1. Describe the procedure and differentiate between the nursing care, assessment pre & post procedure and complications for the
following diagnostic exams.
Explanation of Nursing Care & Assessment Nursing Care & Assessment Complications
Procedure Pre- Procedure Post- Procedure
EGD ● Pt is NPO 6-8 hours ● monitor vital signs and respiratory status Perforation
Insertion of endoscope prior ● withhold fluid and food until gag reflex Hemorrhage
through the mouth into ● Remove dentures prior returns (NPO)
the esophagus, stomach, ● left side lying with ● Use warm saline gargles for sore throat
and duodenum to identify head of bed elevated ● Check temperature q15-30mmin for 1-
or treat areas of bleeding, ● Ensure consent is 2hr (sudden temperature spike is sign of
dilate esophageal given perforation)
stricture, and diagnose ● Give Pre-Op ● instruct client to not drive or use heavy
gastric lesions or celiac medication equipment for 12-18 hours postop
disease. ● Client education about
local anesthetic
Barium Enema Give laxative and monitor stool after procedure Abdominal
To observe (using enemas until colon is give fluids, laxatives, or suppositories to cramping
fluoroscopy) the colon clear of stool evening help in expelling barium. Discomfort
filling with contrast before procedure Observe stool for passage of medium
medium and to observe Follow clear liquids contrast
(by Xray) the filled colon. diet before procedure. Tell patient that stool may be white for
Helps identify polyps, NPO 8hrs before test up to 72hrs
tumors, and other lesions Client education
in the colon. Have pt. retain enema
Not suitable for older
or immobile patient
Colonoscopy Bowel perforation observe for perforation severe pain
Directly visualizes entire varies per doctor Educate patient about pain possible
colon up to ileocecal Patient should avoid Check vitals perforation
valve with flexible fiber for up to 72 hr. hemorrhage
fiberoptic scope. Patient’s prior rectal
position is changed Clear liquid diet 24hr bleeding
frequently during prior abdominal
procedure to assist with Bowel cleansing cramps
advancement of scope to should follow a split
cecum. Used to diagnose dose regimen.
or detect inflammatory Evening before
bowel disease, polyps, procedure -drink
tumors, diverticulosis, cleansing solution
and dilate stricture. Drink the whole
Procedure allows for solution
biopsy of polyps without Stools will be clear or
laparotomy clear yellow liquid
Patient education
Billroth I & II Preoperative management Monitor labs, Vital
Billroth I: focuses on correcting
gastroduodenostomy- nutritional deficits and treating
partial gastrectomy with anemia. Transfusions of
the removal of the distal packed RBCs correct the
2/3 of the stomach and anemia. If gastric outlet
anastomosis of the gastric obstruction occurs, gastric
stump to duedomen decompression may be needed
Billroth II: remove the before surgery.
whole duodenum and part
of the stomach and attach
to the jejunum
, 2. Hiatal Hernia -Describe the etiology, assessment findings, diagnostics & labs, nursing interventions, nutrition, medicatio
& client teaching. Understand the difference between sliding & rolling hernias. Which hernia is a medical emergency an
why
Disorder Name: Hiatal Description: protrusion of the stomach (in part or total) above the diaphragm into the thoracic cavity
Hernia through the hiatus.
Two Types:
Sliding (more common) Portion of the stomach and gastroesophageal junction move above the
diaphragm. This generally occurs with increases in intra-abdominal pressure or while the client is
in a supine position
Paraoesophageal (rolling – can be emergency) Part of the fundus of the stomach moves above the
diaphragm, although the gastroesophageal junction remains below the diaphragm.
Risk Factor
Assessment/ Signs/ Asymptomatic or resemble GERD
Symptoms Sliding – heartburn, reflux, chest pain, dysphagia, belching
Rolling – fullness after eating, sense of breathlessness/suffocation, chest pain, worsening
manifestations when reclining
Pharyngitis
Inspiratory/expiratory wheeze
Complications Strangulation
Volvulus
Obstruction
Iron-deficiency anemia
GERD
Esophagitis
Hemorrhage
Ulcerations
Diagnostic Tests/ Labs Barium Swallow
EGD
CT scan of the chest with contrast
Medications Proton pump inhibitors
Antacids
Therapeutic Procedures Fundoplication
Laparoscopic Nissen fundoplication
Nursing Interventions Collect history
Physical exam
Medication administration
Assess for allergies to medication
Monitor bowel sounds after therapeutic procedures
Assess for gag reflex after EGD
Monitor manifestations of esophageal perforation
Client Education/ nutrition (no alcohol/caffeine/acidic foods)
Management/Preventio avoid eating or drinking 2 hours before bed
n avoid tight fitting clothes
weight loss
HOB elevated 6-8 inches
Medications
Surgery
Endoscopic therapy
, 3. Describe dumping syndrome and the client teaching regarding this condition.
Disorder Name: Description: direct result of surgical removal of a large part of the stomach and pyloric sphincter.
Dumping Syndrome Normally, gastric chyme enters the small intestine in small amounts. After surgery, the stomach no longer
has control over the amount of gastric chyme entering the small intestine. Therefore a large bolus of
hypertonic fluid enters the intestine and causes fluid to be drawn into the bowel lumen. This creates a
decrease in plasma volume, distention of the bowel lumen, and rapid intestinal transit.
Risk Factor
Assessment/ Signs/ Symptoms begin within 15- 30minutes after eating
Symptoms Generalized weakness
Sweating
Palpitations
Dizziness
Abdominal cramps
Borborygmi
Urge to defecate
Manifestations usually last less than 1 hour after eating.
Complications
Diagnostic Tests/ Labs
Medications
Therapeutic Procedures
Nursing Interventions
Client Education/ A short rest period after each meal reduces the chance of dumping syndrome
Management/Preventio Adequate rest
n Smoking cessation
Long-term follow-up care
Avoid alcohol use
following diagnostic exams.
Explanation of Nursing Care & Assessment Nursing Care & Assessment Complications
Procedure Pre- Procedure Post- Procedure
EGD ● Pt is NPO 6-8 hours ● monitor vital signs and respiratory status Perforation
Insertion of endoscope prior ● withhold fluid and food until gag reflex Hemorrhage
through the mouth into ● Remove dentures prior returns (NPO)
the esophagus, stomach, ● left side lying with ● Use warm saline gargles for sore throat
and duodenum to identify head of bed elevated ● Check temperature q15-30mmin for 1-
or treat areas of bleeding, ● Ensure consent is 2hr (sudden temperature spike is sign of
dilate esophageal given perforation)
stricture, and diagnose ● Give Pre-Op ● instruct client to not drive or use heavy
gastric lesions or celiac medication equipment for 12-18 hours postop
disease. ● Client education about
local anesthetic
Barium Enema Give laxative and monitor stool after procedure Abdominal
To observe (using enemas until colon is give fluids, laxatives, or suppositories to cramping
fluoroscopy) the colon clear of stool evening help in expelling barium. Discomfort
filling with contrast before procedure Observe stool for passage of medium
medium and to observe Follow clear liquids contrast
(by Xray) the filled colon. diet before procedure. Tell patient that stool may be white for
Helps identify polyps, NPO 8hrs before test up to 72hrs
tumors, and other lesions Client education
in the colon. Have pt. retain enema
Not suitable for older
or immobile patient
Colonoscopy Bowel perforation observe for perforation severe pain
Directly visualizes entire varies per doctor Educate patient about pain possible
colon up to ileocecal Patient should avoid Check vitals perforation
valve with flexible fiber for up to 72 hr. hemorrhage
fiberoptic scope. Patient’s prior rectal
position is changed Clear liquid diet 24hr bleeding
frequently during prior abdominal
procedure to assist with Bowel cleansing cramps
advancement of scope to should follow a split
cecum. Used to diagnose dose regimen.
or detect inflammatory Evening before
bowel disease, polyps, procedure -drink
tumors, diverticulosis, cleansing solution
and dilate stricture. Drink the whole
Procedure allows for solution
biopsy of polyps without Stools will be clear or
laparotomy clear yellow liquid
Patient education
Billroth I & II Preoperative management Monitor labs, Vital
Billroth I: focuses on correcting
gastroduodenostomy- nutritional deficits and treating
partial gastrectomy with anemia. Transfusions of
the removal of the distal packed RBCs correct the
2/3 of the stomach and anemia. If gastric outlet
anastomosis of the gastric obstruction occurs, gastric
stump to duedomen decompression may be needed
Billroth II: remove the before surgery.
whole duodenum and part
of the stomach and attach
to the jejunum
, 2. Hiatal Hernia -Describe the etiology, assessment findings, diagnostics & labs, nursing interventions, nutrition, medicatio
& client teaching. Understand the difference between sliding & rolling hernias. Which hernia is a medical emergency an
why
Disorder Name: Hiatal Description: protrusion of the stomach (in part or total) above the diaphragm into the thoracic cavity
Hernia through the hiatus.
Two Types:
Sliding (more common) Portion of the stomach and gastroesophageal junction move above the
diaphragm. This generally occurs with increases in intra-abdominal pressure or while the client is
in a supine position
Paraoesophageal (rolling – can be emergency) Part of the fundus of the stomach moves above the
diaphragm, although the gastroesophageal junction remains below the diaphragm.
Risk Factor
Assessment/ Signs/ Asymptomatic or resemble GERD
Symptoms Sliding – heartburn, reflux, chest pain, dysphagia, belching
Rolling – fullness after eating, sense of breathlessness/suffocation, chest pain, worsening
manifestations when reclining
Pharyngitis
Inspiratory/expiratory wheeze
Complications Strangulation
Volvulus
Obstruction
Iron-deficiency anemia
GERD
Esophagitis
Hemorrhage
Ulcerations
Diagnostic Tests/ Labs Barium Swallow
EGD
CT scan of the chest with contrast
Medications Proton pump inhibitors
Antacids
Therapeutic Procedures Fundoplication
Laparoscopic Nissen fundoplication
Nursing Interventions Collect history
Physical exam
Medication administration
Assess for allergies to medication
Monitor bowel sounds after therapeutic procedures
Assess for gag reflex after EGD
Monitor manifestations of esophageal perforation
Client Education/ nutrition (no alcohol/caffeine/acidic foods)
Management/Preventio avoid eating or drinking 2 hours before bed
n avoid tight fitting clothes
weight loss
HOB elevated 6-8 inches
Medications
Surgery
Endoscopic therapy
, 3. Describe dumping syndrome and the client teaching regarding this condition.
Disorder Name: Description: direct result of surgical removal of a large part of the stomach and pyloric sphincter.
Dumping Syndrome Normally, gastric chyme enters the small intestine in small amounts. After surgery, the stomach no longer
has control over the amount of gastric chyme entering the small intestine. Therefore a large bolus of
hypertonic fluid enters the intestine and causes fluid to be drawn into the bowel lumen. This creates a
decrease in plasma volume, distention of the bowel lumen, and rapid intestinal transit.
Risk Factor
Assessment/ Signs/ Symptoms begin within 15- 30minutes after eating
Symptoms Generalized weakness
Sweating
Palpitations
Dizziness
Abdominal cramps
Borborygmi
Urge to defecate
Manifestations usually last less than 1 hour after eating.
Complications
Diagnostic Tests/ Labs
Medications
Therapeutic Procedures
Nursing Interventions
Client Education/ A short rest period after each meal reduces the chance of dumping syndrome
Management/Preventio Adequate rest
n Smoking cessation
Long-term follow-up care
Avoid alcohol use
