LU 2 : GI Investigation and Diagnostic Procedure 2.0

What are the purpose and indication for Endoscopic Retrograde Cholangiopancreatography (ERCP) ?

• purpose : diagnose and treat bile / pancreatic duct disorders

• indications : gallstones, tumors, strictures

What are the patient preparation for ERCP ?

• same with OGDS preparation

• NPO 6-8 hours before test

• Check allergy history : iodine allergy

• obtain consent

What are the nursing responsibilities for ERCP ?

• Before: Explain procedure, monitor vitals, Check coagulation profile, NPO 8 hrs before, Consent is signed

• During: Monitor vitals, Administer sedation and antibiotics as prescribed, Maintain airway, Assist doctor

• After: Check V/S, Monitor for pain, fever, and vital changes, Assess for s/s of perforation or infection

What are the complication for ERCP ?

• pancreatitis : abdominal pain, nausea

• perforation : abdominal rigidity, distention

• bleeding : melena, hypotension

What are the patient education for ERCP ?

• No driving for 24 hours post sedation

• Report severe abdominal pain or vomiting

What is sigmoidoscopy and colonoscopy ?

• Sigmoidoscopy is the endoscopic examination of the large intestine from the rectum up to the sigmoid colon

• Colonoscopy : i) the endoscopic examination of the colon and the distal part of the small bowel ii) is the gold standard test

What are the purpose of sigmoidoscopy and colonoscopy ?

• Detect colorectal cancer, polyps, ulcers

• Any abnormal conditions of lower GIT (esp large bowel)

What are patient preparation for sigmoidoscopy and colonoscopy ?

• bowel preparation with laxatives or enemas

• clear liquid diet 24 hours before procedure

• NPO after midnight

• stop anticoagulants 1 week before procedure

What are the nursing responsibilities for sigmoidoscopy and colonoscopy ?

• PRE • Explain the bowel preparation procedure • Informed consent form signed

• DURING • Monitor vital signs • Position pt in left-lateral decubitus • Administer sedation

• POST • Monitor v/s, • Observe for s/s of bowel bleeding or perforation (eg: melena or per rectal bleed)

What are the complications and nursing actions for sigmoidoscopy and colonoscopy ?

• Perforation: Severe abdominal pain, fever

• Bleeding: Monitor stool and vital signs

What are the patient education for sigmoidoscopy and colonoscopy ?

• teach on bowel preparation process

• report bleeding or severe pain

What is abdominal paracentesis ?

a procedure in which fluid is removed from the peritoneal cavity for diagnostic and therapeutic purposes

What are the purposes of abdominal paracentesis ?

1. To obtain fluid samples from the peritoneal space for diagnostic examination.

2. Evacuate fluid from the peritoneal space.

3. Alleviate respiratory compromise related to pressure on the diaphragm caused by ascetic fluid.

What are the indications for abdominal paracentesis ?

• New onset ascites or ascites of unknown origin.

• Patient with a known ascites who has fever, abdominal pain, hypotension or encephalopathy.

• Symptomatic treatment of large ascites.

What are the contraindications for abdominal paracentesis ?

• Uncooperative patients

• Uncorrected bleeding diathesis

• Acute abdomen that requires surgery

• Intra-abdominal adhesions

• Distended bowel

• Abdominal wall cellulitis at the site of puncture

• Pregnancy

What are the patient preparation for abdominal paracentesis ?

• Informed Consent signed

• obtain coagulation profile

• Empty bladder

• Position sitting upright or semi-Fowler's

Where are the puncture site for abdominal paracentesis ?

What are the nursing responsibilities for abdominal paracentesis ?

• Pre: Explain procedure, prepare sterile equipment, position patient

• During: Monitor vital signs, maintain sterile field

• Post: Observe for leakage, bleeding Documentation

What are the complications and nursing actions for abdominal paracentesis ?

• Hypotension: IV fluids, vitals monitoring

• Peritonitis: Monitor s/s of infection

• Bowel perforation: Rebound tenderness

• Bleeding from paracentesis site

• Ascites leaking from site

What are the patient education for abdominal paracentesis ?

• Report leakage, pain, bleeding or dizziness

• Rest in bed

• Avoid heavy lifting

What are the types of rectal examination ?

1. Digital Rectal Examination (DRE): • A gloved finger is inserted into the anus to feel the rectum and prostate (in males).

2. Proctoscopy (Rigid Sigmoidoscopy): • A rigid, hollow tube (proctoscope) with/without a light is inserted into the anus to visually inspect the rectum and anal canal.

What are the purpose and indication for rectal examination ?

• Detecting causes of rectal bleeding.

• Screening for colorectal cancer.

• Diagnosing hemorrhoids and polyps.

• obtain tissue samples for biopsies.

• Monitoring cancer after treatment.

What are the patient preparation for rectal examination ?

• Administer laxative suppository / enema if ordered

• Left lateral Sims’ position

What are the nursing responsibilities for rectal examination ?

• Provide privacy

• Assist with equipment

• Monitor patient comfort

What are the complications and nursing actions for rectal examination ?

• Minor bleeding

• Vasovagal reaction: Monitor vitals

What are the patient education for rectal examination ?

• mild bleeding expected

• report if severe pain