(GI Tests)

Oscopy

using lighted source to view part of the body

What happens during oscopy tests

Biopsy mucous and lesions
Remove Lesions
Cauterize bleeding

Colonoscopy/ Sigmoidoscopy

Done with rectal bleeding
Injury
IBS

Contrast Medium studies (Barium)

drink a medium that will highlight areas in the body

Esophages

Upper GI
Barium Enema

Upper GI tests

Mouth → Stomach → Esophagus → Small Interstice

Large intestine test

Occult blood
Checks for blood in stool (dark tarry stool)
Avoid red meat, raw fruits, veggies, aspirin, vitamin C for up to 3 days before testing
May cause false positive or negative results

NPO

non per orum (Nothing by mouth)

Nothing by mouth

Prior to surgeries, GI abnormalities, N&V, L&D, lab work or tests, when comatose
No ice chips
Consider health (diabetes, hypoglycemia)
Keep in mind (keeping, mouth moist, good oral care, irritable due to lack of oral intake)

Clear liquid

Any liquid you can see through at room temperature
Broth, coffee, carbonate beverages, ice pops, gelatin, clear juices, tea
1st step after surgery
Poor nutritional value

Order written for clear liquid

Clear diet, advance as tolerated
Allow nurse to assess tolerance to oral (PO) intake
Watch for N/V, full feeling, diarrhea, abdominal pain, & distention
Low nutritional value

Before advancing to a full liquid diet a nurse should do what?

No Nauseous or Vomiting, diarrhea, abnormal pain, distention.
Make sure you hear bowel sounds
Want patient to feel hungry, have +BS, passing flatus, able to eat 1/2-3/4 of tray before advancing

Full liquid

Milk
Puddings, custards, plain frozen desserts, pasteurized eggs, vegetable juices
Last a few days
Better nutrition

Soft diets

Regular diets that are now modified to remove foods that are more difficult to digest or chew

No high fiber (salads, roughage)
No high fat
No highly seasoned
National- Satisfactory

Pureed Diet

Foods that are blended into liquid form
Used for clients with difficult, chewing, swallowing & facial/oral surgery
Foods are blended with broths, gravy, cream soups, cheese, milk, tomato juice, & fruit juice to increase calorie/ nutritional value
- Stroke

Mechanical soft

Food modified for texture
Used for clients with difficult, chewing, swallowing & facial/oral surgery, surgery to head, neck, and mouth
Foods are chopped, ground, or pureed
Mashed soft ripen fruit (bananas, peaches, pears)
Cooked, mashed, soft veggies

Regular / House diet

Anything goes
Patient can generally order what they want- depending on health care facility dietary system

NAS (No added salt or sodium restrcited)

Patients with heart disease, hypertension, kidney disease, ascites

Intake

By mouth
IV fluids
Parenteral nutrition (TPN, PPN)
Antibiotics
Enteral Feedings
Flushes

Output

Urine
Sweat
Stool
Wounds drainage
Drains

Nursing Considerations for nutrition

Impaired appetite
Eating alone
culture
Religion
Serving times
State of health
Oral cavity
Restrictions

How can we stimulate an appetite

Offer small, frequent meals
Solicit favorite foods from home ,if possible
Provide pleasant eating environment
Schedule procedures/medications when they are least likely to interferer with appetite
Control pain, nausea, depression with medications
Offer alternatives for item person who will/not cannot eat
Good oral hygiene
Comfortable position

Enteral Feedings

Feedings administered directly into the stomach

OG (Oral gastric) or NG (nasogastric)
PEG tube (percutaneous gastrostomy or jejunostomy)

When to give an OG or NG tube

Patients intubated in ICU
Patients tracheostomy

PEG TUBE (G or J tube)

Patients with absorption issues

G tube

in the stomach

J stube

Jejunum (SI)

NG tube

inserted through nose & down stomach
Short term use less than or equal to 6 weeks

Risk for NG tube

Risk for aspirating the tube-feeding solution into lungs

What does aspiration look like

Sudden increase in HH, RR, anxiety, vomiting, decreased O2 sat, rhonci

How to adjust for NG tube aspirations

Be sure patient is 30 degrees or higher sitting position when tube feeding running & for 1 hour afterward

Enteral feeding considerations

room temperature
Assess residuals prior to feeding and evaluate absorption
X-ray to check for placement
Assess bowl sounds prior to feeding
Monitor dumping syndrome
Flush tubing

If bowel sounds are absent….

hold feeding

Intermittent enteral feeding

delivering 300-500ml of formula several times a day

Bolus Intermittent

Bag hanging by gravity or a syringe is used to deliver the formula into the stomach. Quick delivery may not be tolerated

Continuous feedings

An infusion pump administered feedings in constant flow 24 hours a day. Stomach never gets a rest

How should you position a patient on continous feeding

30 degrees at all times

Cyclic feedings

Continuous feedings delivered over less than 24 hours (usually a night)

Parenteral feedings

Bypassing GI tract and delivering nutrients into the bloodstream

Solutions for parenteral feedings

dextrose, amino acids, electrolytes, vitamins, & trace elements in sterile water

Parenteral feedings used on clients who

are comatose, non-functioning GI tracts, extensive burns, cancer, premature infants

Duration of parenteral treatment is

less than or equal to 14 days

Total Parenteral Nurition

Prefer a central IV line (port) Coming in from subclavian veins

Highly concentrated, hypertonic nutrient solution

Peripheral Parenteral Nutrition

PIC line (peripheral inserted line) through veins in the arm

Not as nutrient-dense as TPN
Less caustic to the veins

Risks of using a peripheral line

increase risk of infection and phlebitis

Neonates TPN is administered most commonly through the

peripheral IV

Complications of parenteral nutrition

Infection
Liver damage
Hyperglycemia
Sepsis
Phlebitis/infiltration
Complications of central line placement

• infection catheter, fracture, clotting

Bowel elimination

Frequency of bowel movements vary from person to person

Not everyone has a daily BM

Common bowel problems include

Diarrhea
Fecal impaction
Flatulence
Constipation
Bowel incontinence
Infections

Assessment of the bowels

Color
Odor - C-Diff has a specific odor
Amount
consistency
Frequency

Black tarry stools

contain blood can mean cancer or hemorrhoids

Contributing factors t o alter bowel function

activity
physiologic factors
psychologic factors
defecation habits
diagnostic procedures
anesthesia
pathologic
pain
mediations

ostomy

surgically formed opening from the inside of an organ to the outside of the body

intestinal mucosa is brought to the abdominal wall & a stoma is formed by suturing the mucosa's to the skin

Ileostomy’s allow _____ fecal content from the ileum of the small intestine to be eliminated through the stoma

liquid

Someone with an ileostomy is at risk for

dehydration

Colostomy permits ______ feces in the colon to exist through the stoma

formed feces

Why is an colostomy required

Bowel blocked or perforated
Cancer

Trauma
Diversion for wound management
Inflammatory bowl disease exacerbations
May be temporary or permanent

Healthy stoma is

red, pink & moist

Pale stoma

anemia, nutritional deficits

Dark purple/blue stoma

ischemia or compromised circulation

Brown stoma

slough from diseased bowl

Black stoma

tissue death

Nursing ostomy interventions

change pouch/clean stoma when due and/or leaking
Keep skin around perisomal area clean & dry
- Infection & breakdown may occur if care is not taken to protection
- Leaky appliance = skin erosion
Measure I&O
Education
Encourage patient to participate and care for ostomy

Enemas

Used for constipation management or to administer medication
Visualization of intestinal tract during x-ray
Prevent the escape of feces during surgery
Treatment for infection

Introduce a solution into the rectum & large intestine

Ask patient to hold what’s in intestine for as long as possible

Left side of body (sims position)

Types of enemas

Cleansing enema
Retention
Carminative - relieve gas
Return-flow

If patient is cramping

give them 30 seconds and restart at slower rate

Nursing interventions

Promote regular defecation
Provide privacy
Schedule
Lots of fluid and fiber
Provide as normal a position as possible when using a bedpan