2. Assessment of GI (Health Hx & Diagnostic evaluation)

Character, duration, pattern, frequency, location, distribution of referred pain, and timing

What factors should be assessed when evaluating GI pain?

Upper abdominal discomfort or distress associated with eating (indigestion)

What is the most common symptom of GI dysfunction?

Indigestion

What is another term for upper abdominal discomfort related to eating?

Disturbed nervous system control of the stomach or disorders in the GI tract or other parts of the body

What can cause indigestion?

Because they remain in the stomach longer than proteins

Why do fatty foods cause more GI discomfort?

Fatty foods, salads, coarse vegetables, and highly seasoned foods

Which types of foods commonly cause GI distress?

result in belching or flatulence

What happens when gas accumulates in the GI tract?

belching

Expulsion of gas from the stomach through the mouth

flatulence

Expulsion of gas from the rectum

Odors, activity, or food intake

What can trigger nausea?

Undigested food particles or blood (hematemesis)

What can vomitus contain?

hematemesis

Vomitus containing blood

light to dark brown

Stool is normally

Dark brown

What stool color is caused by meat protein?

Green

What stool color is caused by spinach?

Red

What stool color is caused by carrots, beets, and red gelatin?

Dark red or brown

What stool color is caused by cocoa?

Yellow

What stool color is caused by senna?

Black

What stool color is caused by bismuth, iron, licorice, and charcoal?

Milky white

What stool color is caused by barium?

Mouth, abdomen, and rectum

What areas are included in the physical assessment of the GI system?

Mouth, tongue, buccal mucosa, teeth, and gums

What parts of the mouth are inspected during physical assessment?

Ulcers, nodules, swelling, discoloration and inflammation

What abnormalities are noted during mouth inspection?

Remove them to allow good visualization

What should people with dentures do during oral examination?

Supine with knees slightly flexed (dorsal recumbent)

What is the patient’s position during abdominal assessment?

Inspection, auscultation, palpation, and percussion

What are the four techniques used in abdominal assessment?

• CBC

• CARCINOEMBRYONIC ANTIGEN (CEA)

• LIVER FUNCTION TESTS

• SERUM CHOLESTEROL

• TRIGLYCERIDES:

Common blood testsinclude:

4 million — 6 million per mm3 blood

NV of Red blood cells (erythrocytes)

4,000 11,000 per mm3 blood

NV white Blood cells (leukocytes)

20-50 per mm3 blood

NV of Basophils

100-400 per mm3 blood

NV of Eosinophils

3,000 — 7,000 per mrm3 blood

NV of Neutrophils

• Basophils

• Eosinophils

• Neutrophils

Granular Leukocytes

1,500 — 3,000 per mm3 blood

NV of Lymphocytes

100 — 700 per mm’ blood

NV of Monocytes

150,000 ~ 300,000 per mm3 blood

NV of Platelets (thrombocytes)

Fermale: 12—16 g/dL

Male: 13-18g/dl

NV of Hemoglobin (Hgb)

Female: 36% - 48%

Male: 39% - 54%

NV of Hematocrit (HCT)

O to 2.5 ng/ml (Oto 2.5 ug/L)

Normal range of CARCINOEMBRYONIC ANTIGEN (CEA)

7 to 55 units per liter (U/L)

Alanine transaminase (ALT)

8 to 48 U/L

Aspartate transaminase (AST)

40 to 129 U/L

Alkaline Phosphatase (ALP)

3.5 to 5.0 (g/dl)

Albumin

6.3 to 7.9 g/dl

Total protein

0.1 to 1.2 (mg/dL)

Bilirubin

8 to 61 U/L

Gamma-glumyltransferase (GGT)

122 to 222 U/L

L - lactate dehydrogenase (LD)

9.4 10 12.5 seconds

Prothrombin Time (PT)

<200 mg/dL.

Total Cholesterol

>40 mg/dL (men)

>50 mg/dlL (women)

HDL Cholesterol

<100 mg/dL.

LDL Cholesterol

<150 mg/dl

TRIGLYCERIDES

• fasting

• use of laxatives or enemas

• ingestion or injection of a contrast agent or a radiopaque dye

The preparation for many of these studies (endoscopy or GI laboratory) includes

• Establish the nursing diagnosis

• Provide needed information about the test and activities required of the patient

• Provide instructions about post-procedure care and activity restrictions

• Provide health information and procedural education to patients and significant others

• Help the patient cope with discomfort and alleviate anxiety

• Inform the primary provider of known medical conditions or abnormal laboratory values that may affect the procedure

• Assess for adequate hydration before, during, and immediately after the procedure, and provide education about maintaining hydration

General l nursing interventions for the patient who is undergoing a Gl diagnostic evaluation include

Stool Tests

• includes inspecting the specimen for consistency, color, and occult (not visible) blood

• Additional studies, including

  • fecal urobilinogen, fecal fat, nitrogen

  • Clostridium difficile, fecal leukocytes,

  • calculation of stool osmolar gap, parasites, pathogens, food residues, and other substances,

    • require laboratory evaluation.

Breath Tests

• developed to evaluate carbohydrate absorption

• used to aid in the diagnosis of bacterial overgrowth in the intestine and short bowel syndrome.

• determines the amount of hydrogen expelled in the breath after it has been produced in the colon

• Pain

• Dyspepsia

• Intestinal Gas

• Nausea and Vomiting

• Change in Bowel Habits and Stool Characteristics

• Physical Assessment

Health History and Clinical Manifestations