ASSESSMENT OF
THE DIGESTIVE
AND GI FUNCTION
Health History
• Focused on symptoms common to GI dysfunction:
• Pain
• Indigestion
• Intestinal gas
• Nausea and vomiting
• Change in bowel habits
• Change in stool characteristics
Physical Assessment
Oral Cavity Inspection and Palpation
Abdominal Inspection, Auscultation, Percussion and
Palpation
Rectal Inspection and Palpation
DIAGNOSTIC
EXAMINATION
Stool Tests
• Inspect the specimen for consistency, color and
occult blood
• Stool samples are usually collected on a random
basis unless a quantitative study (e.g., fecal fat,
urobilinogen)
• the quantitative 24- to 72-hour collections must be
kept refrigerated until transported to the laboratory
• Fecal occult blood testing (FOBT) can be useful in
initial screening for several disorders
Abdominal Ultrasonography
• a noninvasive diagnostic technique in which high
frequency sound waves are passed into internal
body structures
• Useful in detecting an enlarged gallbladder or
pancreas, the presence of gallstones, an enlarged
ovary, an ectopic pregnancy, or appendicitis
Abdominal Ultrasonography
• Nursing interventions:
• Instruct patient to fast 8-12 hours
• gallbladder studies - the patient should eat a fat-
free meal the evening before the test
• Patients who receive moderate sedation are
observed for about 1 hour to assess for level of
consciousness, orientation, and ability to
ambulate.
Upper Gastrointestinal Tract Study
• An upper GI fluoroscopy delineates the entire GI tract after the
• introduction of a contrast agent.
• Uses a radiopaque liquid (e.g., barium sulfate), a thin barium
(diatrizoate sodium), or water
• Nursing Interventions: Instruct the pt. on the ff.:
• Clear liquid diet before the study
• NPO from midnight the night before the study
• Do not smoke or chew gum during the NPO period
• Stools may appear milky white
• Monitor post test for 3 days to get rid of the barium
(fluids, enemas, laxatives)
Lower GI Tract Study
• Visualization of the lower GI tract is obtained after rectal installation
of barium.
• If active inflammatory disease, fistulas, or perforation of the colon is
suspected, a water-soluble iodinated contrast agent (e.g., diatrizoic
acid [Gastrografin]) can be used.
• Nursing Intervention:
• Bowel preparation to cleanse the lower bowel
• Low residue diet 1-2 days prior the study
• Clear liquid diet for supper, laxative HS, NPO at midnight
• Cleansing enemas until clear in the morning
• Post procedure elimination of the barium (fluids)
Computed Tomography
• provides cross-sectional images of abdominal organs and Structures
• Multiple x-ray images are taken from numerous angles, digitized in
a computer, reconstructed, and then viewed on a computer monitor
• Nursing intervention:
• Assess pt. for allergies to iodine or shellfish and serum
creatinine level
• NPO 6-8 hrs. before the test
• Schedule barium studies after CT Scan
Magnetic Resonance Imaging
• uses magnetic fields and radio waves to produce images of the area
being studied
• useful in evaluating abdominal soft tissues as well as blood vessels,
abscesses, fistulas, neoplasms, and other sources of bleeding
• CI: ferromagnetic objects (metals that contain iron)
• Nursing intervention:
• NPO status 6 to 8 hours before the study
• remove all jewelry and other metals
• Explain that procedure lasts 60-90 minutes
• Explain the type of equipment used and what the pt. may
experience
Endoscopic
Procedures
Esophagogastroduodenoscopy
• allows direct visualization of the esophageal, gastric, and duodenal
mucosa through a lighted endoscope (gastroscope)
Esophagogastroduodenoscopy
• Nursing Intervention:
• NPO 8 hours prior the examination
• Pt. may gargle with local anesthetic
• Pt. may be given Midazolam (Versed), Atropine, and
glucagon
• Pt. is positioned in left lateral position to facilitate clearance
of pulmonary secretions
• After the procedure:
• Assess the LOC, V/S, O2 Sat, pain, signs of perforation
• lozenges, saline gargle, and oral analgesic agents may be
offered once patient’s gag reflex returns
• A family member must stay with the patient
Fiberoptic Colonoscopy
• provides a computer-simulated view of the air-filled distended colon
using conventional CT scanning
Fiberoptic Colonoscopy
• Nursing Interventions:
• Colon preparation
• Clear liquid diet at noon, the day before the test
• Administer laxative for 2 nights prior the examination
• Fleet or saline enema until the return is clear the morning
of the test
• PEG electrolyte lavage solutions (GoLYTELY, CoLyte, and
NuLYTELY) are used as intestinal lavages for effective
cleansing of the bowel
Fiberoptic Colonoscopy
• Nursing Interventions:
• Opioid analgesic or sedative is given for moderate
sedation
• Glucagon is given to reduce spasm
• After the test:
• Monitor for signs of bowel perforation (e.g., rectal
bleeding, abdominal pain or distention, fever)
• Maintain pt. on bed rest until fully alert
• Written instructions should be given
Gastric Analysis, Gastric
Acid Stimulation test &
pH Monitoring
Gastric Analysis
• Determines secretory activity of gastric mucosa and degree of
gastric retention
• Nursing interventions:
• patient is NPO for 8 to 12 hours before the procedure
• Withhold medications that affect gastric secretions for 24
to 48 hours before the test
• Pt. must not smoke on the morning of the test
• A small NGT is inserted through the nose
• Gastric samples are collected every 15 minutes for the
next hour.
Gastric Acid Stimulation
• Histamine or pentagastrin is given subcutaneously to stimulate
gastric secretions.
• Inform the pt. that flushing may occur
• Monitor the pulse and BP every 15 min.
• Collect gastric specimen every 15 mins for 1 hour
pH Monitoring
• NPO 6 hours before the test
• Hold medications 24-36 hours prior
• Probe is inserted through the nose and is connected to an external
recording device
pH Monitoring
• Bravo pH monitoring system
• pH monitoring of the esophagus
• A capsule is attached to the patient’s esophageal wall and
data related to pH are transmitted to a pager-sized
receiver
• Data are collected for 48 hours
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