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BARIUM ENEMA

• Fluoroscopic x-ray examination visualizing the entire large intestine is


administered after rectal instillation of barium SO4

• detects structural changes, such as tumors, polyps, diverticula, fistulas,


obstructions, and ulcerative colitis

• Air may be introduced after the barium to provide a double-contrast study

NURSING AND PATIENT CARE CONSIDERATIONS

• Explain the procedure to the patient

• NPO after midnight the day of procedure

• enema or cathartic may be ordered after the barium enema

• barium may cause light-colored stools for several days after the procedure

PURPOSES OF ENEMA ADMINISTRATION

• 1. Bowel preparation for diagnostic tests or surgery to empty the bowel of


fecal content.

• 2. Delivery of medication into the colon ( such as enemas containing


neomycin to decrease the bowel’s bacteria count or a kayexalate enema
to decrease the serum potassium level)

• 3. To soften the stool ( oil-retention enemas)

• 4. To relieve gas( tidal,milk and molasses,or fleet enemas)

• 5. Promote defecation and evacuate feces from the colon for patients with
constipation or an impaction.

ULTRASONOGRAPHY

• focuses high-frequency sound waves over an abdominal organ to obtain


an image of the structure

• detect small abdominal masses, fluid-filled cysts, gallstones, dilated bile


ducts, ascites, and vascular abnormalities

• Ultrasound with Doppler may be ordered for vascular assessment

NURSING AND PATIENT CARE CONSIDERATIONS

• special diet, laxative, or other medication to cleanse the bowel


and decrease gas

• NPO for at least 6 hours before the procedure


• Change position of patient, as indicated, for better visualization
of certain organs

ENDOSCOPIC PROCEDURES
• to visualize the GI tract and to perform certain diagnostic and therapeutic
procedures

• Images are produced through a video screen or telescopic eyepiece

• can be inserted through the rectum or mouth, depending on which portion


of the GI tract is to be viewed

• Can also be used for biopsy or cytology of lesions, removal of foreign


objects or polyps, control of internal bleeding, and opening of strictures

ESOPHAGOGASTRODUODENOSCOPY (EGD)

• visualization of the esophagus, stomach, and duodenum

• diagnose acute or chronic upper GI bleeding, esophageal or gastric


varices, polyps, malignancy, and gastroesophageal reflux

• can be used to perform a biopsy or cytologic study, remove polyps or


foreign bodies, control bleeding, or open strictures

NURSING AND PATIENT CARE CONSIDERATIONS

• Explain the procedure

• NPO for 8 to 12 hours before the procedure to prevent aspiration and allow
for complete visualization of the stomach

• Remove dentures and partial plates to facilitate passing the scope and
preventing injury

• Inform the health care provider of any known allergies and current
medications. Medications may be held until the test is completed

• Obtain prior x-rays, and send with the patient

• Local anesthesia is administered along with midazolam

• Keep patient NPO according to protocol until patient is alert and gag reflex
has returned

• May resume regular diet after gag reflex returns and tolerating fluids
• May experience a sore throat for 24 to 36 hours after the procedure. When
the gag reflex has returned, throat lozenges or warm saline gargles may
be prescribed for comfort

• Possible complications:

• perforation of the esophagus or stomach

• pulmonary aspiration

• hemorrhage

• respiratory depression or arrest

• infection

• cardiac arrhythmias or arrest

PROCTOSIGMOIDOSCOPY AND COLONOSCOPY

• Proctosigmoidoscopy is the visualization of the anal canal, rectum, and


sigmoid colon through a fiberoptic sigmoidoscope

• Colonoscopy is the visualization of the entire large intestine, sigmoid


colon, rectum, and anal canal

• used to diagnose malignancy, polyps, inflammation, or strictures

• Colonoscopy is used for surveillance in patients with a history of chronic


ulcerative colitis, previous colon cancer, or colon polyps

• Position: lying left side with the knees drawn up to the chest

• Lower GI endoscopy can be used to perform biopsy, remove foreign


objects, or obtain specimen for culture or cytology

• Colonoscopy, a more extensive procedure than proctosigmoidoscopy,


requires several days of bowel preparation and use of conscious sedation
during the procedure

• bowel preparation:

• 1 gallon or less iso-osmolar electrolyte solution to consume over a


3- to 4-hour period the day before the procedure

• clear liquid diet the day before the procedure

• oral laxative the night before the procedure.

NURSING CARE:
• NPO after midnight

• Clear liquid diet at noon a day before the test

• Observe the patient for a change in vital signs, bleeding, pain, vomiting,
abdominal distention or rigidity

• Ensure that patients who have had endoscopic procedures requiring


sedation have a caregiver to drive home after the procedure

NASOGASTRIC AND NASOINTESTINAL INSERTION

• Nasogastric insertion refers to the insertion of a tube through the


nasopharynx into the stomach.

• Nasointestinal insertion is performed by inserting a small-bore tube,


that is carried by way of peristalsis into the duodenum or jejunum

• used for intestinal decompression, administering feedings and


maintaining nutritional intake

PURPOSES OF NASOGASTRIC INSERTION

• Remove fluid and gas from the stomach (decompression)

• Prevent or relieve nausea and vomiting after surgery or traumatic events

• Determine the amount of pressure and motor activity in the GI tract

• Irrigate the stomach (lavage) for active bleeding or poisoning

TOTAL PARENTERAL NUTRITION

• administered to meet a client’s total nutritional needs when oral


feedings,tube feedings, and standard IV feedings are contraindicated

• used for client’s with various GI problems or other conditions that


necessitate nutritional support such as some oncology clients

IMPORTANT POINTS:

• administer TPN through a central vein such as subclavian

• Administer TPN at a constant rate

• The infusion should never be stopped abruptly

• Administer dextrose 10% in water if you must stop the infusion

• In TPN administration, the pancreas secretes increased insulin; abrupt


cessation can cause hypoglycemia
• Maintain strict asepsis

• Monitor blood glucose levels or check urine for glucose every 6 hours

• Observe the client for headache, nausea, vomiting and fever, indicate an
allergy to the protein

• Closely monitor intake and output

• Weigh the client daily (1/4 lb per day)

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