Dane Delion GI REVIEWER Page 1 of 17
Assessment Technique Diagnostic Evaluation
Inspection: • Skin changes Abdominal ultrasonography • Fast 8-12 hrs prior— decreases aniybt if gas in
supine c knees flexed • Nodules bowel
• Lesions: GI diseases often produce skin changes • Gallbladder studies: eat a fat free meal evening
• Scarring prior
• Discoloration • Barium studies should be scheduled after UTZ
• Inflammation • Moderate sedation: observe for 1 hr, assess for
• Bruising LOC, orientation, and ability to ambulate
• Striae
• Contour + symmetry of abdomen: flat, scaphoid, Upper GI tract study • Clear liquid diet
distended Barium sulfate • NPO midnight night before study
Diatrizoate sodium • No gum/smoking: increases gastric secretions +
Auscultation • Occur irregularly — 5-30 per minute salivation
Use diaphragm, soft clicks & gurgles • Normal: sounds heard every 5020 seconds • Polyethylene glycol (PEG): bowel cleansing
• Hypoactive: 1-2 sounds in 2 minutes agent.
Use bell for bruits over aortic, renal, and femoral • Hyperactive: 5-6 sounds in < 30 sec
arteries • Friction rubs are heard over liver and spleen during Lower GI tract study • Low residue diet 1-2 days before test
inspiration Barium enema • Clear liquid diet + laxative enema evening before
*begin in the RLQ • Borborygmi: loud prolonged gurgle Air contrast barium enema • Barium enemas should be scheduled before any
Diatrazoic acid if active inflamm dse, fistulas, or user GI series
perforation is suspected • Post procedure: increase pt fluid intake— barium
increases output.
Percussion Size + density of abdominal organs
Typmpani: air filled: stomach + small intestines CT-scan • W/ contrast: assess for iodine/shellfish allergy
Dullness: solid organs + masses • Kidney function: assess creatinine level
• Pregnancy status
Palpation Light palpation: Identify areas of tenderness or • IV sodium bicarb: 1 hr before & 6 hrs post study
muscular resistance • N-acetylcysteine (mucomyst) before/after study
Deep palpation: used to identify masses
MRI scan NPO 6-8 hrs
CI: pts w devices containing metal: pacemakers,
aneurysm clips, foil backed skin patches
Endoscopy Colonoscopy
• NPO 8 hrs • Adequate bowel prep
• Midazolam Versed) local anesthetic • Laxatives 2 nights prior to exam
• Atropoine: reduce secretions • PEG electrolyte lavage solutions (GoLYTELY)
• Left lateral position: facilitate clearanc of • 2-L PEG split dose for low risk pts
pulmonary secretions + provide smooth entry of • 4-L split dose with sodium picosulfate c
scope bisacodyl in pts c comorbidities
• Signs of perforation: pain, bleeding, dysphagia, • Clear liquid diet noon day before exam
rapidly inc temp • S/E: nausea, bloating, cramps, abdominal
• Hold food and fluids until gag reflex returns fullness, fluid and electrolyte imbalance,
hypothermia.
,Dane Delion GI REVIEWER Page 2 of 17
Enteral Nutrition - Tube feeding Parenteral Nutrition - IV feeding
Indications • Chronic illness, psych disorder Indications • Severe burns, malnutrition, AIDS, sepsis,
• Cancer therapy cancer
• Stroke, head injury, neuro d/o • Paralytic ileus, Chron’s dse,
• Surgery • Major psychiatric illness
• Fistula, short bowel syndrome, pancreatitis, • Extensive bowel surgery
chron’s dse • Acute pancreatitis
• Burns, trauma, multiple fracture, sepsis
Nursing interventions • Inspect PN solution for separation or
Nursing interventions • Elevate head of bed 30-45 degrees precipitate. Do not use if any of these is
• Assess for fullness, bloating, dissension, present
NV, stool pattern • Weigh the pt
• Monitor for s/sx of dehydration • Monitor I&O
• Replace formula given by open system • Blood glucose
q4-8hrs • Abc, platelet count, chemistry panel
• Change tube feeding container and tubing • Concentration >10% glucose should not be
q24h given via peripheral veins bc they irritate
• Flushing to prevent obstruction the intima = chemical phlebitis
• Check GRV after every meal or q4h for • Meticulous aseptic technique anytime IV
continuous feedings. <100 normal line setup is manipulated
• Change CVAD dressing q7days
Preventing dumping syndrome • Slow formula instillation rate: allows carbs • Change occlusive gauze dressings q48hr
and electrolytes to be diluted • Allow chlorhexidine to dry full before
30 minutes of eating and include vertigo, • Administer feedings at room temp: extreme placing dressing
tachycardia, syncope, sweating, pallor, temps stimulate peristalsis • Infuse 10% dextrose with water to prevent
• Administer food via continuous drip instead hypoglycemia if PN runs out
palpitations, and the desire to lie down of bolus feed
• Semi fowler position for 1hr post feeding: Hyperosmolar diuresis Occurs with rapid administration
prolong intestinal transit time Higher than normal urine output
• Instill minimal amount of water need to Decreased intravascular fluid volume
flush the tubing before and after a feeding
time.
, Dane Delion GI REVIEWER Page 3 of 17
GERD: back flow of gastric or duodenal contents Assessment and Diagnostic Findings Pharmacologic Management
into esophagus Antacids/Acid neutralizing agents Proton pump inhibitors decrease
Endoscopy neutralize acid gastric acid production
Risk factors: • Calcium carbonate (tums) Pantoprazole
Barium swallow • Aluminum hydroxide, magnesium Omeprazole
Incompetent lower esophageal sphincter hydroxide, simethicone (Maalox) Esomeprazole
Ambulatory 12-36 hr esophageal pH monitoring
Pyloric stenosis Histamine-2 H2 receptor antagonist Reflux inhibitors stimulates
decrease gastric acid production parasympathetic nervous system
Hiatal hernia Complications Famotidine (Pepcid) Bethanechol chloride
Ranitidine (Zantac)
Motility disorder Dental erosion Cimedidine (Tagamet)
Ulcerations in pharynx and esophagus Prokinetic agents Accelerate gastric Surface agents/Alginate-based barriers
Irritable bowel syndrome emptying preserve mucosal barrier
Laryngeal damage Metoclopramide (Reglan) Sucralfate
Obstructive airway disorders (asthma, COPD, cystic Esophageal strictures
fibrosis)
Barret esophagus —> adenocarcinoma
Peptic ulcer dse
Pulmonary complications Nursing Management
Angina
Eat a low fat diet
Avoid caffeine, tobacco, beer, milk, foods containing peppermint or spearmint,
Clinical Manifestations carbonated beverages
Pyrosis/heartburn Avoid eating 2 hours before bedtime
Elevate head of bead 30 degrees
Dyspepsia (indigestion)
Regurgitation
Dysphagia
Esophagitis
Assessment Technique Diagnostic Evaluation
Inspection: • Skin changes Abdominal ultrasonography • Fast 8-12 hrs prior— decreases aniybt if gas in
supine c knees flexed • Nodules bowel
• Lesions: GI diseases often produce skin changes • Gallbladder studies: eat a fat free meal evening
• Scarring prior
• Discoloration • Barium studies should be scheduled after UTZ
• Inflammation • Moderate sedation: observe for 1 hr, assess for
• Bruising LOC, orientation, and ability to ambulate
• Striae
• Contour + symmetry of abdomen: flat, scaphoid, Upper GI tract study • Clear liquid diet
distended Barium sulfate • NPO midnight night before study
Diatrizoate sodium • No gum/smoking: increases gastric secretions +
Auscultation • Occur irregularly — 5-30 per minute salivation
Use diaphragm, soft clicks & gurgles • Normal: sounds heard every 5020 seconds • Polyethylene glycol (PEG): bowel cleansing
• Hypoactive: 1-2 sounds in 2 minutes agent.
Use bell for bruits over aortic, renal, and femoral • Hyperactive: 5-6 sounds in < 30 sec
arteries • Friction rubs are heard over liver and spleen during Lower GI tract study • Low residue diet 1-2 days before test
inspiration Barium enema • Clear liquid diet + laxative enema evening before
*begin in the RLQ • Borborygmi: loud prolonged gurgle Air contrast barium enema • Barium enemas should be scheduled before any
Diatrazoic acid if active inflamm dse, fistulas, or user GI series
perforation is suspected • Post procedure: increase pt fluid intake— barium
increases output.
Percussion Size + density of abdominal organs
Typmpani: air filled: stomach + small intestines CT-scan • W/ contrast: assess for iodine/shellfish allergy
Dullness: solid organs + masses • Kidney function: assess creatinine level
• Pregnancy status
Palpation Light palpation: Identify areas of tenderness or • IV sodium bicarb: 1 hr before & 6 hrs post study
muscular resistance • N-acetylcysteine (mucomyst) before/after study
Deep palpation: used to identify masses
MRI scan NPO 6-8 hrs
CI: pts w devices containing metal: pacemakers,
aneurysm clips, foil backed skin patches
Endoscopy Colonoscopy
• NPO 8 hrs • Adequate bowel prep
• Midazolam Versed) local anesthetic • Laxatives 2 nights prior to exam
• Atropoine: reduce secretions • PEG electrolyte lavage solutions (GoLYTELY)
• Left lateral position: facilitate clearanc of • 2-L PEG split dose for low risk pts
pulmonary secretions + provide smooth entry of • 4-L split dose with sodium picosulfate c
scope bisacodyl in pts c comorbidities
• Signs of perforation: pain, bleeding, dysphagia, • Clear liquid diet noon day before exam
rapidly inc temp • S/E: nausea, bloating, cramps, abdominal
• Hold food and fluids until gag reflex returns fullness, fluid and electrolyte imbalance,
hypothermia.
,Dane Delion GI REVIEWER Page 2 of 17
Enteral Nutrition - Tube feeding Parenteral Nutrition - IV feeding
Indications • Chronic illness, psych disorder Indications • Severe burns, malnutrition, AIDS, sepsis,
• Cancer therapy cancer
• Stroke, head injury, neuro d/o • Paralytic ileus, Chron’s dse,
• Surgery • Major psychiatric illness
• Fistula, short bowel syndrome, pancreatitis, • Extensive bowel surgery
chron’s dse • Acute pancreatitis
• Burns, trauma, multiple fracture, sepsis
Nursing interventions • Inspect PN solution for separation or
Nursing interventions • Elevate head of bed 30-45 degrees precipitate. Do not use if any of these is
• Assess for fullness, bloating, dissension, present
NV, stool pattern • Weigh the pt
• Monitor for s/sx of dehydration • Monitor I&O
• Replace formula given by open system • Blood glucose
q4-8hrs • Abc, platelet count, chemistry panel
• Change tube feeding container and tubing • Concentration >10% glucose should not be
q24h given via peripheral veins bc they irritate
• Flushing to prevent obstruction the intima = chemical phlebitis
• Check GRV after every meal or q4h for • Meticulous aseptic technique anytime IV
continuous feedings. <100 normal line setup is manipulated
• Change CVAD dressing q7days
Preventing dumping syndrome • Slow formula instillation rate: allows carbs • Change occlusive gauze dressings q48hr
and electrolytes to be diluted • Allow chlorhexidine to dry full before
30 minutes of eating and include vertigo, • Administer feedings at room temp: extreme placing dressing
tachycardia, syncope, sweating, pallor, temps stimulate peristalsis • Infuse 10% dextrose with water to prevent
• Administer food via continuous drip instead hypoglycemia if PN runs out
palpitations, and the desire to lie down of bolus feed
• Semi fowler position for 1hr post feeding: Hyperosmolar diuresis Occurs with rapid administration
prolong intestinal transit time Higher than normal urine output
• Instill minimal amount of water need to Decreased intravascular fluid volume
flush the tubing before and after a feeding
time.
, Dane Delion GI REVIEWER Page 3 of 17
GERD: back flow of gastric or duodenal contents Assessment and Diagnostic Findings Pharmacologic Management
into esophagus Antacids/Acid neutralizing agents Proton pump inhibitors decrease
Endoscopy neutralize acid gastric acid production
Risk factors: • Calcium carbonate (tums) Pantoprazole
Barium swallow • Aluminum hydroxide, magnesium Omeprazole
Incompetent lower esophageal sphincter hydroxide, simethicone (Maalox) Esomeprazole
Ambulatory 12-36 hr esophageal pH monitoring
Pyloric stenosis Histamine-2 H2 receptor antagonist Reflux inhibitors stimulates
decrease gastric acid production parasympathetic nervous system
Hiatal hernia Complications Famotidine (Pepcid) Bethanechol chloride
Ranitidine (Zantac)
Motility disorder Dental erosion Cimedidine (Tagamet)
Ulcerations in pharynx and esophagus Prokinetic agents Accelerate gastric Surface agents/Alginate-based barriers
Irritable bowel syndrome emptying preserve mucosal barrier
Laryngeal damage Metoclopramide (Reglan) Sucralfate
Obstructive airway disorders (asthma, COPD, cystic Esophageal strictures
fibrosis)
Barret esophagus —> adenocarcinoma
Peptic ulcer dse
Pulmonary complications Nursing Management
Angina
Eat a low fat diet
Avoid caffeine, tobacco, beer, milk, foods containing peppermint or spearmint,
Clinical Manifestations carbonated beverages
Pyrosis/heartburn Avoid eating 2 hours before bedtime
Elevate head of bead 30 degrees
Dyspepsia (indigestion)
Regurgitation
Dysphagia
Esophagitis
