Gastro.txt

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Anonymous
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13065
Filename:
Gastro.txt
Updated:
2010-04-04 16:20:19
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Gastro
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Gastro
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  1. Upper GI Tract Study
    • examination of the upper gGI tract under fluroscopy
    • after pt drinks barium sulfate

    PRE PROCEDURE: NPO after Midnight

    POST PROCEDURE: Laxative may be given

    *Monitor stools for passage of Barium
  2. Cholecystography
    • Detect gallstones
    • assess ability of gallbladder to:
    • fill
    • concentrate
    • contract
    • empty

    • PRE PROCEDURE: Assess for allergies to Fish or Iodine
    • contrast given 10-12 Hours prior to test
    • NPO after contrast given

    • POST PROCEDURE:
    • Dysuria, contrast excreted in urine
  3. ERCP
    • Examination of hepatobiliary system.
    • endoscope inserted into esophagus to duodenum

    • PRE PROCEDURE:
    • NPO for several hours prior
    • Sedation

    • POST PROCEDURE:
    • MONITOR FOR GAG REFLEX
    • SIGNS OF PERFORATION
  4. Liver Biopsy
    • Needle inserted through abdominal wall, to obtain tissue sample.
    • PRE PROCEDURE:
    • 1. consent
    • 2. assess coagulation studies
    • 3. Sedative
    • 4. SUPINE or LEFT LATERAL

    • POST PROCEDURE:
    • 1. VS
    • 2. assess site for bleeding
    • 3. monitor for peritonitis
    • 4. bed rest
    • 5. PLACE CLIENT ON RIGHT SIDE W/PILLOW
    • 6. No heavy lifting
  5. Paracentesis
    Removal of fluid from abdominal cavity

    • PRE PROCEDURE:
    • 1. consent
    • 2. *Void prior to procedure
    • 3. measure ab girth, weight, baseline VS
    • 4. Positioned upright at edge of bed, back supported

    • POST PROCEDURE
    • 1. monitor VS
    • 2. Measure fluid collected
    • 3. Send fluid to lab
    • 4. Dry sterile dressing to site
    • 5. measure ab girth, weight
    • 6.* monitor for hypovolemia, E-lyte loss
  6. Esophageal varices
    • Dilated/Tortuous veins in the sub mucosa of esophagus.
    • Caused by PORTAL HYPERTENSION

    • associated with liver cirrhosis
    • high risk for rupture
    • Bleeding is an emergency

    *Goal to control bleeding
  7. Esophageal varices
    Assessment
    • Hematemesis
    • Melena
    • Tarry Stools
    • Ascites
    • Jaundice
    • Hepatomegaly
    • Splenomegaly
    • Dilated abdominal veins
    • Hemorrhoids
    • Signs of shock
  8. Esophageal varices
    Implementation
    • Monitor VS
    • Elevate HOB
    • monitor for orthostatic hypotension
    • Monitor Lung sounds
    • 02 as prescribed/prevent hypoxia
    • LOC
    • NPO
    • IV fluids
    • hgb, hct, coagulation factors
    • blood transfusion/clotting factors
    • NG/Balloon tamponade
  9. Esophageal varices
    • Iced saline
    • Vasopressin
    • nitro
  10. Sengstaken-Blakemore tube.
    • Maintain traction/pressure at 40mmHG
    • Scissors at bedside
    • Oral Suction, mouth care
    • cannot swallow or will aspirate
    • Deflate balloon every 12 hrs
  11. Endoscopic injection
    Sclerotherapy
    Injection of sclerosing agent into and around bleeding vessels

    • complications:
    • chest pain
    • pleural effusion
    • aspiration pneumonia
    • esopahgeal stricutre
    • perforation
  12. Endoscopic variceal ligation:
    • Ligation of the varices with elastic rubber band
    • sloughing, followed by superficial uldceration

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