power point adult nursing iv

8/14/2019 Power Point Adult Nursing IV

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Adult Nursing IV


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Anatomy and

Physiology


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Basic Functional AnatomyBasic Functional Anatomy

of the Digestive Systemof the Digestive System


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Anatomy andnatomy andPh ysio lo gyh ysio lo gy

The digestive system is composed ofThe digestive system is composed of

the digestive or alimentary tube andthe digestive or alimentary tube and

accessory digestive organsaccessory digestive organs..


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An atomy a ndn atomy a ndPh ysio lo gyh ysio lo gy


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An atomy a ndn atomy a ndPh ysio lo gyh ysio lo gy


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Upper GI En dosc opypper GI En dosc opyUpper GI endoscopy, sometimes called EGDUpper GI endoscopy, sometimes called EGD(esophagogastroduodenoscopy), is a visual(esophagogastroduodenoscopy), is a visualexamination of the upper intestinal tract using aexamination of the upper intestinal tract using a

lighted, flexible fiberoptic or video endoscope.lighted, flexible fiberoptic or video endoscope.


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Upper GI En dosc opypper GI En dosc opy

EquipmentEquipment

...flexible endoscope...flexible endoscope

Two typesTwo types1.1. The original pure fiberoptic instrument has a flexibleThe original pure fiberoptic instrument has a flexible

bundle of glass fibers that collect the lighted image at one endbundle of glass fibers that collect the lighted image at one endand transfer the image to the eye piece.and transfer the image to the eye piece.

2.2. The newer video endoscopes have a tiny, optically sensitiveThe newer video endoscopes have a tiny, optically sensitivecomputer chip at the end.computer chip at the end.


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EN DOSC OPYN DOSC OPY


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Upper GI Endosc opypper GI Endosc opy

Reasons for the ExamReasons for the Examulcersulcers

intestinal bleedingintestinal bleeding

esophagitis and heartburnesophagitis and heartburngastritisgastritis


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UG I EN DOS COPYG I EN DOS COPY Preparation:Preparation:

1. Obtain written consent1. Obtain written consent

2. NPO2. NPO

3. Medication3. Medication

4. Remove dentures, bridges4. Remove dentures, bridges

5. Anesthesia5. Anesthesia


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UG I EN DOS COPYG I EN DOS COPY During the procedureDuring the procedure

> the throat is anesthesized> the throat is anesthesized

> IV sedation is given> IV sedation is given

> the endoscope is gently inserted into> the endoscope is gently inserted into

the upper esophagusthe upper esophagus


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Upper GI Endosc opypper GI Endosc opy After the procedureAfter the procedure

1. positioning1. positioning

2. NPO2. NPO 3. NSS gargle3. NSS gargle

4. V/S monitoring4. V/S monitoring

5. Assess5. Assess

6. Advise the pt. Not to drive for 12hours.6. Advise the pt. Not to drive for 12hours.


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Lower GI EndoscopyLower GI Endoscopy

Lower GI endoscopyLower GI endoscopy Purpose:Purpose:

> helps diagnose inflammation of the> helps diagnose inflammation of the

coloncolon > remove abnormal cell growth> remove abnormal cell growth

> take sample of tissue for later study> take sample of tissue for later study

> help detect colon or rectal cancer> help detect colon or rectal cancer


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Lower GI END OSCO PYower GI END OSCO PY Preprocedure:Preprocedure:

> Clear liquid diet for 24hours> Clear liquid diet for 24hours

> Administered cathartic as ordered> Administered cathartic as ordered

> Administer enema until the returns are> Administer enema until the returns are

clearclear


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Lower GI END OSCO PYower GI END OSCO PY

During Procedure:During Procedure: > Knee chest position> Knee chest position

> endoscope is inserted into the rectum> endoscope is inserted into the rectum

> you may feel pressure and cramping> you may feel pressure and cramping

After the procedure:After the procedure: > Supine position for few minutes.> Supine position for few minutes.

> Assess for signs of perforation> Assess for signs of perforation

e.g bleeding,pain,fevere.g bleeding,pain,fever

> Hot sitz bath for discomfort in the anorectal area> Hot sitz bath for discomfort in the anorectal area


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Lower GI En dosc opyower GI En dosc opy


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Colonoscopyolonoscopy

The flexible colonoscope is a remarkableThe flexible colonoscope is a remarkablepiece of equipment that can be directedpiece of equipment that can be directed

and moved around the many bends inand moved around the many bends in

the colon.the colon.


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Colonoscopyolonoscopy

Colonoscopy is used for:Colonoscopy is used for:> Colon CA> Colon CA

> Polyps> Polyps

> Colitis> Colitis > Diverticulosis and diverticulitis> Diverticulosis and diverticulitis

> Bleeding lessions> Bleeding lessions

> Abdominal symptoms> Abdominal symptoms


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Colonoscopyolonoscopy Used for(cont.)Used for(cont.)

> Chronic diarrhea, constipation, or a> Chronic diarrhea, constipation, or a

change in bowel habitschange in bowel habits > Anemia> Anemia


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Colonoscopyolonoscopy Preprocedure:Preprocedure:

> cleansing enema> cleansing enema

> clear liquid diet before the test> clear liquid diet before the test > Midazolam is adminestered through IV to> Midazolam is adminestered through IV to

provide sedationprovide sedation

> position patient on left side;knees flexed> position patient on left side;knees flexed


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Colonoscopyolonoscopy After procedure:After procedure:

> Monitor V/S especially heart rate> Monitor V/S especially heart rate

> Assess for signs and symptoms of> Assess for signs and symptoms ofperforationperforation

> Instruct the client to report any bleeding to> Instruct the client to report any bleeding tothe physician.the physician.


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Colonoscopyolonoscopy The procedure takes 15 to 30 minutesThe procedure takes 15 to 30 minutes

and is seldom remembered by theand is seldom remembered by the

sedated patient.sedated patient. Side Effects and RisksSide Effects and Risks

> Bloating and distension> Bloating and distension

> excessive bleeding> excessive bleeding


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Barium swallow andBarium swallow and

barium meal testsbarium meal tests

> barium swallow and a barium meal test involve swallowing a> barium swallow and a barium meal test involve swallowing a

liquid suspension of barium sulphate before a series of X-rays.liquid suspension of barium sulphate before a series of X-rays.

> In a barium swallow test, X-ray images are taken of your> In a barium swallow test, X-ray images are taken of yourpharynx and your oesophaguspharynx and your oesophagus

> X-ray images are taken of your stomach at the beginning of> X-ray images are taken of your stomach at the beginning of

your duodenumyour duodenum

> Barium is a naturally occurring element that appears white on> Barium is a naturally occurring element that appears white on

X-ray.X-ray.

> the barium is given as a cup of flavoured drink> the barium is given as a cup of flavoured drink


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PreparationPreparation

NPO for several hours before the test. If youNPO for several hours before the test. If you

have diabetes, contact the centrehave diabetes, contact the centreperforming the test, or about how to prepareperforming the test, or about how to preparefor the test.for the test.


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No smoking for several hours before theNo smoking for several hours before the

testtest

Not to take your regular oral medicinesNot to take your regular oral medicineson the day of the test, that is, until afteron the day of the test, that is, until after

the testthe test


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During Barium Swallow or Barium MealDuring Barium Swallow or Barium Meal In the X-ray room you will be told when and how fast to drink the bariumIn the X-ray room you will be told when and how fast to drink the barium

solution, usually about one cup in total. If X-rays are to be taken of yoursolution, usually about one cup in total. If X-rays are to be taken of yourstomach (a barium meal test), you may also be asked to drink a smallstomach (a barium meal test), you may also be asked to drink a smallamount of one or 2 other liquids. These liquids combine to produce a gasamount of one or 2 other liquids. These liquids combine to produce a gasthat expands your stomach, making it easier to detect any abnormalitiesthat expands your stomach, making it easier to detect any abnormalitiesin its lining. This can make you feel a little gassy, but you will be asked toin its lining. This can make you feel a little gassy, but you will be asked toresist the urge to burp so that the gas remains in your stomach until afterresist the urge to burp so that the gas remains in your stomach until afterthe X-rays have been taken. Doctors call this type of barium meal athe X-rays have been taken. Doctors call this type of barium meal adouble contrast study.double contrast study.


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SigmoidoscopySigmoidoscopy

A sigmoidoscope is a small tube with an attached lightA sigmoidoscope is a small tube with an attached lightsource about the thickness of your finger.source about the thickness of your finger.

A doctor or nurse inserts the sigmoidoscope into theA doctor or nurse inserts the sigmoidoscope into the

anus and pushes it slowly into the rectum and sigmoidanus and pushes it slowly into the rectum and sigmoid

colon. This allows the doctor or nurse to see the liningcolon. This allows the doctor or nurse to see the liningof the rectum and sigmoid colon.of the rectum and sigmoid colon.


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Bowel preparationBowel preparation

laxatives for a day or two, or by using one or twolaxatives for a day or two, or by using one or two

enemas prior to the procedure. A commonly usedenemas prior to the procedure. A commonly used

laxative to clear the bowel is called Picolax. A commonlaxative to clear the bowel is called Picolax. A commonplan is:plan is:

For three days before the procedure - eat a light diet.For three days before the procedure - eat a light diet.


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For 12 hours before the procedure - have fluids only (no solids inFor 12 hours before the procedure - have fluids only (no solids inyour diet), but you can eat a normal light breakfast on the morningyour diet), but you can eat a normal light breakfast on the morning

just before the procedure.just before the procedure.

AFTER CARE:AFTER CARE:

> May experience flatulence or gas pain bec. air was used to> May experience flatulence or gas pain bec. air was used todistend the intestines for better visibilitydistend the intestines for better visibility

> Observe for signs of bowel perforation> Observe for signs of bowel perforation

> If biopsy is performed, patient should be informed that slight> If biopsy is performed, patient should be informed that slightrectal bleeding may occurrectal bleeding may occur


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Endos copic R etrog radendos copic R etrog radeCholangiopancr eatog raphyholangiopancr eatog raphy

Direct visualization with radiographic examination of the liver,Direct visualization with radiographic examination of the liver,

gallbladder, and pancreas.gallbladder, and pancreas.

Contrast medium is introduced via the endoscopeContrast medium is introduced via the endoscope

Through the endoscope, the physician can see the inside ofThrough the endoscope, the physician can see the inside of

the stomach and duodenum, and inject dyes into the ducts inthe stomach and duodenum, and inject dyes into the ducts in

the biliary tree and pancreas so they can be seen on x rays.the biliary tree and pancreas so they can be seen on x rays.


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Endoscopi c Retr og radendoscopi c Retr og radeCho langi opancr eatog raphho langi opancr eatog raphyPreparationPreparation

Secure written consentSecure written consent NPO 10-12hoursNPO 10-12hours Check for allergy to iodine/seafoodsCheck for allergy to iodine/seafoods Take initial V/STake initial V/S

AtSO4; valium as orderedAtSO4; valium as ordered Local anesthetic spray into the throatLocal anesthetic spray into the throat


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Endoscopi c Retr og radendoscopi c Retr og radeCho langi opancr eatog raphho langi opancr eatog raphyProcedureProcedure Lie on the left side on an examining table in an x-ray room. PatientLie on the left side on an examining table in an x-ray room. Patient

will be given medication to help numb the back of the throat and awill be given medication to help numb the back of the throat and asedative to help you relax during the exam. You will swallow thesedative to help you relax during the exam. You will swallow theendoscope, and the physician will then guide the scope throughendoscope, and the physician will then guide the scope throughyour esophagus, stomach, and duodenum until it reaches the spotyour esophagus, stomach, and duodenum until it reaches the spotwhere the ducts of the biliary tree and pancreas open into thewhere the ducts of the biliary tree and pancreas open into theduodenum. At this time, the pt. will be turned to lie flat on hisduodenum. At this time, the pt. will be turned to lie flat on hisstomach, and the physician will pass a small plastic tube throughstomach, and the physician will pass a small plastic tube throughthe scope.the scope.

Through the tube, the physician will inject a dye into the ducts toThrough the tube, the physician will inject a dye into the ducts to

make them show up clearly on x rays.make them show up clearly on x rays. X rays are taken as soon as the dye is injected. An ERCP canX rays are taken as soon as the dye is injected. An ERCP can

take 30 minutes to 2 hours to completetake 30 minutes to 2 hours to complete


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Endoscopi c Retr og radendoscopi c Retr og radeCho langi opancr eatog raphho langi opancr eatog raphyPurposePurpose

An ERCP may be necessary to find theAn ERCP may be necessary to find the

cause of jaundice, upper abdominal pain,cause of jaundice, upper abdominal pain,or unexplained weight loss.or unexplained weight loss.


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Endoscopi c Retr og radendoscopi c Retr og radeCho langi opancr eatog raphho langi opancr eatog raphy Care after ERCPCare after ERCP

> NPO until gag reflex returns> NPO until gag reflex returns > turn to side to prevent aspiration> turn to side to prevent aspiration

> Monitor V/S> Monitor V/S

> Monitor signs and symptoms of sepsis,> Monitor signs and symptoms of sepsis,perforation, pancreatitisperforation, pancreatitis


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Liver BiopsyLiver Biopsy

DefinitionDefinition

A biopsy is a tinyA biopsy is a tiny

sample of bodysample of body

tissue -- in thistissue -- in thiscase, liver tissue.case, liver tissue.

A needle is insertedA needle is inserted

through thethrough the

abdominal wall toabdominal wall tothe liver to obtain athe liver to obtain a

tissue sample fortissue sample for

biopsy andbiopsy and

microscopic exam.microscopic exam.


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Liver Bi opsyiver Bi opsy PreparationPreparation Obtained informed consentObtained informed consent

NPO 2-4hoursNPO 2-4hours Vit.K injectionVit.K injection

Monitor Prothrombin time; initialMonitor Prothrombin time; initialV/SV/S

Administered a sedative as orderedAdministered a sedative as ordered

Position in the left side or supinePosition in the left side or supineposition with the pillow under theposition with the pillow under theright shoulderright shoulder

Instruct to exhale deeply; holdInstruct to exhale deeply; holdbreath for 5-10sec during needlebreath for 5-10sec during needleinsertion to prevent trauma to theinsertion to prevent trauma to thediaphragmdiaphragm


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Liver Bi opsyiver Bi opsy


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Liver Bi opsyiver Bi opsy


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Liver Biopsyiver Biopsy Care after liver biopsyCare after liver biopsy

Turn to the right side forTurn to the right side for4hours to apply pressure4hours to apply pressure

and prevent bleedingand prevent bleeding Maintain bedrest for severalMaintain bedrest for several

hourshours

Monitor VS every 30mins-Monitor VS every 30mins-every hour for the firstevery hour for the first

24hours24hours Monitor biopsy site forMonitor biopsy site for

bleedingbleeding

Monitor for peritonitisMonitor for peritonitis

Avoid heavy lifting &Avoid heavy lifting &


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EsophagogastroduodenoscopyEsophagogastroduodenoscopy

DefinitionDefinition is a diagnostic endoscopic procedure that visualisesis a diagnostic endoscopic procedure that visualises

the upper part of the gastrointestinal tract up to thethe upper part of the gastrointestinal tract up to the

duodenum. It is considered a minimally invasiveduodenum. It is considered a minimally invasiveprocedure since it does not require an incision into oneprocedure since it does not require an incision into oneof the major body cavities and does not require anyof the major body cavities and does not require anysignificant recovery after the procedure (unlesssignificant recovery after the procedure (unlesssedation or anesthesia has been used). A sore throat issedation or anesthesia has been used). A sore throat is

also commonalso common..


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EG DG D


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EsophagogastroduodenosEsophagogastroduodenos

copycopy

Diagnostic IndicationDiagnostic Indication

* Unexplained anemia (usually along with a* Unexplained anemia (usually along with acolonoscopy)colonoscopy)* Upper gastrointestinal bleeding as evidenced by* Upper gastrointestinal bleeding as evidenced byhematemesis or melenahematemesis or melena* Persistent dyspepsia in patients over the age of 40-45* Persistent dyspepsia in patients over the age of 40-45yearsyears* Heartburn and chronic acid reflux - this can lead to a* Heartburn and chronic acid reflux - this can lead to a

precancerous lesion called Barrett's esophagusprecancerous lesion called Barrett's esophagus* Persistent vomiting* Persistent vomiting* Dysphagia - difficulty in swallowing* Dysphagia - difficulty in swallowing* Odynophagia - painful swallowing* Odynophagia - painful swallowing* Surveillance of gastric ulcer or duodenal ulcer* Surveillance of gastric ulcer or duodenal ulcer* Occasionally after gastric surgery* Occasionally after gastric surgery* Abnormal barium swallow or barium meal* Abnormal barium swallow or barium meal


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EsophagogastroduodenosEsophagogastroduodenos

copycopy TherapeuticTherapeutic

* Treatment (banding/sclerotherapy) of esophageal* Treatment (banding/sclerotherapy) of esophagealvaricesvarices* Injection of liquids through a needle (e.g.* Injection of liquids through a needle (e.g.

adrenalin in bleeding lesions)adrenalin in bleeding lesions)* Cutting off of larger pieces of tissue with a snare* Cutting off of larger pieces of tissue with a snaredevice (e.g. polyps, endoscopic mucosaldevice (e.g. polyps, endoscopic mucosalresection)resection)* Application of cautery to tissues* Application of cautery to tissues

* Retrieval of foreign bodies that have been* Retrieval of foreign bodies that have beeningestedingested* Tamponade of bleeding esophageal varices with* Tamponade of bleeding esophageal varices witha balloona balloon* Application of photodynamic therapy for* Application of photodynamic therapy for

treatment of esophageal malignanciestreatment of esophageal malignancies**


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EG DG D The patient lies on his/her left side withThe patient lies on his/her left side with

the head resting comfortably on a pillow.the head resting comfortably on a pillow.

A mouth-guard is placed between theA mouth-guard is placed between theteeth, partly to protect the patient's teethteeth, partly to protect the patient's teeth

but more importantly to prevent thebut more importantly to prevent the

patient from biting on the very expensivepatient from biting on the very expensive

endoscope.endoscope.

The endoscope is then passed over theThe endoscope is then passed over the

tongue and into the oropharynx.tongue and into the oropharynx.

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