1
Med Surg Exam 2
Small Intestine
➢ Absorption of nutrients
➢ Folic acid
➢ Cobalamin
➢ Iron
➢ Fat-soluble vitamins
➢ Hormones and neurotransmitters
➢ Absorption of fat, carbohydrates, and proteins
Abdominal Quadrants
➢ Right upper
o Pylorous
o Duodenum
o Gallbladder
o Liver
➢ Left upper
o Stomach
o Spleen
➢ Right lower
o Cecum
o Appendix
➢ Left lower
o Sigmoid colon
➢ Midline
o Urinary bladder
o Uterus
GI Focused Assessment Health History
➢ Current GI Symptoms
➢ Previous GI Problems
➢ Family History of GI Problems
➢ Medication Use: prescription and OTC
➢ Diet and Nutrition (Food Allergies)
➢ Use of Alcohol, street drugs, Caffeine
➢ Bowel Elimination Pattern
➢ Social/Cultural Factors
GI Focused Assessment Physical
➢ Vital Signs
➢ Height and Weight
➢ Lab and diagnostic test results
, 2
➢ Emesis, amount, color, consistency
➢ Stool, amount, color, consistency, odor.
➢ Oral Assessment
➢ Abdominal Assessment
➢ Rectal Assessment
Factors affecting bowel elimination
➢ Age
➢ Diet
➢ Fluids
➢ Physical activity
➢ Personal habits
➢ Pain
➢ Pregnancy
➢ Surgery & anesthesia
➢ Medications
Effects of Aging
➢ Mouth
o Teeth loosen, reduced circulation to gums, teeth darken and
fracture
o Decreased output of salivary glands
o Decreased stimulation of taste buds
➢ Stomach
o Atrophy of gastric mucosa
o Decreased secretion of hydrochloric acid
o Decreased bile secretion
➢ Decreased muscle tone and strength
Diagnostic Tests
➢ Lab tests
o
➢ Bowel preparations
o
➢ Colonoscopy
o Provides direct visualization of the rectum, colon, entire
large intestine, and distal small bowel. A flexible scope is
inserted through the rectum and advanced to the cecum.
o Useful in detecting lower GI disease.
o Positioning: LT side with knees to chest
o Anesthesia: Moderate sedation (Midazolam, fentanyl, and/or
propofol)
o Prep
, 3
▪ Bowel Prep (laxatives, such as bisacodyl and polyethyline
glycol)
▪ Clear liquid diet, NPO after midnight
▪ Patient must avoid medications such as aspirin,
anticoagulants, and antiplatelets.
o Post
▪ Monitor for rectal bleeding
▪ Do not drive or use equipment for 12-18 hrs after
➢ Laparoscopy
o The peritoneal cavity, pelvis, and abdomen are examined. This
test is used to detect cysts, adhesions, fibroids, infections of the
uterus, fallopian tubes, and ovaries, ectopic pregnancies, liver
lacerations, and cirrhosis.
➢ Esophagogastoduodenoscopy
o 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.
o Position: LT side laying with head of bed elevated
o Anesthesia: Moderate sedation per IV access. Topical anesthetic
to depress gag reflex, atropine to decrease secretions.
o Prep: NPO 6-8 hrs.
o Post: Withhold fluids until return of gag reflex
➢ Proctosigmoidoscopy
o Digital examination to dilate the anal sphincters to detect
obstruction that might hinder passage of the endoscope,
a sigmoidoscope to examine the distal sigmoid colon and
rectum, and a proctoscope to examine the lower rectum and
anal canal. The proctosigmoidoscopy is used to identify
internal hemorrhoids, hypertrophic anal papillae, polyps,
fissures, fistulae, and rectal and anal abscesses.
➢ Paracentesis
o The aspiration of fluid from the abdominal cavity.
Nutrition Support
➢ Daily weights
➢ Gastrostomy feedings
o Patients require 25–30 kcal/kg/day and 30 mL free water/kg/day.
o If the feeding tube will be used for less than 30 days, select a
nasogastric tube in the range of 8-Fr to 18-Fr. A larger bore
nasogastric tube allows for suction if needed. Smaller tubes, 8-Fr
to 12-Fr, are used for intestinal feeding (duodenal and jejunal).
➢ Parenteral nutrition
o Providing nutrients to patients in an intravenous (IV) solution.
Med Surg Exam 2
Small Intestine
➢ Absorption of nutrients
➢ Folic acid
➢ Cobalamin
➢ Iron
➢ Fat-soluble vitamins
➢ Hormones and neurotransmitters
➢ Absorption of fat, carbohydrates, and proteins
Abdominal Quadrants
➢ Right upper
o Pylorous
o Duodenum
o Gallbladder
o Liver
➢ Left upper
o Stomach
o Spleen
➢ Right lower
o Cecum
o Appendix
➢ Left lower
o Sigmoid colon
➢ Midline
o Urinary bladder
o Uterus
GI Focused Assessment Health History
➢ Current GI Symptoms
➢ Previous GI Problems
➢ Family History of GI Problems
➢ Medication Use: prescription and OTC
➢ Diet and Nutrition (Food Allergies)
➢ Use of Alcohol, street drugs, Caffeine
➢ Bowel Elimination Pattern
➢ Social/Cultural Factors
GI Focused Assessment Physical
➢ Vital Signs
➢ Height and Weight
➢ Lab and diagnostic test results
, 2
➢ Emesis, amount, color, consistency
➢ Stool, amount, color, consistency, odor.
➢ Oral Assessment
➢ Abdominal Assessment
➢ Rectal Assessment
Factors affecting bowel elimination
➢ Age
➢ Diet
➢ Fluids
➢ Physical activity
➢ Personal habits
➢ Pain
➢ Pregnancy
➢ Surgery & anesthesia
➢ Medications
Effects of Aging
➢ Mouth
o Teeth loosen, reduced circulation to gums, teeth darken and
fracture
o Decreased output of salivary glands
o Decreased stimulation of taste buds
➢ Stomach
o Atrophy of gastric mucosa
o Decreased secretion of hydrochloric acid
o Decreased bile secretion
➢ Decreased muscle tone and strength
Diagnostic Tests
➢ Lab tests
o
➢ Bowel preparations
o
➢ Colonoscopy
o Provides direct visualization of the rectum, colon, entire
large intestine, and distal small bowel. A flexible scope is
inserted through the rectum and advanced to the cecum.
o Useful in detecting lower GI disease.
o Positioning: LT side with knees to chest
o Anesthesia: Moderate sedation (Midazolam, fentanyl, and/or
propofol)
o Prep
, 3
▪ Bowel Prep (laxatives, such as bisacodyl and polyethyline
glycol)
▪ Clear liquid diet, NPO after midnight
▪ Patient must avoid medications such as aspirin,
anticoagulants, and antiplatelets.
o Post
▪ Monitor for rectal bleeding
▪ Do not drive or use equipment for 12-18 hrs after
➢ Laparoscopy
o The peritoneal cavity, pelvis, and abdomen are examined. This
test is used to detect cysts, adhesions, fibroids, infections of the
uterus, fallopian tubes, and ovaries, ectopic pregnancies, liver
lacerations, and cirrhosis.
➢ Esophagogastoduodenoscopy
o 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.
o Position: LT side laying with head of bed elevated
o Anesthesia: Moderate sedation per IV access. Topical anesthetic
to depress gag reflex, atropine to decrease secretions.
o Prep: NPO 6-8 hrs.
o Post: Withhold fluids until return of gag reflex
➢ Proctosigmoidoscopy
o Digital examination to dilate the anal sphincters to detect
obstruction that might hinder passage of the endoscope,
a sigmoidoscope to examine the distal sigmoid colon and
rectum, and a proctoscope to examine the lower rectum and
anal canal. The proctosigmoidoscopy is used to identify
internal hemorrhoids, hypertrophic anal papillae, polyps,
fissures, fistulae, and rectal and anal abscesses.
➢ Paracentesis
o The aspiration of fluid from the abdominal cavity.
Nutrition Support
➢ Daily weights
➢ Gastrostomy feedings
o Patients require 25–30 kcal/kg/day and 30 mL free water/kg/day.
o If the feeding tube will be used for less than 30 days, select a
nasogastric tube in the range of 8-Fr to 18-Fr. A larger bore
nasogastric tube allows for suction if needed. Smaller tubes, 8-Fr
to 12-Fr, are used for intestinal feeding (duodenal and jejunal).
➢ Parenteral nutrition
o Providing nutrients to patients in an intravenous (IV) solution.
