1. Assessment of Digestive and GI Function Connie K. Cupples, MS, MSN, RN Union University

2. Outcome 1 Review the structure and function of the organs of the GI tract. A. Draw abdomen depicting organs in the four quadrants. B. Identify function of each of the organs of digestion.

3. Abdomen

4. Function of Organs Mouth Stomach Small Intestine Colon

5. Outcome 2 Explain the processes involved in the digestion, absorption, and elimination of food products. A. Identify major digestive enzymes, sources, and digestive actions. refer to pg. 943 table 34-1 Action of enzymes that digest CHO, protein, and fat

6. Outcome 3 Describe assessment paramaters and techniques used when evaluating the GI tract. A. Draw a torso and shade common sites of referred abdominal pain. B. Discuss the order of the examination of the abdomen and give the rationale.

7. Sites of Referred Abdominal Pain

8. Health History Focus on symptoms common to GI dysfunction: Pain Indigestion Intestinal gas Change in bowel habits Change in stool characteristics

9. Physical Assessment Inspect mouth and contents Supine with knees flexed slightly Order of assessment: inspection auscultation palpation percussion Rationale for order of GI Assessment?

10. Abdomen - Ascites

11. Abdomen-Obese

12. Abdomen - Hernia

13. Outcome 4 Describe preparation, education, and follow-up care for patients undergoing the following diagnostic testing of the GI tract. A. Discuss how the nurse would prepare and educate patients for GI tests, including post procedure interventions.

14. Stool Tests Collect on random basis except specimen where quantitative study is performed (fecal fat and urobilinogen) Refrigerate quantitative specimen (24-72 hr. collections) Special diet required for some tests Fecal occult blood tests (foods & meds may alter results.

15. Abdominal Ultrasonography Noninvasive means of imaging abdominal organs and structures. NPO for 8-12 hrs. Fat-free meal at supper if GB studies are done Schedule barium studies after test if ordered as well

16. Upper GI X-ray Studies X-ray imaging after contrast media injested. Low residue diet X several days prior NPO after MN Laxative prep Discourage smoking day of test Hold all meds on day of test Monitor post test for 3 days to get rid of barium (fluids, laxatives, enemas)

17. Lower GI X-ray Studies Visualization of lower GI tract after instillation of barium Bowel prep to cleanse lower bowel Low-residue diet 1-2 days prior C/L diet for supper, laxative HS, NPO after MN Cleansing enemas until clear in a.m. Post procedure elimination of barium

18. CT Cross-sectional images of abdominal organs and structures NPO 6-8 hrs. before test Question about contrast dye allergies Schedule barium studies after CT scan if ordered

19. MRI Noninvasive technique to supplement ultrasonography and CT scanning NPO 6-8 hrs. prior to test Remove all jewelry & other metals Explain that procedure lasts 30-90 minutes Explain type of equipment used (pt. may experience claustrophobia & hear knocking sound)

20. Esophagogastroduodenoscopy Visualization of upper GI tract with fiberoptic lenses. NPO 6-12 hrs. Pt. may gargle with local anesthetic Versed given IV – monitor pt. per conscious sedation protocol Atropine may be given to dry secretions Position on left side during procedure

21. Nursing Interventions Post EGD Keep NPO until return of gag reflex Simms position until awake, then semi- fowlers Observe for s/s of perforation (pain, bleeding, unusual difficulty swallowing, temp) Monitor for changes in P & BP Instruct not to drive for 10-12 hrs. post

22. EGD

23. Colonsocopy Direct visual inspection of the colon using flexible fiberoptic colonoscope. Colon preparation a must C/L diet at noon day before Laxatives the night before Use of preparation such as Golytely to lavage the bowel over 3-4 hrs. until returns are clear

24. Nursing Interventions post Colonoscopy Monitor according to conscious sedation guidelines Observe for s/s of bowel perforation (abdominal pain, distention, rectal bleeding, temp) Provide written instructions due to amnesic effect of meds

25. Colonoscopy

26. Gastic Analysis, Gastic Acid Stimulation test & pH Monitoring Determines secretory activity of gastic mucosa and gastric retention. NPO 8-12 hrs. Hold meds that affect gastic secretion Smoking not allowed day of test Insert small NG tube Aspirate entire contents of stomach q 15 minutes for 1 hr.

27. Gastic Acid Stimulation Med given to stimulate gastric secretion Inform pt. that flushing may occur Monitor P & BP q 15 min. Collect gastic specimen q 15 minutes for 1 hr.

28. pH Monitoring NPO 6 hrs. before test Hold meds 24-36 hrs. Probe inserted through nose Connected to external recording device