Assessment of the Gastrointestinal System Chapter 55 Assessment of the Gastrointestinal System

Gastrointestinal System The gastrointestinal system (GI tract) can be thought of as a tube (with necessary structures) extending from the mouth to the anus for a 25-foot length. The structure of this tube (shown enlarged) is basically the same throughout its length.

Video Normal Swallowing Digestive System Review http://www.youtube.com/watch?v=WtsTaNfodEQ Digestive System Review http://www.youtube.com/watch?v=lm3oIX6jjn4

Assessment Techniques History What questions do you ask? Nutritional history Examples? Family history and genetic risk Current health problems Physical assessment (next slide) Psychosocial assessment What questions? Diagnostic testing (slides)

Physical Assessment A topographic division of the abdomen into quadrants.

Nursing Assessment of GI Video: http://www.youtube.com/watch?v=w6EKeIzojms Students: Pair up and do assessment on each other. First, assess the diet history, then proceed to the assessing the GI system.

Diagnostic Testing Methods Be familiar with all of the following, including preparation, test, and follow-up care. Laboratory studies Name a few. Know the norms! EGD Upper/lower GI series Barium enema Percutaneous transhepatic cholangiography CT Endoscopy Ultrasound Liver-spleen scan

Esophagogastroduodenoscopy Esophagogastroduodenoscopy allows visualization of the esophagus, the stomach, and the duodenum. If the esophagus is the focus of the examination, the procedure is called esophagoscopy. If the stomach is the focus, the procedure is called gastroscopy.

Endoscopic Retrograde Cholangiopancreatography ERCP http://www.youtube.com/watch?v=IRdA2krJ6LQ

Care of the Patient Post-Procedure Student Discussion

Group Work Prepare a diet-teaching plan for the patient with peptic ulcer disease (PUD) or gastritis. Teach your plan to your classmates. Prepare a stress reduction plan for the patient with PUD or gastritis & teach it to your classmates. Identify nursing diagnoses and collaborative problems that apply to patients with digestive and nutrition problems. Write a nursing outcome (NOC) for each. Reinforce how the nurse collaborates with others to assist in meeting the patient’s needs.

NCLEX Review Questions Chapter 55 NCLEX Review Questions 13

Question 1 Which patient response requires a focused GI assessment? “I take ibuprofen 600 mg three times a day for arthritis pain.” “I experience occasional constipation.” “I have had dentures for 3 years.” “Spicy foods upset my stomach.” Answer: A Rationale: Large amounts of aspirin or other NSAIDs such as ibuprofen can predispose the patient to peptic ulcer disease and GI bleeding.

Answer Answer: A Rationale: Large amounts of aspirin or other NSAIDs such as ibuprofen can predispose the patient to peptic ulcer disease and GI bleeding.

Question 2 After abdominal surgery, what is the most reliable assessment finding that suggests return of peristaltic movement? Presence of normal bowel sounds Patient report of passing flatus Patient report of hunger Absence of nausea Answer: B Rationale: Recent best evidence suggests that patient report of passing flatus is more reliable than return of bowel sounds in assessing peristaltic movement after abdominal surgery.

Answer Answer: B Rationale: Recent best evidence suggests that patient report of passing flatus is more reliable than return of bowel sounds in assessing peristaltic movement after abdominal surgery.

Question 3 When administering a new medication to an older patient, the nurse understands that: The dose may need to be increased to greater-than-normal levels. Close monitoring is needed because toxic levels may develop. The dose may need to be decreased to lower-than-normal levels. Nausea and vomiting may develop rapidly and are common side effects in older adults. Answer: B Rationale: The older patient should be monitored closely for adverse effects of all medications, even those administered in normal doses, because toxic levels can develop rapidly. Medications should never be increased to greater-than-normal levels because age-related changes in the liver and intestinal absorption may cause development of toxic drug levels. The patient also should not receive drug doses that are lower than normal. Nausea and vomiting in response to medication are not expected side effects of a patient’s use of prescribed medication in appropriate dosages.

Answer Answer: B Rationale: The older patient should be monitored closely for adverse effects of all medications, even those administered in normal doses, because toxic levels can develop rapidly. Medications should never be increased to greater-than-normal levels because age-related changes in the liver and intestinal absorption may cause development of toxic drug levels. The patient also should not receive drug doses that are lower than normal. Nausea and vomiting in response to medication are not expected side effects of a patient’s use of prescribed medication in appropriate dosages.