Gastroenterology Nursing Core Curriculum

Chapter 1: GI Nurse and Associate

What type of nurse is referred to gastroenterology nurse

APRN, RN, LPN/LVN

What is Professor Harold Hopkins known for

Developing fiberoptic scopes

Who is Gabriele Schindler

Wife of Dr. Rudolph Schindler-master gastroscopist

She became first recorded gastroenterology assistant

What does SGNA stand for

Society of Gastroenterology Nurses & Associates, Inc

During what period was medicine so far advanced they have today's equivalent of specialties

Period of Egyptians

What is the rationale for rapid adoption of fiberoptic instruments

Simplicity, ease of use, and pt safety

The 1st Society of Gastroenterology Assistants (SGA) was formed what year

1974

To practice as a gastroenterology nurse, need to apply nursing process

Assessment, Diagnosis, Planning, Implementation, Evaluation

What is a gastroenterology assosciate

A person trained to function in an assistive role in GI setting w/ direct Pt care responsibilities

Initial assessment of a patient arriving to GI unit is the responsibility of the

GI RN (staff nurse)

What is a general requirement for a new grad RN interested in GI

Work 1 full year in Med-surg to gain experience

Chapter 2: Nursing Administration: Leadership & Management of GI dept.

What year was Magnet recognition established

1990

Who was the 1st nurse leader

Florence Nightingale

What is the role of a nurse manager (5 functions of management)

planning, organizing, staffing, directing, controlling

What is the role of a nurse leader

Deeper understanding of interrelationships between leadership roles, principles, functions of humans and material resources

Define Leadership

Multifaceted process that identifies, motivates, supports people to achieve common goals

What is a group

Number of individuals working together toward a common goal

What are the 4 A's of Leadership

Awareness

Assertiveness

Accountability

Advocacy

Define a leadership Awareness

Capacity to assess self objectively

Evaluate groups abilities, maturity, endurance, commitment to organization goals

Set limits and delegate responsibility for efficiency

Effective communication skills-participate

Define Assertiveness

Expression of feelings, needs, ideas, & rights professionally

Define Accountability

Obligation & willingness to accept responsibility for actions

Define Advocacy

Ability to support and defend group

What is Organizations Structure

Process of the group to distribute responsibility, communication, identify relationships, establish authority

Define Planning function

Develop purpose/mission, goals, philosophy, objectives

Create work flows for efficiency/evaluate unit work flow

Integrate/Implement regulatory & professional changes

Forecast trends for patient and technology

Staff input & projections

Space planning-smooth work flow

Manage budget-operating and capital

Define Organizing function

Develops order and fosters productivity=maximum efficiency

Define Directing function

Directing staff and activities to meet unit goals

Define Controlling function

To set standards, measure performance, report results, take corrective actions.

Define Staffing function

Employee selection, placement, training, compensation

What is EBP

Based on empirical data resulting from nursing research

Chapter 3: Infection Prevention

What is a microrganism

organism of microscopic size ie: bacteria, viruses, fungi, protozoa, helminths

Difference between Endogenous and Exogenous infections

Endogenous occur when microflora that colonize GI or respiratory tract enter the bloodstream or sterile body sites

Exogenous occur when microorganisms introduced from source outside the body

Is Cholangitis an endogenous or exogenous infection

Endogenous

What is the most frequent exogenous infection

Mycobacteria

Population most susceptible to infection

Very young and elderly

Immunocompromised/underlying disease

Endovascular surface integrity

Indwelling foreign material: prosthetic heart valves, joint replacements

Presence of intrinsic foci

What is biofilm

different types of bacteria & extracellular material that adhere to the interior surfaces of endoscopes

Why is it important to not allow biofilm to form within a scope

Can create a protective mass that cannot be removed with high-level disinfection

*prompt manual meticulous cleaning is necessary

What can medication often used during endoscopy procedures, may foster microbial growth and biofilm development despite proper reprocessing because it contains sugars and thickener

Simethicone-use at a minimum

Name some organisms of concern in Endoscopy setting

Clostridium difficile

Helicobacter pylori

Escherichia coli

Human immunodeficiency virus (HIV)

Hepatitis C virus,

Hepatitis B virus

multidrug-resistant M. tuberculosis

Vancomycin-resistant enterococcus (VRE)

Methicillinresistant Staphylococcus aureus (MRSA)

What is proper PPE when cleaning a scope

Gowns, gloves, protective eyewear, and/or face protection are recommended when handling any high-level disinfectant or sterilant

What are the most common infections agents in the clinical setting

Bacteria

Describe the process of Pre-cleaning once scope if removed from Pt

Wipe insertion tube with wet sponge

Suction lg volume of solution through scope to clear (10 sec)

Suction air

Time & contain scope to prevent exposure to staff & pt's

Labeled as Biohazardous contents

Container free of gross contamination

Transport to reprocessing area for decontamination

Describe Leak Testing

Apply air pressure inside of scope

Look for bubbles

Flex distal end in all directions

Why is it important to leak test a scope

Detect damage to interior/exterior of scope

*Done before submersing scope to minimize further damage not designed for fluid exposure

If a scope has a leak, what should be done

Remove scope from service

Describe Manual cleaning

Detach all disposable parts

Immerse scope in fresh prepared detergent

Wash all debris with sponge-keep scope submerged

Use soft brush to clean all channels, crevices, valves

Extra attn to ERCP/EUS elevators

Attached channel-cleaning adaptors for suction, air, water

Purge solution from channels

Rinse outer surface

Flush with clean water

Why do we keep scope submerged at all time

To prevent aerosolization

High level disinfection is the ________________

Gold Standard for reprocessing GI scopes

What can occur if residual chemicals remain within an endoscope

Chemical colitis (often mimicking pseudomembranous colitis)

Name another critical step in scope reprocessing

Drying-moisture allows microorganisms and biofilms to develop

How many minutes of forced air should a scope receive

10 minutes

What are the steps for decontamination of a scope

Pre-clean, leak test, manual clean, inspect, high-level disinfection (AER), rinse, dry

Where should scopes be stored and for up to how long

Drying cabinets, hanging, 7-day storage interval

Name the agents approved for high-level disinfection

Glutaraldehyde, Hydrogen Peroxide, Peracetic acid, Ortho-phthalaldehyde

Advantages of Glutaraldehyde

Effective against microorganisms

Inexpensive

Compatible

No adverse reproductive and cancer incidence

Disadvantages of Glutaraldehyde

Some evidence of resistance to microorganisms

Coagulates blood & fixes tissue to surface

Skin, eye, respiratory irritant

Disposal requirements

Noxious

Advantages of Hydrogen Peroxide

No activation required

May enhance removal of organic material & organisms

Inactivates Cryptosporidium

No disposal, odor, irritation

Disadvantages Hydrogen Peroxide

Corrosive

Mild eye/skin irritation

Vapors

Advantages of Peracetic acid

Rapid sterilization

Environmentally friendly

Fewer adverse health effects

No coagulation of blood

Rapid sporicidal

Disadvantage of Peracetic acid

Dulling of aluminum

More expensive (compared to aldehydes)

Serious eye/skin damage

Advantages to Ortho-phthalaldhyde

Chapter 4: Environmental Safety

Give examples of electrical equipment that should be checked in endo suit

Outlet switches & plates for damage

Power cords & plugs for fraying/damage

*Make sure all new equipment has been inspected hospital

Give examples of what high voltage electrocution can do

Brain damage

Impair respiration

Cardiac dysrhythmia (v-fib)

Vascular injury

Tissue injury

Loss of consciousness

Infection

Eye damage

What does RACE stand for

Rescue: Pt & staff from danger zone

Alarm: Per policy, if unable to put out-pull alarm

Contain: Close all doors, deter smoke & flames

Extinguish/Evacuate: Halon extinguisher/Horizontal evacuation first

What is a dispersive electrode

Grounding pad

What is the difference between Bipolar and Monopolar endoscopic instruments

Monopolar passes current from the probe, through the patient's body, to a return grounding pad.

Bipolar devices contain both electrode poles at the tip, restricting current to only the tissue between the jaws

Does Bipolar require a grounding pad

No

Bipolar is safer for what pt profile

Those with pacemakers, ICDs, - closed circuit

Where should grounding pads not be placed

Bony prominences

Skin over implanted metal prosthesis

Scar tissue

Areas of poor circulation

Near pacemakers or ICDs

Older pacemakers and ICDs may interpret electrocautery as cardiac activity and inhibit them from initiating. What additional precautions should be taken

Know manufacturer of device

Validate battery life

Magnet to avoid interference

Place cautery pad far from pacemaker

Keep all electrocautery cords/cables away

Use lowest setting on ESU & cautery devices

What does APC or AEC stand for

Argon Plasma Coagulation or Argon Enhanced Coagulation

What is APC (Argon plasma coagulation) or AEC (Argon enhanced coagulation)

a minimally invasive, non-contact, endoscopic procedure used to stop bleeding, destroy abnormal tissue (ablation), and treat vascular lesions in the gastrointestinal tract or airways

Common uses for APC

Treat bleeding (GAVE, Dieulafoye lesion, AVM)

Tissue ablation

Is APC bipolar or monopolar

Monopolar

What sort of radiation is used in the Endoscopy suite

Fluoroscopy

What is the hazard of radiation

Modifies cells in the body-cell dysfunction, alteration, stop replication, destruction

What is considered a "Primary, Secondary, and Tertiary" source of radiation

Primary-Patient focused

Secondary-Personnel in room

Tertiary/Third-Radiation leakage from radiographic machine

What is a MPD

maximum permissible dose

What is the MPD annually for Whole body, organs, and gonads

5 MPD

What is the MPD annually for lens of the eyes

15 MPD

What is the MPD for extremities and skin yearly

50 MPD

What is the recommended MPD for pregnant women/fetus

0.5 MPD

What minimizes radiation exposure

Limit time of exposure

Greater distance from source

Place shield in place between source & body

Wear film badges & lead lined flexible wrap around aprons, gloves, thyroid collars, protective eye wear

Allergies to these foods put you at a higher risk for latex allergy

Avocados

Potatoes

Bananas

Tomatoes

Chestnuts

Kiwi

Papaya

Medical conditions putting you at higher risk for latex allergy

Spina bifida

Asthma

Hx multiple sx

Mercury-filled dilators (Bougies) are becoming rare, now filled with

Tungsten