Git Part 1- Run

GIT part 1GIT part 1

Ruby Ruth Roces, R.N., M.D.Ruby Ruth Roces, R.N., M.D.

Common laboratory Common laboratory ProceduresProcedures

COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES

FECALYSISFECALYSIS Examination of stool Examination of stool

consistency, color and the consistency, color and the presence of occult blood.presence of occult blood.

Special tests for fat, nitrogen, Special tests for fat, nitrogen, parasites, ova, pathogens and parasites, ova, pathogens and othersothers

COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES

FECALYSIS: Occult Blood FECALYSIS: Occult Blood TestingTesting

3-day meatless diet3-day meatless diet No intake of NSAIDS, aspirin, No intake of NSAIDS, aspirin,

iron,steroids & anti-coagulant iron,steroids & anti-coagulant 48 Hrs prior48 Hrs prior

3 stool specimen3 stool specimen Screening test for colonic Screening test for colonic

cancercancer

Test for ova- fresh stoolTest for ova- fresh stool Test for lipids- inc fat diet, no Test for lipids- inc fat diet, no

alcohol 3 days prioralcohol 3 days prior

72 hr stool specimen- store in ice72 hr stool specimen- store in ice

no mineral oil, no neomycin SO4no mineral oil, no neomycin SO4

COMMON COMMON LABORATORY LABORATORY PROCEDURESPROCEDURESUpper GIT study: barium Upper GIT study: barium

swallowswallow Pre-testPre-test: NPO post-midnight: NPO post-midnight Post-testPost-test: Laxative is ordered, : Laxative is ordered,

increase pt fluid intake, increase pt fluid intake, instruct that stools will turn instruct that stools will turn white, monitor for obstructionwhite, monitor for obstruction

COMMON COMMON LABORATORY LABORATORY PROCEDURESPROCEDURESLower GIT study: barium Lower GIT study: barium

enemaenema Pre-testPre-test: low residue diet x 1-2 : low residue diet x 1-2

days, Clear liquid diet and days, Clear liquid diet and laxatives, NPO post-midnight, laxatives, NPO post-midnight, cleansing enema prior to the cleansing enema prior to the testtest

Post-test:Post-test: Laxative is ordered, Laxative is ordered, increase patient fluid intake, increase patient fluid intake, instruct that stools will turn instruct that stools will turn white, monitor for obstructionwhite, monitor for obstruction

COMMON COMMON LABORATORY LABORATORY PROCEDURESPROCEDURESGastric analysisGastric analysis Aspiration of gastric juice to measure Aspiration of gastric juice to measure

pH, appearance, volume and pH, appearance, volume and contents- NGT is inserted, connected contents- NGT is inserted, connected to suction & contents collected q 15 to suction & contents collected q 15 mins to 1 hr.mins to 1 hr.

Pre-test:Pre-test: NPO 8-12 hours, avoidance NPO 8-12 hours, avoidance of stimulants& drugs for 24-48 hrs, of stimulants& drugs for 24-48 hrs, cigarette and chewing gum for 6 hrs cigarette and chewing gum for 6 hrs before testbefore test

Post-test:Post-test: resume normal activities resume normal activities

COMMON COMMON LABORATORY LABORATORY PROCEDURESPROCEDURESLower GI- scopy Lower GI- scopy (anoscopy, proctoscopy, (anoscopy, proctoscopy, sigmoidoscopy, sigmoidoscopy, colonoscopy) colonoscopy)

Pre-test:Pre-test: consent, clear consent, clear liquids 24 hrs,NPO 8 hours, liquids 24 hrs,NPO 8 hours, cleansing enema until return cleansing enema until return is clearis clear

Intra-test:Intra-test: position is position is LEFTLEFT lateral, right leg is bent and lateral, right leg is bent and placed anteriorlyplaced anteriorly

Post-test:Post-test: supine for few supine for few minutes to prevent minutes to prevent orthostatic hypotensionbed orthostatic hypotensionbed rest, monitor for rest, monitor for complications like bleeding complications like bleeding and perforationand perforation

COMMON COMMON LABORATORY LABORATORY PROCEDURESPROCEDURESParacentesisParacentesis Pre-test:Pre-test: ensure consent, ensure consent,

instruct to VOID and empty instruct to VOID and empty bladder, measure abdominal bladder, measure abdominal girthgirth

Intra-test:Intra-test: Upright on the Upright on the edge of the bed, back edge of the bed, back supported and feet resting on supported and feet resting on a foot stoola foot stool

postprocedure:postprocedure: monitor vs, hypovolemia, monitor vs, hypovolemia,

elecstrolyte loss, hematuriaelecstrolyte loss, hematuria instruct to notify if urine become s instruct to notify if urine become s

bloody, pink, redbloody, pink, red apply a dry sterile dressingapply a dry sterile dressing measure fluid collected, describe measure fluid collected, describe

and recordand record

Conditions of the GITConditions of the GIT

UPPER GI systemUPPER GI system

CONDITION OF THE CONDITION OF THE ESOPHAGUSESOPHAGUS

HIATAL HERNIAHIATAL HERNIA Protrusion of the esophagus Protrusion of the esophagus

into the diaphragm thru an into the diaphragm thru an openingopening


ASSESSMENT ASSESSMENT 1. Heartburn1. Heartburn 2. Regurgitation2. Regurgitation 3. Dysphagia3. Dysphagia 4. 50%- without 4. 50%- without

symptomssymptoms


DIAGNOSTIC TESTDIAGNOSTIC TESTBarium swallow and Barium swallow and fluoroscopyfluoroscopy


NURSING INTERVENTIONSNURSING INTERVENTIONS small frequent feedingssmall frequent feedings AVOID supine positionAVOID supine position for 1 hour for 1 hour

after eatingafter eating Elevate the headElevate the head of the bed on 8- of the bed on 8-

inch blockinch block avoid anticholinergic wch delays avoid anticholinergic wch delays

emptyingemptying


Esophageal VaricesEsophageal Varices Dilation and tortuosity of the Dilation and tortuosity of the

submucosal veins in the distal submucosal veins in the distal esophagus esophagus

ETIOLOGY: commonly caused ETIOLOGY: commonly caused by PORTAL hypertension by PORTAL hypertension secondary to liver cirrhosissecondary to liver cirrhosis

This is an Emergency This is an Emergency condition!condition!


ASSESSMENTASSESSMENT HematemesisHematemesis MelenaMelena AscitesAscites jaundicejaundice

hepatomegaly/splenomegalyhepatomegaly/splenomegaly Signs of ShockSigns of Shock


DIAGNOSTIC DIAGNOSTIC PROCEDUREPROCEDURE

EsophagoscopyEsophagoscopy

COMMON COMMON LABORATORY LABORATORY PROCEDURESPROCEDURESEGDEGD(esophagogastroduodenosco(esophagogastroduodenosco

py)py) Pre-testPre-test: ensure consent, NPO : ensure consent, NPO

8 hours, pre-medications like 8 hours, pre-medications like atropine and anxiolytics, atropine and anxiolytics, remove dentures, local spray remove dentures, local spray to post. Pharynx-advise not to to post. Pharynx-advise not to swallowswallow

COMMON COMMON LABORATORY LABORATORY PROCEDURESPROCEDURES

EGDEGD Intra-test:Intra-test: position : position : LEFTLEFT lateral to lateral to

facilitate salivary drainage and facilitate salivary drainage and easy accesseasy access

Post-testPost-test: NPO until gag reflex : NPO until gag reflex returns, place patient in returns, place patient in SIMS SIMS position until he awakensposition until he awakens, monitor , monitor for complications, saline gargles for complications, saline gargles for mild oral discomfortfor mild oral discomfort


NURSING INTERVENTIONS NURSING INTERVENTIONS 1. Monitor VS strictly.1. Monitor VS strictly. 2. Monitor for LOC2. Monitor for LOC 3. Maintain NPO3. Maintain NPO 4. Monitor blood studies4. Monitor blood studies 5. Administer O25. Administer O2 6. prepare for blood 6. prepare for blood

transfusiontransfusion


7. prepare to administer Vasopressin 7. prepare to administer Vasopressin and Nitroglycerinand Nitroglycerin

8. Assist in NGT and Sengstaken-8. Assist in NGT and Sengstaken-Blakemore tube insertion for balloon Blakemore tube insertion for balloon tamponade tamponade

9. Prepare to assist in surgical 9. Prepare to assist in surgical management:management:– Endoscopic sclerotherapyEndoscopic sclerotherapy– Variceal ligationVariceal ligation– Shunt proceduresShunt procedures

Conditions of the Conditions of the StomachStomach

Gastro-esophageal refluxGastro-esophageal reflux due to incompetent lower due to incompetent lower

esophageal sphincter , pyloric esophageal sphincter , pyloric stenosis or motility disorderstenosis or motility disorder

Symptoms may mimic ANGINA Symptoms may mimic ANGINA or MIor MI


ASSESSMENT ( for GERD)ASSESSMENT ( for GERD) HeartburnHeartburn DyspepsiaDyspepsia RegurgitationRegurgitation Epigastric painEpigastric pain Difficulty swallowingDifficulty swallowing PtyalismPtyalism

Diagnostic testDiagnostic test Endoscopy or barium swallowEndoscopy or barium swallow Gastric ambulatory pH analysisGastric ambulatory pH analysis

– Note for the pH of the Note for the pH of the esophagus, usually done for 24 esophagus, usually done for 24 hourshours

– The pH probe is located 5 The pH probe is located 5 inches above the lower inches above the lower esophageal sphincteresophageal sphincter

– The machine registers the The machine registers the different pH of the refluxed different pH of the refluxed material into the esophagusmaterial into the esophagus


NURSING INTERVENTIONSNURSING INTERVENTIONS AVOID stimulus that AVOID stimulus that

increases stomach increases stomach pressure and decreases pressure and decreases LES pressureLES pressure

( spices, coffee, tobacco ( spices, coffee, tobacco and carbonated drinks)and carbonated drinks)

LOW-FAT, HIGH-FIBER dietLOW-FAT, HIGH-FIBER diet

Conditions of the Conditions of the StomachStomachNURSING INTERVENTIONSNURSING INTERVENTIONS Avoid foods and drinks TWO Avoid foods and drinks TWO

hours before bedtimehours before bedtime Elevate the head of the bed Elevate the head of the bed

with an approximately 8-inch with an approximately 8-inch blockblock

Administer prescribed meds Administer prescribed meds Advise proper weight reductionAdvise proper weight reduction


GASTRITISGASTRITIS Inflammation of the gastric Inflammation of the gastric

mucosamucosa May be Acute or ChronicMay be Acute or Chronic Etiology: Acute- bacteria, Etiology: Acute- bacteria,

irritating foods, NSAIDS, irritating foods, NSAIDS, alcohol, bile and radiation, alcohol, bile and radiation, Autoimmune disease, diet, Autoimmune disease, diet, smokingsmoking


DIAGNOSTIC PROCEDUREDIAGNOSTIC PROCEDURE EGD- to visualize the gastric EGD- to visualize the gastric

mucosa for inflammationmucosa for inflammation Low levels of HClLow levels of HCl Biopsy to establish correct Biopsy to establish correct

diagnosis whether acute or diagnosis whether acute or chronicchronic


NURSING INTERVENTIONSNURSING INTERVENTIONS Give Give BLANDBLAND diet diet Monitor for signs of Monitor for signs of

complications like bleeding, complications like bleeding, obstruction and pernicious obstruction and pernicious anemiaanemia

Instruct to avoid spicy foods, Instruct to avoid spicy foods, irritating foods, alcohol and irritating foods, alcohol and caffeinecaffeine


NURSING INTERVENTIONSNURSING INTERVENTIONS Administer prescribed Administer prescribed

medications- H2 blockers, medications- H2 blockers, antibiotics, mucosal antibiotics, mucosal protectantsprotectants

Inform the need for Vitamin Inform the need for Vitamin B12 injection if deficiency is B12 injection if deficiency is presentpresent


PEPTIC ULCER DISEASEPEPTIC ULCER DISEASE An ulceration of the gastric An ulceration of the gastric

and duodenal lininand duodenal linin Most common Peptic Most common Peptic

ulceration: anterior part of ulceration: anterior part of the upper duodenumgthe upper duodenumg

Condition of the Condition of the DuodenumDuodenum

DIAGNOSTIC DIAGNOSTIC TESTSTESTS

EGD and BiopsyEGD and Biopsy

Drugs:Drugs: Histamine H2 receptors antagonists (po/iv)Histamine H2 receptors antagonists (po/iv) Axn: Axn: HCl production HCl production Taken with meals or at h.s., cigarettes Taken with meals or at h.s., cigarettes

reduces the reduces the axn.axn. SE: headache, skin rash, bleeding and SE: headache, skin rash, bleeding and

dizzinessdizziness 8 weeks medication (if s/sx will not 8 weeks medication (if s/sx will not

improve start antibiotics) improve start antibiotics) Cimetidine (Tagamet)Cimetidine (Tagamet) Ranitidine (Zantac)Ranitidine (Zantac) Famotidine (Pepcid)Famotidine (Pepcid) Nizatidine (Axid)Nizatidine (Axid)

Drugs:Drugs: AntibioticsAntibiotics AmoxilAmoxil TetracyclineTetracycline Can be combined with other drugsCan be combined with other drugs

Drugs:Drugs:

Mucosal BarrierMucosal Barrier Axn: adheres to ulcer surfaceAxn: adheres to ulcer surface 30 min interval before taking 30 min interval before taking

antacidsantacids SE: constipation, diarrhea and n/vSE: constipation, diarrhea and n/v Give 1-2 hour after meal or during Give 1-2 hour after meal or during

bedtime on an empty stomach bedtime on an empty stomach 5 hours duration5 hours duration Sucralfate (Carafate)Sucralfate (Carafate)

Drugs:Drugs: AntacidsAntacids (non absorbable) (non absorbable) Axn: Axn: gastric acidity gastric acidity Chew thoroughly then swallowChew thoroughly then swallow Taken 1 hour after meals or at bedtimeTaken 1 hour after meals or at bedtime Aluminum HydroxideAluminum Hydroxide SE: constipation SE: constipation Don’t give other drugs within 1-2 hour after Don’t give other drugs within 1-2 hour after

taking antacidstaking antacids Magnesium OxideMagnesium Oxide SE: diarrhea SE: diarrhea Taken in between meals or at bedtimeTaken in between meals or at bedtime May increase serum Magnesium level in RF clientMay increase serum Magnesium level in RF client Chew follow with waterChew follow with water Calcium CarbonateCalcium Carbonate SE: SE: uric acid uric acid Taken in between meals or at bedtime with milkTaken in between meals or at bedtime with milk NaHCO3NaHCO3 SE: metabolic alkalosis and tetani SE: metabolic alkalosis and tetani

Drugs:Drugs:

Proton Pump InhibitorProton Pump Inhibitor Axn: block HCl release from Axn: block HCl release from

parietal cellparietal cell 4-8 weeks medications4-8 weeks medications Omeprazole (Prilosec)Omeprazole (Prilosec) Lansoprazole (Prevacid)Lansoprazole (Prevacid)

SurgerySurgery

Vagotomy Vagotomy (complication is diarrhea) give (complication is diarrhea) give KAOPECTATEKAOPECTATE

AntrectomyAntrectomy

Complications:Complications:

Hemorrhage Hemorrhage (anemia, hematemesis, (anemia, hematemesis, hematochezia, melena)hematochezia, melena)

PerforationPerforation Pyloric obstruction Pyloric obstruction

Nursing Considerations:Nursing Considerations:

Avoid spicy foodsAvoid spicy foods Milk stimulates HCl secretionMilk stimulates HCl secretion Avoid coffee, chocolate, cola, Avoid coffee, chocolate, cola,

caffeinecaffeine No snacks at bedtime (No snacks at bedtime ( HCL HCL

secretions) secretions)

Gastric CancerGastric Cancer

Most commonMost common Key Test GASTROSCOPYKey Test GASTROSCOPY Surgery:Surgery: Billroth I Billroth I

gastroduodenostomygastroduodenostomy Billroth II gastrojejunostomyBillroth II gastrojejunostomy

Post opPost op

Observe NGT drainage:Observe NGT drainage: -NaCl irrigating solution-NaCl irrigating solution -bloody for the first 12 hours-bloody for the first 12 hours -attached to continuous suction machine-attached to continuous suction machine -don’t give cold give warm weak tea-don’t give cold give warm weak tea -color, amount and consistency-color, amount and consistency IVF with KClIVF with KCl Early ambulationEarly ambulation Listen for bowel sounds (1 min/quadrant)Listen for bowel sounds (1 min/quadrant)

Post opPost op

Observe for dumping syndromeObserve for dumping syndrome -subsides in 6 months-subsides in 6 months -s/sx are related to FVD-s/sx are related to FVD -palpitations-palpitations -perspirations-perspirations -faintness-faintness -weakness-weakness

Dumping SyndromeDumping Syndrome

avoid CHOavoid CHO CHON, CHON, CHO CHO no fluids after mealno fluids after meal lie supine after meallie supine after meal avoid fowlers position after mealavoid fowlers position after meal

Inflammatory Bowel Inflammatory Bowel DiseasesDiseases

Crohns DiseaseCrohns Disease Ulcerative ColitisUlcerative Colitis

AssessmentAssessment

chronic diarrheachronic diarrhea cramplike pain after mealscramplike pain after meals feverfever mucus bloody stoolmucus bloody stool dehydration and anemia ( more dehydration and anemia ( more

sever in ulcerative colitis) 15-20x sever in ulcerative colitis) 15-20x BMBM

Management:Management: calories and CHON, calories and CHON, residue residue bland diet with ironbland diet with iron All foods must be cookedAll foods must be cooked rehydraterehydrate vitamin B12( crohn”s)vitamin B12( crohn”s) steroids and antibioticssteroids and antibiotics antidiarrheal (lomotil)antidiarrheal (lomotil) sedatives and narcotics to decrease sedatives and narcotics to decrease

apprehension and painapprehension and pain immunosuppressive drugs to prevent another immunosuppressive drugs to prevent another

attackattack TPNTPN Ileostomy/ hemicolectomyIleostomy/ hemicolectomy

AppendicitisAppendicitis

Inflammation of the appendix due Inflammation of the appendix due to obstruction from fecalith, to obstruction from fecalith, lymphoid hyperplasia, helminth, lymphoid hyperplasia, helminth, foreign bodyforeign body

Assessment:Assessment: Key Test – IPPA, Lab results Key Test – IPPA, Lab results

((WBC)painepigastric----WBC)painepigastric----periumbilical---RLQperiumbilical---RLQ

RovsingsRovsings PsoasPsoas ObturatorObturator McburneysMcburneys CBC- inc WBCCBC- inc WBC Urinalysis- +/-RBCUrinalysis- +/-RBC

Management:Management: Semi fowler’s to relieve pain and Semi fowler’s to relieve pain and

discomfortdiscomfort NPO til bowel sounds present (postop)NPO til bowel sounds present (postop) No laxatives and enemas as it may No laxatives and enemas as it may

rupturerupture No warm compress or heat applicationNo warm compress or heat application NGT insertionNGT insertion Rectal tube to pass flatusRectal tube to pass flatus Surgery: AppendectomySurgery: Appendectomy

CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE

Post-operative carePost-operative care POSITION post-op: POSITION post-op: RIGHT side-RIGHT side-

lying, SEMI- FOWLER’S to lying, SEMI- FOWLER’S to decrease tension on incision, decrease tension on incision, and legs flexed to promote and legs flexed to promote drainagedrainage

Intestinal Obstructions Intestinal Obstructions

Partial or complete stoppage of Partial or complete stoppage of forward flow of intestinal contentsforward flow of intestinal contents

Key Test – UTZ, don’t use contrast Key Test – UTZ, don’t use contrast media if obstruction is suspectedmedia if obstruction is suspected

Abdominal UTZAbdominal UTZ

Mechanical Type:Mechanical Type: Adhesions-fibrous band of scar tissue from surgeryAdhesions-fibrous band of scar tissue from surgery Hernias-incarcerated or strangulatedHernias-incarcerated or strangulated Volvulus-twisting of bowelVolvulus-twisting of bowel Intussusception-telescoping of the bowel upon Intussusception-telescoping of the bowel upon

itselfitself TumorsTumors HematomaHematoma Fecal impactionFecal impaction Intraluminal obstructionIntraluminal obstruction Diverticula/diverticulosisDiverticula/diverticulosis

Neurogenic Type:Neurogenic Type:

Paralytic ileus Paralytic ileus Adynamic ileusAdynamic ileus

Vascular Type:Vascular Type:

Occlusion of arterial blood supplyOcclusion of arterial blood supply Mesenteric thrombosisMesenteric thrombosis Abdominal anginaAbdominal angina

What will happen?What will happen? Fluids and air are collected proximal to Fluids and air are collected proximal to

the obstructionthe obstruction peristalsis peristalsis ’s as the bowel attempts to ’s as the bowel attempts to

force-out the collected materialforce-out the collected material peristalsis ends and the bowel peristalsis ends and the bowel

becomes blockedbecomes blocked pressure increases and the absorption pressure increases and the absorption

ability is decreasedability is decreased this will lead to vomiting and this will lead to vomiting and

decreased absorption resulting to decreased absorption resulting to shockshock

Assessment:Assessment:

ConstipationConstipation vomitingvomiting Cramplike or diffused pain in the abdomenCramplike or diffused pain in the abdomen gaseous distentiongaseous distention no flatusno flatus

Management:Management:

intestinal tube insertion (miller intestinal tube insertion (miller abott, cantor tube) for abott, cantor tube) for decompressiondecompression

fluid and electrolyte replacementfluid and electrolyte replacement prophylactic antibioticprophylactic antibiotic v/s, I&Ov/s, I&O stool examstool exam surgerysurgery

HemorrhoidsHemorrhoids

Dilated varicose veins of the anal canal Dilated varicose veins of the anal canal (internal and external may be affected)(internal and external may be affected)

Due to:Due to: Portal HPN Portal HPN Straining from constipationStraining from constipation Irritation and diarrhea, Irritation and diarrhea, CHF CHF Increased abdominal pressure, pregnancyIncreased abdominal pressure, pregnancy

Assessment:Assessment: Itchiness Itchiness Pain ( external)Pain ( external) BleedingBleeding Complications:Complications: Hemorrhage Hemorrhage Strangulation Strangulation Prolapse and ThrombosisProlapse and Thrombosis

Management:Management: Stool softenersStool softeners Laxative for constipationLaxative for constipation AnalgesicAnalgesic Hot sitz bathHot sitz bath Infrared photocoagulation and laser Infrared photocoagulation and laser

therapytherapy Surgery:Surgery: HemorrhoidectomyHemorrhoidectomy CryosurgeryCryosurgery

CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE

Post-operative care for Post-operative care for hemorrhoidectomyhemorrhoidectomy

1. Position: 1. Position: Prone or Side-Prone or Side-lyinglying

2. Maintain dressing & 2. Maintain dressing & Monitor for bleedingMonitor for bleeding

4. Administer analgesics and 4. Administer analgesics and stool softenersstool softeners

5. Advise SITZ bath 3-4x a day5. Advise SITZ bath 3-4x a day

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Git Part 1- Run