V Examination of the upper GI tract under

fluoroscopy after the client drinks barium

sulfate
V NPO after midnight the day of the test

V A laxative may be prescribed

V Instruct client to increase oral fluid intake

to help pass the barium

V Monitor stools for the passage of barium

(chalky white stools) because barium
can cause a bowel obstruction
V A fluoroscopic and radiographic
examination of the large intestine is
performed after rectal instillation of
barium sulfate
V A low-residue diet is given for 1 to 2 days
before the test

V A clear liquid diet and laxative are given

the evening before the test

V NPO after midnight the day of the test

V Cleansing enemas on the morning of the

test
V Instruct client to increase oral fluid intake
to help pass the barium

V Administer a mild laxative as prescribed

to facilitate emptying of the barium

V Monitor stools for the passage of barium

V Notify the physician if a bowel

movement does not occur within 2 days
V equires the passage of a nasogastric
tube into the stomach to aspirate gastric
contents for the analysis of acidity,
appearance, and volume; the entire
gastric contents are aspirated, and then
specimens are collected every 15
minutes for 1 hour
V °asting for 8 to 12 hours is required before
the test

V Tobacco and chewing gum are avoided 6

hours before the test

V Client may resume normal activities after

V efrigerate gastric samples if not tested

within 4 hours
V Also known as
esophagogastroduodenoscopy

V °ollowing sedation, an endoscope is

passed down the esophagus to view the
gastric wall, sphincters, and duodenum;
tissue specimens can be obtained
V The client must be NPO for 6 to 12 hours
before the test

V A local anesthetic (spray or gargle) is

administered along with medication that
provides conscious sedation and relieves
anxiety, such as IV midazolam (Versed),
just before the scope is inserted
V Atropine sulfate may be administered to
reduce secretions

V Client is positioned on the left side to

facilitate saliva drainage and to provide
easy access of the endoscope

V Airway patency is monitored during the

test and pulse oximetry is used to monitor
oxygen saturation
V Client must be NPO after the procedure
until gag reflex returns

V Monitor for pain, bleeding, unusual

difficulty swallowing, elevated
temperature

V Maintain bed rest for the sedated client

until alert
V equires the use of a rigid scope to
examine the anal canal

V Client is placed in the knee-chest or left

lateral position
V equire the use of a flexible scope to
examine the rectum and sigmoid colon

V The client is placed on the left side with

the right leg bent and placed anteriorly
V Enemas are given before the procedure
until the returns are clear

V Monitor for rectal bleeding and signs of

perforation and peritonitis
V The lining of the large intestine is visually
examined; biopsies can be performed

V Performed with the client lying on the left

side with the knees drawn up to the
chest; position may be changed during
the test to facilitate passing of the scope
V A clear liquid diet is started on the day
before the test

V Consult the physician regarding

medications that must be withheld
before the test

V Client is NPO after midnight on the day

of the test
V Midazolam (Versed) is administered
intravenously to provide sedation

V Provide bed rest until alert

V Monitor for signs of bowel perforation

and peritonitis

V Instruct the client to report any bleeding

V Examination of the hepatobiliary system
is performed via a flexible endoscope
inserted into the esophagus to the
descending duodenum

V Multiple positions are required during the

procedure to pass the endoscope
V Client is NPO for several hours before the
procedure

V Sedation is administered before the

procedure

V Monitor vital signs

V Monitor for the return of the gag reflex

V Transabdominal removal of fluid from the
peritoneal cavity for analysis
V Kave client void before the start of the
procedure to empty the bladder and to
move the bladder out of the way of the
paracentesis needle

V Measure abdominal girth, weight, and

baseline vital signs

V °owler·s position is used for the client

confined to bed
V Monitor vital signs

V Measure fluid collected, describe and

record

V Label fluid samples and send to the

laboratory for analysis

V Apply a dry sterile dressing to the

insertion site; monitor site for bleeding
V Measure abdominal girth and weight

V Monitor for hematuria

V Instruct the client to notify the physician if

the urine becomes bloody, pink, or red
V A needle is inserted through the
abdominal wall to the liver to obtain a
tissue sample for biopsy and microscopic
examination
V Assess results of coagulation tests

V Administer a sedative as prescribed

V Position client supine or left lateral to

expose the right side of the abdomen

V Assess vital signs

V Asses biopsy site for bleeding

V Monitor for peritonitis

V Maintain bed rest for several hours

V Place the client on the right side with a

pillow after the procedure

V Instruct the client to avoid coughing and

straining as well as heavy lifting for 1
week
V ãetects the presence of Kelicobacter
pylori, the bacteria that cause peptic
ulcer disease

V The client consumes a capsule of

carbon-labeled urea and provides a
breath sample10 to 20 minutes later
V Is the backflow of gastric and duodenal
contents into the esophagus

V The reflux is caused by an incompetent

lower esophageal sphincter, pyloric
stenosis, or motility disorder
V Pyrosis

V ãyspepsia

V egurgitation

V Pain and difficulty with swallowing

V Kypersalivation
V Instruct the client to avoid factors that
decrease lower esophageal sphincter
pressure or cause esophageal irritation

V Instruct the client to eat a low-fat, high fiber

diet

V Instruct client to avoid anticholinergics

V Instruct client to avoid caffeine, tobacco,

and carbonated beverages
V Instruct client to avoid eating and
drinking 2 hours before bed time, and
wearing tight clothes

V Elevate the head of the bed on a 6 to 8

inch blocks

V Instruct the client regarding prescribed

medications, such as antacids, K2-
receptor antagonists, or proton pump
inhibitors
V Inflammation of the stomach or gastric
mucosa

V Caused by ingestion of food

contaminated with disease causing
microorganisms or food that is too
irritating, or too highly seasoned, the
overuse of aspirin and NSAIãS, excessive
alcohol intake, smoking, or reflux
V Abdominal discomfort

V Anorexia, nausea,
and vomiting
acute
V Keadaches

V Kiccuping
V Anorexia, nausea,
and vomiting

V Belching

V Keartburn after eating chronic

V Sour taste in the mouth

V Vitamin B12 deficiency

V °ood and fluids may be withheld until
symptoms subside; afterward, ice chips
can be given followed by clear fluids,
and then solid food

V Monitor for signs of hemorrhagic gastritis

such as hematemesis, tachycardia and
hypotension
V Instruct client to avoid irritating foods,
fluids and other substances, such as
spicy and highly seasoned foods,
caffeine, alcohol, and nicotine
V Is an ulceration in the mucosal wall of
the stomach, pylorus duodenum, or
esophagus in portions accessible to
gastric secretions

V May be referred to as gastric, duodenal,

esophageal, depending on its location

V The most common are gastric and

duodenal ulcers
V Antral region and V Pyloric region
lesser curvature

V Peak age 50-60 V Peak age 30-45

years old years old

V Normal to V Increased acid

decreased acid secretion
secretion
V Melena
V Kematemesis
V K pylori (60-80%) V K pylori (100%)

V °ood-pain pattern V Pain-food-relief

pattern

V Weight loss is V No weight loss

common

V Gnawing sharp pain V Burning pain occurs

in or left of the in the midepigastric
midepigastric region area 1 ½ to 3 hours
30 ² 6o minutes after after a meal and
meal during the night
V Monitor vital signs and for signs of bleeding

V Administer small, frequent bland feedings

during the active phase

V Administer K2 antagonist as prescribed to

decrease the secretion of gastric acid

V Administer antacids as prescribed to

neutralize gastric seretions
V Administer anticholinergics as prescribed
to reduce gastric motility

V Administer mucosal barrier protectants

as prescribed 1 hour before each meal

V Inform client to avoid consuming alcohol

and substances that contain caffeine or
chocolate

V Avoid aspirin or NSAIãs

V Avoid smoking

V Obtain adequate rest and reduce stress

V Total Gastrectomy ² removal of the
stomach with attachment of the
esophagus to the jejunum or duodenum

V V llroth 1 ² partial gastrectomy, with the

remaining segment anastomosed to the
duodenum
V V llroth 2 ² Partial gastrectomy with the
remaining segment anastomosed to the
jejunum

V uyloroplasty ² enlargement of the

pylorus to prevent or decrease pyloric
obstruction, thereby enhancing gastric
emptying
V Monitor vital signs

V Place in a °owler·s position for comfort

and to promote drainage

V Monitor intake and output

V Administer fluids and electrolytes as

prescribed
V Assess bowel sounds

V Monitor nasogastric suction as

prescribed

V ão not irrigate or remove the nasogastric

tube; assist physivian in irrigation and
removal

V Maintain NPO status as prescribed for 1

to 3 days until peristalsis occurs
V Progress the diet from NPO to sips of
clear water to six small bland meals a
day, as prescribed when bowel sounds
return

V Monitor for postoperative complications

of hemorrhage, dumping syndrome,
diarrhea, hypoglycemia, and vitamin
B12 deficiency
V The rapid emptying of the gastric
contents into the small intestine that
occurs following gastric resection

V Symptoms occurring 30 minutes after

eating

V Nausea and vomiting

V °eelings of abdominal fullness and
abdominal cramping

V ãiarrhea

V Palpitations and tachycardia

V Perspiration

V Weakness and dizziness

V Borborygmi
V Eat a high-protein, low carbohydrate
diet

V Eat small meals and avoid consuming

fluids with meals

V Lie down after meals

V Take antispasmodic as prescribed to

delay gastric emptying
V An inflammatory disease that can occur
at anywhere in the GI tract but most
often affects the terminal ileum and
leads to thickening and scarring, a
narrowed lumen, ulcerations, and
abscesses

V Characterized by remissions and

exacerbations
V °ever

V Cramp-like and colicky pain after meals

V ãiarrhea, which may contain pus and

mucus

V Abdominal distention

V Anorexia, nausea, and vomiting

V Weight loss

V Anemia

V ãehydration

V Electrolyte imbalances
V estrict client's activity to reduce
intestinal activity

V Monitor bowel sounds and for

abdominal tenderness and cramping

V Monitor stools, noting color, consistency

and the presence of blood
V Instruct client to avoid gas-forming
foods, milk products, nuts, raw fruits and
vegetables, pepper, alcohol, and
caffeine containing products

V Instruct the client to avoid smoking

V Inflammation of the gallbladder that
may occur as an acute or chronic
process

V Acute inflammation is associated with

cholelithiasis

V Chronic cholecytitis results when

inefficient bile emptying and gallbladder
muscle wall disease cause fibrotic and
contracted gallbladder
V Acalculous cholecystitis occurs in the
absence of gallstones and is caused by
bacterial invasion via the lymphatic or
vascular system
V Nausea and vomiting

V Inidgestion

V Belching

V °latulence

V Epigastric pain that radiates to the scapula

2 to 4 hours after eating fatty foods and
may persist for 4 to 6 hours
V Pain localized in the right upper
quadrant

V Guarding, rigidity, and rebound

tenderness

V Mass palpated in the right upper

quadrant

V Murphy·s sign
V Elevated temperature

V Tachycardia

V Signs of dehydration

V [

V

V


V Maintain NPO status during nausea and
vomiting episodes

V Maintain nasogastric decompression as

prescribed for severe vomiting

V Administer antiemetics as prescribed

V Administer analgesics as prescribed

(morph e sulfate a coe e sulfate are
avo e
V Administer antispasmodics as prescribed
to relax smooth muscles

V Instruct the client with chronic

cholecystitis to eat small, low-fat meals

V Instruct the client to avoid gas forming

foods

V Prepare the client for surgical

interventions
V ëholecystectomy ² is the removal of the
gallbladder

V ëholeochol thotomy ² requires incision

into the common bile duct to remove
the stone

V Surgical procedures may be performed

by laparoscopy
V Monitor for respiratory complications
caused by pain at the incisional site

V Encourage coughing and deep breathing

V Encourage early ambulation

V Instruct the client about splinting the

abdomen to prevent discomfort during
coughing
V Administer antiemetics as prescribed for
nausea and vomiting

V Administer analgesics as prescribed for

pain relief

V Maintain NPO status and nasogastric

tube suction as prescribed

V Advance diet from clear liquids to solids

when prescribed as tolerated by the
client
V Maintain and monitor drainage from the
T tube, if present
V A T tube is placed after surgical
exploration of the common bile duct
The tube preserves patency of the duct
and ensures drainage of bile until
edema resolves and bile is effectively
draining into the duodenum]

V A gravity drainage bag is attached to

the t tube to collect the drainage
V Position the client in a semi-°owler·s
position to facilitate drainage

V Monitor the amount, color, consistency,

and odor of the drainage

V eport sudden increases in bile output to

the physician

V Monitor for inflammation and protect the

skin from irritation
V reep the drainage system below the
level of the gallbladder

V Monitor for foul odor and purulent

drainage and report its presence to the
physician

V Avoid irrigation, aspiration, or clamping

of the T tube without a physician·s order
V Inflammation of the pancreas appears
to be caused by a process called
autodigestion

V Commonly associated with excessive

alcohol consupmtion
V Abdominal pain (midepigastric or left
upper quadrant) with radiation to the
back

V Pain aggravated by a fatty meal or

alcohol

V Abdominal tenderness and guarding

V Nausea and vomiting

V Weight loss

V Cullen·s signs

V Turner·s sign

V Absent or decreased bowel sounds

V Elevated WBC, glucose, and bilirubin

V Elevated serum lipase and amylase

levels
V Maintain NPO status and maintain
hydration with IV fluids as prescribed

V Administer parenteral nutrition for severe

nutritional depletion

V Administer supplemental preparations

and vitamins and minerals to increase
caloric intake if prescribed
V Maintain nasogastric tube to decrease
gastric distention and suppress
pancreatic secretion

V Administer meperidine hydrochloride as

prescribed for pain

V Administer antacids as prescribed

V Administer K2 receptor antagonists as

prescribed
V Administer anticholinergics as prescribed

V Instruct the client in the importance of

avoiding alcohol

V Instruct the client in the importance of

follow-up visits with the physician

V Instruct the client to notify the physician if

acute abdominal pain, jaundice, clay-
colored stools, or dark colored urine
develops
V Continual inflammation and destruction
of the pancreas, with scar tissue
replacing pancreatic tissue

V The acinar, or enzyme-producing cells of

the pancreas ulcerate in response to
inflammation
V Abdominal pain and tenderness

V Left upper quadrant mass

V Steatorrhea and foul-smelling stools that

may increase in volume

V Weight loss

V Muscle wasting

V Jaundice
V Instruct client to limit fat and protein
intake

V Instruct the client to avoid heavy meals

V Instruct the client about the importance

of avoiding alcohol

V Provide supplemental preparations

V Administer pancreatic enzymes as
prescribed

V Administer insulin and oral hypoglycemic

agents as prescribed

V Instruct the client in the importance of

follow-up visits
V Also known as gluten enteropathy or
celiac sprue

V Intolerance to gluten, the protein

component of wheat, barley, rye, and
oats

V esults in the accumulation of the amino

acid glutamine, which is toxic to
intestinal mucosal cells
V Intestinal villi atrophy occurs, which
affects absorption of ingested nutrients
V Acute or insidious diarrhea

V Steatorrhea

V Anorexia

V Abdominal pain

V Muscle wasting
V Vomiting

V Anemia

V Irritability
V Maintain a gluten-free diet, substituting
corn and rice as grain sources

V Instruct parents and child about lifelong

elimination of gluten sources such as
wheat, rye, oats, and barley

V Administer mineral and vitamin

supplements
V Teach client about a gluten-free diet
and about reading food labels carefully
for hidden sources of gluten
V eact with gastric acid to produce
neutral salts or salts of low acidity

V Inactivate pepsin and enhance mucosal

protection but do not coat the ulcer
crater

V Taken 1 t0 3 hours after each meal

V Should be chewed thoroughly and
followed with a glass of milk or water

V Aluminum hydroxide preprations

V Calcium carbonate (Tums)

V Magnesium hydroxide preparations

V Sodium bicarbonate
V Misoprostol (Cytotec)
  Suppresses secretion of gastric acid
  Promotes secretion of bicarbonate and
cytoprotective mucus

V Sucralfate (Carafate)
  Creates a protective barrier against acid
and pepsin
V Cimetidine (Tagamet)
  °ood reduces rate of absorption

V anitidine (Zantac)
  Not affected by food

V °amotidine (Pepcid)
  Not affected by food
V Suppress gastric acid secretion

V Keadache, diarrhea, abdominal pain,

and nausea

V Esomperazole (Nexium), Lansoprazole

(Prevacid), Omeprazole (Prilosec)
V To control vomiting and motion sickness

V Monitor for drowsiness and protect the

client from injury

V Ondansetron (Zofran), Metoclopramide

(eglan), Promethazine hydrochoride
(Phenergan)