GIT (Assessment)

Demographic Data

• age

• gender

• culture

• occupation

Personal and Family Hx

• previous GI disorders

• abdominal surgery

• Hx of diabetes, CA of digestive tract, peptic ulcer, gallbladder disease, hepatitis, alcoholism, intestinal polyps, obesity

Why do we auscultate before palpation in abdominal assessment? (IAPP)

to avoid disturbing bowel sounds and stimulating bowel activity

Diet Hx

• inquire about special diet and food allergies

• describe usual foods eaten daily and time of meals

• changes in taste or difficulty/pain swallowing

• abdominal pain/discomfort, nausea, vomiting, or dyspepsia (indigestion) that accompanies eating

• unintentional weight loss

• alcohol and caffeine consumption

Socioeconomic Status

ability to obtain food, medication, and medical care

Current Health Problems

• chronological account of current problem, symptoms, and treatments taken

• explore characteristics associated with each symptom

• types of pain: gnawing, burning, stabbing

• location of pain: have pt. point to site

Preparation for Ab Assessment

1. empty the bladder (for pt’s comfort)

2. have patient lie in dorsal recumbent (make sure arms are at sides to avoid tensing of the abdominal muscles)

Abdominal Inspection

• color, condition of umbilicus, striae, texture shape, rashes, lesions, dilated blood, symmetry, bulging, muscular position

• describe contour

Contour of Abdomen

• flat

• convex (rounded)

• concave (sunken - may have tumor underneath)

• protuberant or distended

6 Common Causes of Abdominal Distention

• food

• fat

• fluid

• feces

• flatus

• fetus

Auscultate

peristalsis and bruits with stethoscope

Direction of Auscultation

RLQ - RUQ - LUQ - LLQ

Normal Bowel Sound Rate

5 - 35 gurgles/minute

Hypoactive Bowel Sounds

<5 gurgles/min

Hyperactive Bowel Sounds

>30 gurgles/min in one quadrant and decreased sounds in another

Absence of Bowel Sounds

no sound at each of the 4 quadrants for 5 min.

Vascular Sounds

• bruits (swooshing sound)

• peritoneal friction rub (heard over spleen or liver)

• venous hum

Physical Assessment - Palpation

• detect tenderness, sensitivity, masses, swelling, and muscular resistance, and to confirm (+) findings

Areas to check in abdominal palpation

• liver

• spleen and kidney

• urinary bladder distention

Percussion

Tapping to detect presence of air, fluid, or masses underlying tissues

Purpose of Percussion

• to determine size of solid organ

• detect presence of fluid, masses, and air

• estimate the size of liver and spleen

Tympany or Resonant Sound

high-pitched, loud musical sound heard over areas filled with air

Dull or Flat Sound

medium-pitched, soft, thud-like sound heard over solid organ

Assessing Ascites

• place pt. supine with hands at the sides and knees flexed

• observe bulging flanks indicating liquid accumulation

• measure abdominal girth

Laboratory Tests

• fecal occult blood test (analysis of stool for blood)

• stool culture or fecal immunochemical test

Nsg Responsibilities: fecal analysis and FOBT

• explain procedure

• pt. avoid red meat, iron, high-fiber meal for 1-3 days

• document administration of vit. C, aspirin, and anti-inflammatory drugs

Fecal Fat Test

analysis of stool for fat

Nsg. Responsibilities: fecal fat test

• advise pt. to restrict alcohol and eat high-fat diet for 72 hours before examination

• refrigerate specimen until it can be sent to lab

• document current medication

Barium Swallow

locate obstruction, ulceration, or growths in the esophagus, stomach, and duodenum

Nsg. Care: Barium Swallow

• have pt. take light supper: jello, soup, toast, or tea night before

• advise to be NPO and avoid smoking 8-12 hours before exam

• pt will drink 16-20oz. of chalky liquid (barium sulfate AKA Gastrografin) before exam

Nsg. Care: After Barium Swallow

• ensure elimination of barium by giving laxatives and forcing fluids

• stool may be white up to 3 days

• observe for barium impaction: distended abdomen, constipation

Barium Enema (BE)

to locate tumors, obstruction, and ulceration

Nsg. Care: Barium Enema

• pt. on NPO 8 hours before test

• give ordered laxative and enema; bowel must be clear of stool

Nsg. Care: Computed tomography (CT)

• pt. on NPO for 4 hours when oral contrast is to be used

• secure consent

• assess for allergy to shellfish and iodine

Nsg. Care: UTZ imaging

• advise pt. to remain on NPO for 8-12 hours prior to test

Nsg. Care: esophagogastroduodenoscopy (after test)

• side-lying to avoid aspiration of saliva

• remain NPO until gag reflex returns

• NSS gargle, throat lozenges

• VS q15-30 min as ordered

• watch for signs of perforation: rising temperature, pain, changes in VS

Lower GI Endoscopy/Colonoscopy/Proctosigmoidoscopy

directly views the lining of the colon with a flexible endoscope

Nsg. Care: Lower GI Endoscopy/Colonoscopy/Proctosigmoidoscopy

• secure consent

• clear liquid 1-3 days before test

• NPO 8 hours before test

• bowel preparation as ordered

Nsg. Care: After Lower GI Endoscopy/Colonoscopy/Proctosigmoioscopy

check for rectal bleeding and signs of perforation

Nsg. Care: Endoscopic Retrograde Cholangiopancreatography

• pt. NPO 8 hours before test

Endoscopic Retrograde Cholangiopancreatography

visualize gastrointestinal structures, and to retrieve gallstones

Nsg. Care: After Endoscopic Retrograde Cholangiopancreatography

• assess vital signs and gag reflex

• monitor for complications (common being pancreatitis)

Nsg Care: Liver Biopsy

• place pt. in supine and side-lying

• NPO for 4-8 hours prior to test

• procedure may take 15 min.

• vital signs q 15 mins for 1 hour; then q 30 mins for 4 hours; then q 4 for 24 hours

• observe for signs of respiratory distress: dyspnea, cyanosis, or restlessness (may be sign of pneumothorax)

•  patient to avoid coughing or straining

Esophageal pH Monitoring

Probe is placed 5 cm above LES and pH is measured for 24 hours

How does esophageal pH monitoring detect GERD?

If pH above the LES is less than 4

Nsg. Care: Esophageal pH Monitoring

• kept on NPO night before test

• mouth care in the morning

• door of the room kept closed to avoid smell of food entering