Class notes
Nur 203 Med-surg Gastrointestinal Lecture Notes
- Course
- NUR 203
- Institution
- Nassau Community College
This is a comprehensive and detailed note on Med-surg Gastrointestinal for Nur 203. *An Essential Study Resource!!
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GastrointestinalGI Lab Values
Blood Test Value Interpretation
Aspartate aminotransferase (AST) 0-35 U/L Elevated in hepatitis or cirrhosis
Alanine aminotransferase (ALT) 4-36 U/L
Alkaline Phosphate (ALP) 30-120 U/L Elevation indicates liver damage
Amylase 30-120 U/L Elevated in pancreatitis
Lipase 0-160 U/L
Total Bilirubin 0.3-1 mg/dL Elevations indicate altered liver function, bile duct
Direct (conjugated) bilirubin 0.1-0.3 mg/dL obstruction, other hepatobiliary disease
Indirect (unconjugated) bilirubin 0.2-0.8 mg/dL
Albumin 3.5-5 g/dL DECREASE indicates hepatic disease (also indicator of
malnutrition)
Alpha-fetoprotein < 40 mcg/L Elevated in cirrhosis, liver cancer, hepatitis
Ammonia 10-80 mcg/dL Elevated in liver disease
Diagnostic Procedures
Fecal Occult blood
Obtain Guaiac cards, usually need 3 samples
Medication restrictions: NO anticoagulants and NSAIDs 7 days before testing
Diet restrictions: NO Vitamin C, red meat, chicken or fish
+ Test results: indicate GI bleed (ulcer, colitis, cancer)
Dark red blood: (tarry) Indicate bleed higher in GI tract
Bright Red blood: bleeding is acute and usually from the colon
, Gastrointestinal
Diagnostic Procedures
Endoscope (image)
Procedure Sedation Position Prep Postprocedure
Colonoscopy: Used to Moderate Left side with knees Bowl prep: laxatives, ● Monitor for rectal
visualize the colon to chest liquid prep to clean out bleeding
through anus colon. Clear liquid diet ● Encourage plenty of
NPO after midnight. fluids
Sigmoidoscopy: None Left side Stop NSAIDs, Coumadin, ● Monitor vitals and resp
Visualize only the anus, ASA (bleeding) ● Increased flatulence due
rectum, sigmoid colon to air instillation during
procedure
● Do not drive 12-18 hrs
after
Esophagogastro- Moderate & Left side laying NPO 6-8 hrs before ● Monitor vitals & resp
duodenoscopy (EGD): Topical anesthetic to Removal of dentures ● Notify MD of bleeding,
Visualization of mouth, depress gag reflux, abdominal or chest pain
esophagus, stomach and Atropine to decrease ● Withhold fluids till return of
duodenum through the secretions gag reflux
mouth (anticholinergic) ● Do not drive 12-18 hrs after
Endoscopic retrograde Conscious Semi-prone, with NPO 6-8 hrs ● Same as EGD
chol. (ERCP): through Topical anesthetic repositioning Remove dentures
mouth into biliary tree throughout Informed consent
via duodenum. To procedure Verify driver present for
visualize gall bladder transport.
and bile ducts
Complications: over sedation, hemorrhage, aspiration, and perforation of GI tract
Barium swallow/ Gastrografin: Allow clear view of esophagus. Can diagnose swallowing difficulty from CVA. Gastrografin is used in
pts. at risk for GI bleed or who may need surgery. NPO after midnight, stool will be light in color until barium is expelled, increase fluids.
Bowel prep for better visualization. Do not do in an acute GI disruption. Drink plenty fluid and stool softener to � excretion.
Bernstein Test: acid perfusion test to diagnose reflux. NPO for 8 hrs and all antacids are held. NG tube is inserted and mild HCL is
instilled if patient experiences pain test is + for reflux.
, Gastrointestinal
GI Series: can be done with or w/o contrast to visualize anatomical and functional abnormalities. Used to diagnosis: gastric ulcers,
tumors, varices, and intestinal enlargements. Bowl prep, NPO after midnight, increase fluids to flush contrast out, stools will be white for
24-72 hrs after until barium is flushed from body.
GI Therapeutic Procedures
Procedure Indication Interventions Complications
Enteral feeding Pt. cannot take in oral ● Check residual, hold for ● Overfeeding
nutrition, malnutrition residual >100mL ● Diarrhea
● Keep the pt. in semi-fowlers ● Aspiration pneumonia
● Check for placement ● Refeeding syndrome-
● Monitor for aspiration life threatening! (body has
begun to catabolize protein &
fats should not receive enteral
feedings)
TPN/PPN: IV feeding complete Any situation the affects ● Lab values, TPN is customized ● Metabolic complications
or partial nutrition. Usually the ability to absorb based on electrolytes ● Air embolism
administered through a central feeding through GI, cancer ● Maintain sterility for central lines ● Infection, high concentration
line. TPN hypertonic D10-50, pts, weight loss >10% of ● Change bag and tubing Q24h of Dextrose increased risk for
PPN usually D10 body weight ● Must using tubing with filter infection through growth.
● Monitor glucose levels ● Fluid imbalances
Paracentesis: insertion of a Abdominal ascites: ● Informed consent ● Hypovolemia
needle through the abdominal accumulation of protein ● Have pt. void prior to ● Bladder perforation
wall to relieve fluid rich fluid in the abdomen procedure ● Peritonitis
accumulation (ascites) usually due to cirrhosis of ● High fowlers
the liver ● Review baseline weight and
vitals
● Usually 4-6L is drained by
gravity
● Monitor I&O
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