from infusion of greater quantity of feeding than can be readily digested, resulting in abdominal distention, n/v.

nursing actions for overfeeding

check residual every 4-6 hours

follow protocol for withholding excess residual volumes as directed (typically 100-200mL)

withhold feeding as prescribed and resume at reduced rate as prescribed

diarrhea from enteral feedings

occurs secondary to concentration of feeding or its constituents

nursing actions for diarrhea of enteral feedings

slow rate of feeding and notify provider

confer with the dietitian

provide skin care and protection

aspiration pneumonia

age