EXPECTED REFERENCE RANGES
Sodium: 136 to 145 mEq/L
Calcium: 9 to 10.5 mg/dL
Potassium: 3.5 to 5 mEq/L
Magnesium: 1.3 to 2.1 mEq/L
Chloride: 98 to 106 mEq/L
Phosphorus: 3 to 4.5 mg/dL
Procedures
Esophagogastroduodenoscopy (EGD)
Insertion of endoscope through the mouth into the esophagus, stomach, and
duodenum to identify or treat areas of bleeding, dilate an esophageal stricture,
and diagnose gastric lesions or celiac disease.
directly visualizes the mucosal lining of the stomach with a flexible endoscope.
Ulcers or tumors can be directly seen and biopsies obtained.
This is performed under moderate (conscious) sedation to detect the presence of
esophageal varices, ulcerations in the stomach, or duodenal ulcers and bleeding.
-Detects inflammation, ulcerations, tumors, varices, or Mallory-Weiss tears.
NURSING ACTIONS: Monitor vital signs until sedation wears off. Keep client NPO until
return of gag reflex.
Monitor for manifestations of perforation: pain, bleeding, fever. Verify gag response
has returned prior to providing oral fluids or food following the procedure.
ANESTHESIA: Moderate sedation per IV access:
Topical anesthetic to depress the gag reflex, atropine to decrease secretions
POSITIONING: Left side-lying with head of bed elevated
PREPARATION: NPO 6 to 8 hr. Remove dentures prior to procedure.
POSTPROCEDURE
● Monitor vital signs and respiratory status. Maintain an open airway until the client is
awake.
● Notify the provider of bleeding, abdominal or chest pain, and any evidence of
infection.
● Withhold fluids until return of gag reflex.
,● Discontinue IV fluid therapy when the client tolerates oral fluids without nausea and
vomiting.
● Instruct the client not to drive or use equipment for 12 to 18 hr after the procedure.
● Teach the client to use throat lozenges if a sore throat or hoarse voice persists
following the procedure.
Nursing care & assessment
Pre-procedure:
Left side lying with HOB elevated
Ensure consent form is signed
evaluate understanding of the procedure
NPO 6 to 8 hr prior to exam
Remove dentures
check for signed consent
assess v/s, allegories
check labs and hx for risk of complications
Give preoperative medication if ordered.
Explain to patient that local anesthesia may be sprayed on throat before insertion
of scope and that patient will be sedated during procedure
Post-procedure:
Keep patient NPO until gag reflex returns.
Gently tickle back of throat to determine reflex.
Use warm saline gargles for relief of sore throat.
Check temperature q15-30min for 1-2 hr (sudden temperature spike is sign of
perforation).
Check gag reflex before giving fluids to reduce risk of aspirations
Monitor for clinical manifestations of esophageal perforation (fever, pain,
dyspnea, bleeding)
No driving/equipment 12-15 hr after
Barium enema: - A barium enema is done by instilling a radiopaque liquid into the
rectum and colon. Air is infused after the barium flows through transverse colon. Used
to detect the presence of tumors, diverticula, and polyps.
, A small bowel barium enema can identify abnormal mucosal patterns
Helpful to distinguish ulcerative colitis from other disease processes
Barium is inserted into the rectum as a contrast medium for x-rays.
This allows for the rectum and large intestine to be visualized, and is used to
diagnose ulcerative colitis.
A barium enema can show the presence of diverticulosis and is contraindicated
in the presence of diverticulitis due to the risk of perforation.
NURSING ACTIONS: Monitor postprocedure for manifestations of bowel perforations
(rectal bleeding, firm abdomen, tachycardia, hypotension). Schedule before upper GI
series
Pre-procedure:
Administer laxatives and enemas until colon is clear of stool evening before
procedure.
Administer clear liquid diet evening before procedure.
Keep patient NPO for 8 hr before test and perform bowel preparation.
Teach patient about barium being given by enema.
Explain that cramping and urge to defecate may occur during procedure and
patient may be placed in various positions on tilt table.
Inform the client about medications, food and fluid restrictions (clear liquid and/or
low residue diet, NPO after midnight), avoid smoking or chewing gum ( increases
peristalsis).
Assess the client’s understanding of bowel preparation (laxatives, enemas) so
the image will not be distorted by feces
access for contraindications for bowel prep ( bowel obstruction, perforation,
inflammatory bowel disease)
There can be possible abdominal discomfort and cramping during the barium
enema..
Post-procedure
Give fluids, laxatives, or suppositories to assist in expelling barium.
Observe stool for passage of contrast medium.
Monitor for elimination of contrast
Stools will be white 24 -72 hrs until barium clears
Give laxative as ordered
, Report abdominal pain/fullness or delay in brown stool
FINDINGS
● Small intestine ulcerations and narrowing is consistent with Crohn’s disease.
● Ulcerations and inflammation of the sigmoid colon and rectum is significant for
ulcerative colitis.
Colonoscopy nursing care & assessment pre & post procedure (complications)
Use of a flexible fiber optic colonoscope, which enters through the anus, to visualize the
rectum and the sigmoid, descending, transverse, and ascending colon
A lighted, flexible scope inserted into the rectum to visualize the rectum and large
intestine.
Directly visualizes entire colon up to ileocecal valve with flexible fiberoptic scope.
Used to diagnose or detect inflammatory bowel disease, polyps, tumors, and
diverticulosis and dilate strictures. Procedure allows for biopsy and removal of
polyps
PREPARATION/ Before:
● Bowel preparation
● Preparation can include laxatives, such as bisacodyl and polyethylene glycol.
● Polyethylene glycol is not recommended for older adult clients because it can cause
fluid and electrolyte imbalances.
● Polyethylene glycol can inhibit the absorption of some medications. Review the
client’s medications and consult with the provider.
● Clear liquid diet (avoid red, purple, orange fluids). NPO after midnight.
● The client must avoid medications indicated by the provider (aspirin, anticoagulants,
antiplatelet).
Bowel preparation prior varies depending on HCP. For example, patient follows
either a low-residue or full liquid diet the day before until bowel cleansing begins.
Bowel cleansing follows a split-dose regimen.
The evening before the procedure the patient drinks 2 L of oral polyethylene
glycol (PEG) lavage solution.
The second 2 L dose begins 4-6 hr before procedure.
Explain to patient that a flexible scope will be inserted while patient in side-lying
position and sedation will be given.
POSTPROCEDURE/ After:
● Notify the provider of severe pain (possible perforation) or indication of hemorrhage.
Sodium: 136 to 145 mEq/L
Calcium: 9 to 10.5 mg/dL
Potassium: 3.5 to 5 mEq/L
Magnesium: 1.3 to 2.1 mEq/L
Chloride: 98 to 106 mEq/L
Phosphorus: 3 to 4.5 mg/dL
Procedures
Esophagogastroduodenoscopy (EGD)
Insertion of endoscope through the mouth into the esophagus, stomach, and
duodenum to identify or treat areas of bleeding, dilate an esophageal stricture,
and diagnose gastric lesions or celiac disease.
directly visualizes the mucosal lining of the stomach with a flexible endoscope.
Ulcers or tumors can be directly seen and biopsies obtained.
This is performed under moderate (conscious) sedation to detect the presence of
esophageal varices, ulcerations in the stomach, or duodenal ulcers and bleeding.
-Detects inflammation, ulcerations, tumors, varices, or Mallory-Weiss tears.
NURSING ACTIONS: Monitor vital signs until sedation wears off. Keep client NPO until
return of gag reflex.
Monitor for manifestations of perforation: pain, bleeding, fever. Verify gag response
has returned prior to providing oral fluids or food following the procedure.
ANESTHESIA: Moderate sedation per IV access:
Topical anesthetic to depress the gag reflex, atropine to decrease secretions
POSITIONING: Left side-lying with head of bed elevated
PREPARATION: NPO 6 to 8 hr. Remove dentures prior to procedure.
POSTPROCEDURE
● Monitor vital signs and respiratory status. Maintain an open airway until the client is
awake.
● Notify the provider of bleeding, abdominal or chest pain, and any evidence of
infection.
● Withhold fluids until return of gag reflex.
,● Discontinue IV fluid therapy when the client tolerates oral fluids without nausea and
vomiting.
● Instruct the client not to drive or use equipment for 12 to 18 hr after the procedure.
● Teach the client to use throat lozenges if a sore throat or hoarse voice persists
following the procedure.
Nursing care & assessment
Pre-procedure:
Left side lying with HOB elevated
Ensure consent form is signed
evaluate understanding of the procedure
NPO 6 to 8 hr prior to exam
Remove dentures
check for signed consent
assess v/s, allegories
check labs and hx for risk of complications
Give preoperative medication if ordered.
Explain to patient that local anesthesia may be sprayed on throat before insertion
of scope and that patient will be sedated during procedure
Post-procedure:
Keep patient NPO until gag reflex returns.
Gently tickle back of throat to determine reflex.
Use warm saline gargles for relief of sore throat.
Check temperature q15-30min for 1-2 hr (sudden temperature spike is sign of
perforation).
Check gag reflex before giving fluids to reduce risk of aspirations
Monitor for clinical manifestations of esophageal perforation (fever, pain,
dyspnea, bleeding)
No driving/equipment 12-15 hr after
Barium enema: - A barium enema is done by instilling a radiopaque liquid into the
rectum and colon. Air is infused after the barium flows through transverse colon. Used
to detect the presence of tumors, diverticula, and polyps.
, A small bowel barium enema can identify abnormal mucosal patterns
Helpful to distinguish ulcerative colitis from other disease processes
Barium is inserted into the rectum as a contrast medium for x-rays.
This allows for the rectum and large intestine to be visualized, and is used to
diagnose ulcerative colitis.
A barium enema can show the presence of diverticulosis and is contraindicated
in the presence of diverticulitis due to the risk of perforation.
NURSING ACTIONS: Monitor postprocedure for manifestations of bowel perforations
(rectal bleeding, firm abdomen, tachycardia, hypotension). Schedule before upper GI
series
Pre-procedure:
Administer laxatives and enemas until colon is clear of stool evening before
procedure.
Administer clear liquid diet evening before procedure.
Keep patient NPO for 8 hr before test and perform bowel preparation.
Teach patient about barium being given by enema.
Explain that cramping and urge to defecate may occur during procedure and
patient may be placed in various positions on tilt table.
Inform the client about medications, food and fluid restrictions (clear liquid and/or
low residue diet, NPO after midnight), avoid smoking or chewing gum ( increases
peristalsis).
Assess the client’s understanding of bowel preparation (laxatives, enemas) so
the image will not be distorted by feces
access for contraindications for bowel prep ( bowel obstruction, perforation,
inflammatory bowel disease)
There can be possible abdominal discomfort and cramping during the barium
enema..
Post-procedure
Give fluids, laxatives, or suppositories to assist in expelling barium.
Observe stool for passage of contrast medium.
Monitor for elimination of contrast
Stools will be white 24 -72 hrs until barium clears
Give laxative as ordered
, Report abdominal pain/fullness or delay in brown stool
FINDINGS
● Small intestine ulcerations and narrowing is consistent with Crohn’s disease.
● Ulcerations and inflammation of the sigmoid colon and rectum is significant for
ulcerative colitis.
Colonoscopy nursing care & assessment pre & post procedure (complications)
Use of a flexible fiber optic colonoscope, which enters through the anus, to visualize the
rectum and the sigmoid, descending, transverse, and ascending colon
A lighted, flexible scope inserted into the rectum to visualize the rectum and large
intestine.
Directly visualizes entire colon up to ileocecal valve with flexible fiberoptic scope.
Used to diagnose or detect inflammatory bowel disease, polyps, tumors, and
diverticulosis and dilate strictures. Procedure allows for biopsy and removal of
polyps
PREPARATION/ Before:
● Bowel preparation
● Preparation can include laxatives, such as bisacodyl and polyethylene glycol.
● Polyethylene glycol is not recommended for older adult clients because it can cause
fluid and electrolyte imbalances.
● Polyethylene glycol can inhibit the absorption of some medications. Review the
client’s medications and consult with the provider.
● Clear liquid diet (avoid red, purple, orange fluids). NPO after midnight.
● The client must avoid medications indicated by the provider (aspirin, anticoagulants,
antiplatelet).
Bowel preparation prior varies depending on HCP. For example, patient follows
either a low-residue or full liquid diet the day before until bowel cleansing begins.
Bowel cleansing follows a split-dose regimen.
The evening before the procedure the patient drinks 2 L of oral polyethylene
glycol (PEG) lavage solution.
The second 2 L dose begins 4-6 hr before procedure.
Explain to patient that a flexible scope will be inserted while patient in side-lying
position and sedation will be given.
POSTPROCEDURE/ After:
● Notify the provider of severe pain (possible perforation) or indication of hemorrhage.
