Git Procedures

GASTROINTESTINAL PROCEDURES

Gastrointestinal (GI) Series
GASTROINTESTINAL
PROCEDURES The introduction of barium, an opaque medium, into
the upper GI tract via the mouth, gastrostomy tube,
or nasogastric tube to visualize the area by x-ray
methods

Nursing care
1. Explain procedure to client
2. Maintain the client NPO after midnight
3. Inform client that the stool will be white or pink for
NIO C. NOVENO, RN, MAN
24 to 72 hours after procedure
4. Encourage fluids and administer cathartics as
ordered
5. Evaluate client's response to procedure

nionoveno@yc GI PROCEDURES 2

Barium Enema
Barium Enema Nursing care

Explain procedure to the client
1.
Prepare the client for the procedure by:
2.
Administering cathartics and/or enemas as
The introduction of a.
A.
ordered to evacuate the bowel
barium, an opaque
medium, into the Maintaining the client NPO for 8 to 10 hours prior
b.
to the test
intestines for the
purpose of x-ray Inspect stool after the procedure for the
3.
visualization for presence of barium
pathologic changes Administer enemas and/or cathartics as
4.
ordered if the stool does not return to normal
Encourage fluid intake
5.
Evaluate client's response to procedure
6.

nionoveno@yc GI PROCEDURES 3 nionoveno@yc GI PROCEDURES 4

DEAN NIO C. NOVENO, RN, MAN 1


Colostomy Irrigation and Care Colostomy irrigation
Instillation of fluid into the lower colon
1.
via a stoma on the abdominal wall to
stimulate peristalsis and facilitate the
expulsion of feces
Cleansing the colostomy stoma and
2.
collection of feces
sigmoid colon will tend to produce formed
o
stools
transverse or ascending colostomy will
o
produce less formed stools


Colostomy Irrigation and Care
Colostomy Irrigation and Care
Nursing care
Nursing care
Secure a physician's order
1.
Provide privacy while waiting for fecal returns or
6.
Irrigate the stoma at the same time each day to
2.
permit the client to ambulate with the collection bag
approximate normal bowel habits in place to further stimulate peristalsis
Insert a well-lubricated catheter tip into the
3. Clean the stoma
7.
stoma if excoriation occurs, a soothing ointment may be
o
7 to 10 cm in the direction of the remaining bowel ordered
o
as the solution is allowed to flow, the catheter may be Apply a colostomy bag or gauze dressing
o 8.
advanced Teach the client to control odor when necessary
9.
Hold the irrigating container
4. place two aspirin tablets (or commercially available
o
height: 30.5 to 45.7 cm (12 to 18 inches) deodorizers) in the colostomy bag
o
temperature: 105oF (40.5oC) take bismuth subcarbonate tablets orally to control
o o
odor
Clamp tubing or temporarily lower the container
5.
if the client complains of cramping 10.




Colostomy bag Endoscopy
The visualization of the esophagus, stomach,
gallbladder, pancreas, colon, or rectum using a
hollow tube with a lighted end

Gastroscopy: stomach
1.
Esophagoscopy: esophagus
2.
Sigmoidoscopy: sigmoid colon
3.
Proctoscopy: rectum
4.
Endoscopic retrograde
5.
cholangiopancreatography (ERCP)
One-piece Two-piece


Gastric endoscopy Endoscopy




Sigmoidoscopy Colonoscopy


Endoscopic retrograde Endoscopy
cholangiopancreatography (ERCP) Nursing care

Obtain an informed consent for the procedure
1.
If rectal examination is indicated, administer
2.
cleansing enemas prior to the test
Restrict diet (NPO) prior to procedure
3.
Following the procedure, observe for bleeding,
4.
changes in vital signs, or nausea
If the throat is anesthetized (as for a
5.
gastroscopy or esophagoscopy), check for the
return of gag reflex before offering oral fluids
6.




Enemas Enemas
Tap-water enema (TWE): introduction of
1.
water into the colon to stimulate
evacuation
Soapsuds enema (SSE): introduction of
2.
soapy water into the colon to stimulate
peristalsis by bowel irritation
contraindicated as a preparation for an
o
endoscopic procedure
• may alter the appearance of the mucosa

Hypertonic enema: commercially
3.
prepared small-volume enema that works
on the principle of osmosis

Enemas
Enemas Nursing care

Harris flush or drip: introduction of water Explain procedure to client
4. 1.
into the colon as tolerated and subsequent
Provide privacy
2.
repeated drainage of that water through the
place in side-lying position
o
same tubing to facilitate passage of flatus
Obtain the correct solution
High colonic irrigation: introduction of 3.
5.
water into the upper portion of the colon to Lubricate the tip of a rectal catheter
4.
facilitate complete fecal evacuation
with water-soluble jelly
Instillation: introduction of a liquid (usually
6.
Insert the catheter 10 to 15 cm (4 to
5.
mineral oil) into the colon to facilitate fecal
6 inches) into the rectum
activity through lubricating effect




Enemas
Gastric Analysis
Nursing care

Allow the solution to enter slowly Analysis of stomach contents for the
6. 1.
presence of abnormal constituents or
keep it no more than 30.5 to 45.7 cm (12 to
o
18 inches) above the rectum lack of normal constituents such as
temporarily interrupt flow if cramps occur hydrochloric acid, blood, acid-fast
o

bacteria, and lactic acid
Allow ample time for the client to expel
7.
the enema Acid content is elevated in ulcers,
2.
Observe and record the amount and decreased in malignant conditions of
8.
consistency of returns the stomach, and absent in pernicious
anemia
9.


Gastric Analysis
Gavage (Tube Feeding)
Nursing care

Explain procedure to client Nasogastric
1. 1.
Maintain the client NPO prior to the test and Placement of a tube through the nose into the
2. a.
have a nasogastric tube passed at time of stomach, securing it in place with tape
procedure Prepared nutritional supplements are
b.
Administer histamine or caffeine to stimulate
3. introduced through this tube
hydrochloric acid secretion prior to the
Intestinal
2.
procedure if ordered
Placement of a tube through the nose into the
a.
Obtain stomach contents, secure in an
4.
small intestine, securing it in place with tape
appropriate container, and send to laboratory
There is less likelihood of aspiration because
b.
5.
the pyloric sphincter inhibits backflow




Gavage (Tube Feeding) Gavage (Tube Feeding)
Surgically placed feeding tubes Percutaneous endoscopic gastrostomy
3. 4.
Cervical esophagostomy: tube is sutured directly
a.
(PEG)
into the esophagus for clients who have had head
and neck surgery Stomach is punctured during endoscopy
a.
procedure
Gastrostomy: tube is placed directly into stomach
b.
Does not require general anesthesia or
b.
through the abdominal wall and sutured in place
laparotomy
• used for clients who require tube feeding on a
long-term basis
Dressing should be changed daily
c.
Although associated with reduced risks,
d.
Jejunostomy: tube is inserted directly into the
c.
accidental removal and aspiration still
jejunum for clients with pathologic conditions of
the upper GI tract may occur


Nursing care Nursing care

Verify placement of tube prior to feeding Aspirate contents of stomach prior to
1. 2.
Inject a small amount of air into the tube and, feeding to determine residual
a.
with a stethoscope placed over the epigastric
reinstill to avoid electrolyte imbalance
•
area, listen for the passage of air into the
withhold feeding if the residual is greater
stomach •
than 150 ml
Aspirate for presence of stomach contents;
b.
reinstill to avoid electrolyte imbalance

Test aspirate for acid pH
c.

Small-bore tube placement must be verified by
d.
x-ray examination




Intermittent feeding cont…
3.
Intermittent feeding
3.
Slowly administer the feeding at room or body
d.
Position the client so that the head is elevated temperature
a.
during and for 1 hour after the feeding observe and question the client to determine
–
tolerance
the higher the feeding container and the
–
Appropriately verify placement of tube
b.
larger the lumen of the feeding tube, the
more rapid the flow
Administer a small amount of water to clear the
Introduce a small amount of water (30 ml) first to e.
c.
tube at the completion of the feeding
verify the patency of the tube
Clamp the tubing and clean the equipment
f.
– the tube should not be allowed to empty during
Place client in sitting position for 1 hour after
g.
feeding so that excess air is not forced into the feeding
stomach
place infant in right side-lying position
–


Continuous feeding cont…
4.
Continuous feeding
4.
Appropriately verify placement of tube when adding
d.
Place prescribed feeding in gavage bag and prime
a. additional fluid to a continuous feeding
tubing to prevent excess air from entering stomach
Flush tube intermittently with water to prevent occlusion
e.
of tube with feeding
Set rate of flow
b.
– rate of flow can be manually regulated by setting
Monitor for gastric distention and aspiration
f.
drops per minute or mechanically regulated by
gastric distention and subsequent aspiration are less
–
using an electric pump frequent

Discard unused fluid that has been in gavage
Position the client to keep the head elevated g.
c.
administration bag at room temperature for longer than 4
throughout the feeding
hours




Care common for all clients receiving tube feedings cont…
5.
Care common for all clients receiving
5. When appropriate, encourage the client to chew foods
d.
that will stimulate gastric secretions while providing
tube feedings psychologic comfort
chewed food may not be swallowed
Monitor for abdominal distention –
a.
changes in bowel sounds or diarrhea
– Provide special skin care
e.
if the client has a gastrostomy tube sutured in place,
–
the skin may become irritated from gastrointestinal
enzymes
Discontinue feeding if nausea and/or
b.
if the client has a nasogastric tube, the skin may
–
vomiting occur become excoriated at point of entry because of
irritation

Evaluate client's response to the procedure
f.
Provide oral hygiene
c.


Ileostomy Care Ileostomy
The physical care of the ileostomy stoma and surrounding skin

Nursing care
Protect the skin from irritation, since the feces will be
1.
liquid because of the anatomic location of the stoma
Explain procedure to the client and family and encourage
2.
selfcare
Do not irrigate the stoma
3.
Affix an appliance with an adequate seal (e.g., karaya) to
4.
prevent accidental leakage around the stoma; the
appliance is generally changed every 2 to 4 days but
emptied every 6 hours
5.




Irrigation of Nasogastric
Gastric decompression: Levin
(Levin) Tube

The Levin tube is commonly used for gastric
1.
decompression
Purposes of insertion of a nasogastric tube
2.
include emptying the stomach, obtaining a
specimen for diagnostic purposes, or
providing a means for nourishment
Irrigation is the insertion and then removal of
3.
fluid (usually normal saline) to maintain
patency


Irrigation of Nasogastric
Irrigation of Nasogastric (Levin) Tube
(Levin) Tube
Nursing Care

Instill approximately 30 ml of fluid into the
Check that the order for irrigations has 5.
1.
tube
been written by the physician
Gently withdraw the same volume of fluid as
6.
Ascertain the patency of the Levin tube
2.
was instilled
attached to intermittent suction by
o if the client has undergone gastric surgery, the
observing for drainage physician will generally order instillations
nausea or abdominal discomfort may indicate o irrigation fluid is instilled but not withdrawn
that the tube is occluded o the amount instilled must be subtracted from total
gastric output
Assemble equipment: 30-ml syringe or
3.
Chart the amount, color, and consistency of
7.
bulb syringe, irrigating solution, and
drainage
basin for returning fluid
8.
Verify placement
4.




Paracentesis
Paracentesis Nursing care

The surgical puncture of the peritoneal Explain the procedure; obtain consent
1.
membrane of the abdominal cavity for Have the client void prior to procedure
2.
the purpose of removing fluid to avoid accidental trauma to the
bladder
Assist the client to a sitting position
3.

Observe for signs of shock
4.
sudden fluid shifts can result in
•
hypotension


Paracentesis
Paracentesis Nursing care

Chart the amount and characteristics
5.
of fluid withdrawn
Apply a dry sterile dressing to the
6.
puncture site
Properly label the specimen if required
7.
and send to the laboratory
Evaluate client's response to the
8.
procedure




Parenteral Replacement Therapy Parenteral Replacement Therapy
Total Parenteral Nutrition (TPN)
Peripheral parenteral nutrition (PPN)
Administration of carbohydrates, amino
1. Administration of isotonic lipid and 1.
acids, vitamins, and minerals via a central
amino acid solutions through a
vein (usually the superior vena cava)
peripheral vein
High osmolality solutions (25% dextrose)
2.
2. Amino acid content should not exceed are administered in conjunction with 5% to
4%; dextrose content should not be 10% amino acids, electrolytes, minerals,
greater than 10% and vitamins
3. Assists in maintaining a positive Assists in maintaining a positive nitrogen
3.
balance
nitrogen balance



Intralipid therapy Total nutrient admixture (TNA or quot;3 in 1quot;)
1. Infusion of 10% to 20% fat emulsion 1. Combination of dextrose, amino acids
that provides essential fatty acids and lipids in one container; vitamins
and minerals may be added
2. Administered through a central line
Provides increased caloric intake to
2.
over 24 hours
maintain positive nitrogen balance




Parenteral Replacement Therapy
Parenteral Replacement Therapy
Nursing care

Precisely regulate the fluid infusion rate; an
Infuse fluid through a large vein such 3.
1.
intravenous pump should be used if available
as the subclavian because of the high
Rapid infusion may result in movement of the
a.
osmolarity of the solution used in TPN fluid into the intravascular compartment
dehydration, circulatory overload, and
Ensure proper placement of the tube •
2.
hyperglycemia can occur
by chest x-ray examination after
insertion of a catheter; accidental Slow infusion may result in hypoglycemia,
b.
since the body adapts to the high osmolarity of
pneumothorax can occur during
this fluid by secreting more insulin
insertion therapy is never terminated abruptly but is
•
gradually discontinued



Use aseptic technique when handling Utilize a filter for TPN; filters cannot
4. 6.
the infusion or changing the dressing be used for lipids
(in many institutions, only nurses Use surgically aseptic technique when
7.
specially prepared are allowed to changing tubing
change the dressing because of the Record daily weights, and monitor
8.
high risk of infection) urinary sugar and acetone or blood
Consult manufacturer's instructions
5. glucose levels frequently
about tubing when administering lipids




Parenteral Replacement Therapy Stool Specimens
Stool for guaiac (occult blood): specimen or smear of
Check laboratory reports daily, especially 1.
8.
stool on a commercially prepared card is analyzed for
glucose, creatine, BUN, and electrolytes the presence of blood
serum lipids and liver function studies if lipids are positive results indicate the presence of blood in the
• •
stool
administered
peptic ulcer, gastritis, gastric or colonic carcinoma,
•
Monitor temperature every four hours since
9. colitis, or diverticulitis
infection is the most common complication of
TPN Stools for O and P (ova and parasites): must be sent to
2.
the laboratory while still warm for microscopic
if the client has a temperature elevation, order
•
examination unless a preservative is available
cultures of blood, urine, and sputum to rule out
other sources of infection
Stool culture: specimen or swab of stool is sent in a
3.
10. sterile container for identification of abnormal
bacterial growth


Stool Specimens
Guaic’s test Nursing care

Explain procedure to the client
1.

Collect specimen in an appropriate
2.
container
Label the container with the client's
3.
name, identification number,
physician, and room number
Chart that the specimen was sent and
4.
any unusual assessment of the stool




GASTROINTESTINAL
PROCEDURES

THANK YOU!

NIO C. NOVENO, RN, MAN


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