Chapter 18 - Prep and Exam of Gl Tract

KEY TERMS

  • abscess

  • bowel obstruction

  • cathartic

  • commode

  • Hirschsprung disease

  • hygroscopic

  • hypervolemia

  • inflammatory bowel disease (IBD)

  • congenital megacolon

  • Crohn disease

  • diverticulitis

  • diverticulosis

  • diverticulum (pl. diverticula)

  • duodenitis

  • dysphagia

  • enema

  • esophagitis

  • esophagogram

  • fistula

  • gastritis

  • gastroesophageal reflux disease (GERD)

  • hemorrhoids

  • hiatal hernia

  • irrigation

  • irritable bowel syndrome (IBS)

  • mucosa

  • peristalsis

  • peritonitis

  • polyp

  • pylorospasm

  • spasm

  • stricture

  • suppository

  • ulcer

  • ulcerative colitis

  • Valsalva maneuver

  • varices (sing. varix)

  • viscosity

  1. Barium sulfate products

  2. Water-soluble iodine compounds

  3. Gases

SCHEDULING AND SEQUENCING

Challenges in Scheduling Procedures

Communication between nursing services and imaging departments is essential

Key factors include # of procedures per day w/o interference.

Barium studies scheduled last for imaging procedures b/c residual barium can obscure results in subsequent examinations like urinalysis or CT scans.

Recommendations for Scheduling

  • Outpatients: multiple procedures in one visit, unless pt req recovery time.

  • Prioritization: Emergencies take precedence (diabetic or elderly patients eat)

  • Fiberoptic Studies: perform b4 barium studies to avoid interference in visual assessments.

ENSURING COMPLIANCE WITH PREPARATION ORDERS

  • Nursing ensure preparation orders are current and followed accurately.

  • Preliminary or scout images may be taken to evaluate the patient’s readiness.

  • Avoid repeating exams due to inadequate prep… causes unnecessary time and rad exposure

  • Written & oral Instructions given to outpatients & confirm understanding.

PREPARATION FOR EXAMINATION

General Preparation Guidelines:

Specific preparation can vary; however, common procedures include:

  • Dietary Restrictions: Low-residue diets leading up to examination.

  • Cathartics: Used to enhance bowel cleansing.

  • Suppositories (solid) & Enemas (liquid): Stimulate bowel evacuation.

Dietary Preparation

  1. Low-Residue Diet: Encourages quick transit through digestive system.

  2. Clear Liquids Diet: 24 hrs prior to exams; foods absorbed w/o residue.

Cathartics

Cathartics aid in cleansing the bowel. Types include:

  • Bulk Cathartics: High-fiber formulas

  • Lubricants: Mineral oil

  • Saline & Stimulants: Used extensively to increase bowel movements

Common medications include bisacodyl and citrate of magnesia.

Must hydrate w/ cathartics to alleviate discomfort.

Suppositories

  • Insert rectal suppositories to stimulate peristalsis.

  • Careful administering

  • hold for at least 30 minutes.

Cleansing Enemas

Assist in thorough bowel cleansing, usually involving equipment such as enema bag & tubing. Patients in Sims (left side lying w/ bent knees) position for comfort & effectiveness.

ADMINISTERING CONTRAST MEDIA

Barium Sulfate

  • Clarified as inert and primarily used in GI imaging.

  • Forms include liquids and powdered mixtures.

  • Proper admin improves image quality

Dosage Recommendations

Barium sulfate administration varies by exam type and patient characteristics.

Balance viscosity for effective imaging outcomes.

Importance of Hydration

adequate hydration b4 & after following exam to avoid complications; especially 4 elderly patients.

CONDITIONS INDICATING EXAMINATION

Common indications for upper GI studies include:

  • ESOPHAGUS: Varices, obstruction, foreign body issues.

  • STOMACH: Ulcers, gastritis, and hiatal hernia.

  • LOWER GI: Crohn's disease, diverticulitis, IBS/IBD conditions, etc.

Upper GI Conditions

These conditions often result in symptoms that necessitate further investigation via imaging.

  • Gastroesophageal Reflux Disease (GERD): Can cause pain and various esophageal symptoms, such as heartburn.

FOLLOW-UP CARE

Follow-Up After Exams: Post-procedure care focuses on advising patients to increase fluid intake and monitoring for any adverse reactions to contrast media, ensuring thorough evacuation of barium.

Medications Post-Examination

Commonly administered after barium studies include cathartics and laxatives, tailored to the patient's individual needs based on their medical history.

REVIEW QUESTIONS

  1. Preparation for an upper GI series usually involves:

    • D. nothing by mouth for 8 hours

  2. The usual contrast medium used for GI studies is:

    • A. barium sulfate

  3. A position that assists gravity flow of barium from the stomach is:

    • C. right anterior oblique

  4. Oral administration and enteroclysis are methods of administering the contrast medium for examination of the:

    • C. small bowel

  5. Follow-up care after an upper GI series or other barium study usually involves:

    • C. a cathartic such as citrate of magnesia

  6. When performing a BE on a patient with Hirschsprung disease, safety concerns may require mixing the barium with:

    • B. normal saline

  7. A suppository is most likely used in preparation for which of the following examinations?

    • A. Barium enema

  8. A Foley catheter would be useful in performing which of the following examinations?