Question

Case Study: Introduction to the Gastrointestinal System and Accessory Structures

Mark Deak, a 22-year-old male client, is seen at an outpatient clinic for the recent development of pain with eating and bloody loose bowel movements. He has generalized abdominal colicky pain that radiates to his right shoulder. At times, he vomits bile; before the bloody stools began, he had episodes of clay-colored stools and tea-colored urine. Currently, his urine is dark amber-colored. The renal profile is within normal range. The vital signs are T, 100° F; BP, 150/80 mm Hg; HR, 100 beats/minute; RR, 22 breaths/minute. He asked the LPN/LVN what he needs to do to prepare for the ordered upper GI, barium enema, and cholecystography, and what to expect.

a. Explain the overall prep the client will need to do prior to the scheduled tests and in what order the diagnostic tests should be scheduled by the nurse.

b. Explain instructions the nurse should provide the client for the diagnostic tests.

Answer 1

Overall prepare barium enema

Before a barium enema procedure ,patient will be instructed to empty colon.

To empty the patients colon, nurses explains to patients :

· Follow a special diet the day before the procedure. Patients may be asked not to eat and to drink only clear liquids — such as water, tea or coffee without milk or cream, broth, and clear carbonated beverages.

· Fast after midnight. Usually, patients will be asked not to drink or eat anything after midnight before the procedure.

· Take a laxative the night before the procedure. A laxative, in a pill or liquid form, will help empty patients colon.

· Use an enema kit. In some cases, patients may need to use an over-the-counter enema kit — either the night before the procedure or a few hours before the procedure— that provides a cleansing solution to remove any residue in your colon.

Oral Cholecystogram

A cholecystogram is an x-ray procedure used to help evaluate the gallbladder. For the procedure, a special diet is consumed prior to the test and contrast tablets are also swallowed to help visualize the gallbladder on x-ray. The test is used to help in diagnosing disorders of the liver and gallbladder, including gallstones and tumors.

Oral refers to the oral medication you take before the test. The medication is an iodine-based contrast agent that makes your gallbladder more clearly visible on the X-ray.

The X-ray can show inflammation of the organ, a condition known as cholecystitis. It can also reveal other abnormalities such as polyps and gallstones.

How nurses can give Prepare a patient for oral cholecystogram

Preparing for oral cholecystogram is a multistep process.

Nurse should explain to the patient as follows:

What to eat two up to two days before

Two days before the test, you generally can eat normal meals. If instructed otherwise, follow your doctor’s directions closely to ensure accurate test results.

What to eat the day before

Follow a low-fat or fat-free diet the day before the procedure. Ideal choices include:

• chicken
• fish
• vegetables
• fruits
• bread
• skim milk

Taking the contrast medication before the test

The evening of the day before the test, you’ll take the contrast agent medication. The medication is available in pill form. You’ll take a total of six pills, one each hour. Your doctor will tell you what time to start taking the first pill.

Take each dose of medication with a full glass of water. On the evening before the test, don’t eat any solid foods after you’ve started taking the contrast agent. Drinking water is fine until midnight. By then, you should be fully fasting. You should also refrain from smoking cigarettes or chewing gum.

What to expect the morning of the oral cholecystogram

Don’t eat or drink anything the morning of your procedure. Ask your doctor ahead of time if you’re allowed to take routine medications, or if you should skip it. You may be able to take a few sips of water, but be sure to ask your doctor first.

If you’ve completed certain types of gastrointestinal imaging in the few days before your oral cholecystogram, your doctor may recommend a rectal laxative, or enema, to clear your bowels.

The contrast agents used in certain imaging tests, such as an upper gastrointestinal series or barium enema, can obscure your gallbladder. Clearing your bowels makes your gallbladder more visible.

Oral cholecystogram procedure

Oral cholecystogram can be performed as an outpatient procedure while you’re awake. You might be given a special high-fat drink to stimulate your gallbladder to contract and release bile, which can help your doctor identify problems.

The doctor will likely have you lie down on a table, but you may be asked to stand. This depends on the what views of your gallbladder are required. Then, they’ll use an X-ray camera called a fluoroscope to see your gallbladder. You may be able to see what the doctor is seeing on a monitor, depending on the room setup. Your doctor will take X-rays throughout the procedure.

Oral cholecystogram is painless. However, you might experience diarrhea, nausea, or stomach cramping due to the contrast agent. If done as an outpatient imaging study, typically you can go home after the procedure, as long as no complications arise.

Risks of oral cholecystogram

Severe risks caused by oral cholecystogram are rare. Some people may experience mild temporary symptoms, such as:

• diarrhea
• nausea
• vomiting

Some people may also experience problems caused by an adverse reaction or mild allergic reaction to the contrast agent. Allergy or intolerance symptoms can include:

• rash
• itching
• nausea

• wheezing
• shortness of breath
• facial swelling

People with certain types of medical conditions may not be candidates for this test. These include:

• kidney disease
• liver disease
• other chronic conditions
• severe adverse reaction to prior iodine contrast exposure

Results

Your doctor will notify you of the results of the test and any treatments that may need to follow.

For instance, cancerous growths and gallstones that cause pain or biliary dysfunction may be treated with medications or surgery. Benign polyps on your gallbladder and small gallstones may not require any further treatment.

· (Ask your doctor about your medications. At least a week before your procedre , talk with your doctor about the medications you normally take. He or she may ask you to stop taking them days or hours before the procedure.)

What patient can expect

During the procedure

During your barium enema, you'll wear a gown and be asked to remove eyewear, jewelry or removable dental devices. The procedure will be performed by a radiology technician and a physician who specializes in diagnostic imaging (radiologist).

You'll begin the procedure lying on your side on a specially designed table. An X-ray will be taken to make sure your colon is clean. Then a lubricated enema tube will be inserted into your rectum. A barium bag will be connected to the tube to deliver the barium solution into your colon.

If you're having an air-contrast (double-contrast) barium enema, air will flow through the same tube and into your rectum.

The tube that's used to deliver the barium has a small balloon near its tip. When positioned at the entrance of your rectum, the balloon helps keep the barium inside your body. As your colon fills with barium, you may feel the urge to have a bowel movement. Abdominal cramping may occur.

Do your best to hold the enema tube in place. To relax, take long, deep breaths.

You may be asked to turn and hold various positions on the procedure table. This helps ensure that your entire colon is coated with barium and enables the radiologist to view the colon from various angles. You also may be asked to hold your breath at times.

The radiologist may press firmly on your abdomen and pelvis, manipulating your colon for better viewing on a monitor attached to the X-ray machine. A number of X-rays will likely be taken of your colon from various angles.

A barium enema procedure typically takes about 30 to 60 minutes.

After the procedure

After the procedure , most of the barium will be removed from your colon through the enema tube. When the tube is removed, you'll be able to use the toilet to expel additional barium and air. Any abdominal cramping usually ends quickly, and you should be able to return to your usual diet and activities right away.

You may have white stools for a few days as your body naturally removes any remaining barium from your colon. Barium may cause constipation, so you may find you can reduce your risk of constipation by drinking extra fluids in the days following your procedure. Your doctor may recommend a laxative, if needed.

Check with your doctor if you're unable to have a bowel movement or pass gas more than two days after the procedure or if your stool doesn't return to its normal color within a few days.

Results

The radiologist prepares a report based on the results of the procedure and sends it to your doctor. Your doctor will discuss the results with you, as well as subsequent tests or treatments that may be required:

· Negative result. A barium enema test  is considered negative if the radiologist detects no abnormalities in the colon.

· Positive result. A barium enema test is considered positive if the radiologist detects abnormalities in the colon. Depending on the findings, you may need additional testing — such as a colonoscopy — so that any abnormalities can be identified more thoroughly, biopsied or removed.

After the procedure the patient has to follow the doctors instructions may can start orally clear liquid followed by soft diet for the patient.This will be depends upon the patient condetion.IV fluid therapy will be continuing as per orders.Monitor the patient closly,especially vital signs.If any deviations inform to a particular concerned person like doctors.