Assessment of Digestive and GI Function

Connie K. Cupples, MS, MSN, RN

Union University

Outcome 1

• Review the structure and function of the organs of the GI tract.

• A. Draw abdomen depicting organs in the four quadrants.

• B. Identify function of each of the organs of digestion.

Abdomen

Function of Organs

• Mouth

• Stomach

• Small Intestine

• Colon

Outcome 2

• Explain the processes involved in the digestion, absorption, and elimination of

food products.

A. Identify major digestive enzymes, sources, and digestive actions.

refer to pg. 943 table 34-1

Action of enzymes that digest CHO,

protein, and fat

Outcome 3

• Describe assessment paramaters and techniques used when evaluating the GI tract.

• A. Draw a torso and shade common sites

of referred abdominal pain.

• B. Discuss the order of the examination of the abdomen and give the rationale.

Sites of Referred Abdominal Pain

Health History

• Focus on symptoms common to GI dysfunction:

Pain

Indigestion

Intestinal gas

Change in bowel habits

Change in stool characteristics

Physical Assessment

• Inspect mouth and contents• Supine with knees flexed slightly• Order of assessment:

inspectionauscultationpalpationpercussion

Rationale for order of GI Assessment?

Abdomen - Ascites

Abdomen-Obese

Abdomen - Hernia

Outcome 4

• Describe preparation, education, and follow-up care for patients undergoing the following diagnostic testing of the GI tract.

• A. Discuss how the nurse would prepare and educate patients for GI tests, including post procedure interventions.

Stool Tests

• Collect on random basis except specimen where quantitative study is performed (fecal fat and urobilinogen)

• Refrigerate quantitative specimen (24-72 hr. collections)

• Special diet required for some tests

• Fecal occult blood tests (foods & meds

may alter results.

Abdominal Ultrasonography

• Noninvasive means of imaging abdominal organs and structures.

• NPO for 8-12 hrs.

• Fat-free meal at supper if GB studies are done

• Schedule barium studies after test if ordered as well

Upper GI X-ray Studies

X-ray imaging after contrast media injested.Low residue diet X several days priorNPO after MNLaxative prepDiscourage smoking day of testHold all meds on day of testMonitor post test for 3 days to get rid of

barium (fluids, laxatives, enemas)

Lower GI X-ray Studies

• Visualization of lower GI tract after instillation of barium

• Bowel prep to cleanse lower bowel

• Low-residue diet 1-2 days prior

• C/L diet for supper, laxative HS, NPO after MN

• Cleansing enemas until clear in a.m.

• Post procedure elimination of barium

CT

• Cross-sectional images of abdominal organs and structures

• NPO 6-8 hrs. before test

• Question about contrast dye allergies

• Schedule barium studies after CT scan if ordered

MRI

• Noninvasive technique to supplement ultrasonography and CT scanning

• NPO 6-8 hrs. prior to test

• Remove all jewelry & other metals

• Explain that procedure lasts 30-90 minutes

• Explain type of equipment used (pt. may experience claustrophobia & hear knocking sound)

Esophagogastroduodenoscopy

• Visualization of upper GI tract with fiberoptic lenses.

• NPO 6-12 hrs.

• Pt. may gargle with local anesthetic

• Versed given IV – monitor pt. per conscious sedation protocol

• Atropine may be given to dry secretions

• Position on left side during procedure

Nursing Interventions Post EGD

• Keep NPO until return of gag reflex

• Simms position until awake, then semi-fowlers

• Observe for s/s of perforation (pain, bleeding, unusual difficulty swallowing, temp)

• Monitor for changes in P & BP

• Instruct not to drive for 10-12 hrs. post

EGD

Colonsocopy

• Direct visual inspection of the colon using flexible fiberoptic colonoscope.

• Colon preparation a must

• C/L diet at noon day before

• Laxatives the night before

• Use of preparation such as Golytely to lavage the bowel over 3-4 hrs. until returns are clear

Nursing Interventions post Colonoscopy

• Monitor according to conscious sedation guidelines

• Observe for s/s of bowel perforation (abdominal pain, distention, rectal bleeding, temp)

• Provide written instructions due to amnesic effect of meds

Colonoscopy

Gastic Analysis, Gastic Acid Stimulation test & pH Monitoring

• Determines secretory activity of gastic mucosa and gastric retention.

• NPO 8-12 hrs.

• Hold meds that affect gastic secretion

• Smoking not allowed day of test

• Insert small NG tube

• Aspirate entire contents of stomach q 15 minutes for 1 hr.

Gastic Acid Stimulation

• Med given to stimulate gastric secretion

• Inform pt. that flushing may occur

• Monitor P & BP q 15 min.

• Collect gastic specimen q 15 minutes for 1 hr.

pH Monitoring

• NPO 6 hrs. before test

• Hold meds 24-36 hrs.

• Probe inserted through nose

• Connected to external recording device