Chapter 39

Nursing Assessment Gastrointestinal System

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Assessment of the Gastrointestinal System

Subjective data

Important health information

Past health history Medications Surgery or other treatments

Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

Assessment of the Gastrointestinal System

Objective data Physical examination Mouth Inspection Palpation Abdomen Supine, bend knees and raise head of bed, empty bladder, warm hands Inspection- skin changes Auscultation- do first because P&P may alter bowl sounds Percussion- to determine if fluid, distension, or masses are present heard by dullness. Tympany (air) is what you want to hear Palpation- to detect tenderness, muscular resistance Rectum and anus

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Fig. 39-7

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Diagnostic Studies of the Gastrointestinal System

Radiologic studies Upper gastrointestinal series/barium swallow- structural abnormalities of the esophagus, stomach, and duodenum NPO 8-12 hrs, no smoking after 24:00, give fluids and lax after to prevent impaction. White stool for 72hrs after Lower gastrointestinal series/barium enema- Colon Contrast medium every 30 min until reaches ileum. Give lax and enema before. Clear liquid diet evening before. NPO 8 hrs before test. Barium by enema. Cramping and urge to defecate may occur. Fluids and lax after Ultrasounds- Gallbladder Pt: NPO 8-12 hrs before. Air/gas reduce quality, food can cause gallbladder contraction, CT Biliary tract, liver, pancreatic disorders. Oral and IV contrast medium. **Iodine** MRI Hepatic region and staging colon cancer. IV contast used. Contraindicated in pregnant or metal implants
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Fig. 39-10

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Fig. 39-11

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Diagnostic Studies of the Gastrointestinal System (contd)

Endoscopy mucosal lining of the esophagus, stomach, duodenum. Visualize motility, inflammation, ulcers, tumors, tears. Biopsies can be taken. Varices can be treated. NPO 8 hrs, Signed consent, local anesthesia sprayed on throat, sedated during procedure. NPO until gag reflux returns. check temp every 15-20 min for 1-2 hrs to check for proforation. Capsule endoscopy GI tract, small intestines, Crohns, small bowel tumors, celiac, malabsorption, GI bleeding in areas other oscopys cant reach. * hrs after swallowing, pt returns to have capsule removed ColonoscopySigmoidoscopy ERCP Liver biopsy

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Fig. 39-12

Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

Fig. 39-13

Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.