Question

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

A. A nurse should prepare the client in such a way that one procedure should not interupt  the another one since it can lead to wrong diagnosis.The first procedure that can be carried out is UPPER GI,then barium enema and finally most probably on the next day cholysystogram.

The reason behind this order is,for all these procedures the patient need to be nill per mouth,mainly for upper GI,and can drink clear liquids 6 hours before procedure .This is common for all three procedures.The second should be barium enema because for this procedure the patient can follow the same instruction as upper GI.It is kept as a second because for the cholysystogram the patient preparation is the same same but it can cause loose stools.The barium enema can cause constipation.so if we do cholysystigram after barium enema constipation can be avoided also we get accurate result of barium enema.

The over all preparation of the patient include,prepare the patient psychologically for the procedure by explaining about the procedure and by showing videos.Tell the patient that he or she is not allowed to eat solid food after the midnight,if needed can drink clear liquid.For the cholysystohram ask the patient to take the mdication which doctor has given according to his instruction like one tablet in every one hour (total 6 tablets) in the prevoius evening of the procedure.

B. The nurse sholud explain the procedure to the patient correctly.

Instruct the client clearly about the nill per oral status in his or her own language and ask questions to make sure the client has understood the instruction.

Instruct the patient to follow the preparation instructions strightly to get the correct diagnosis and thereby the correct treatment.

Certain diagnostic test need the client to take medications before the procedure,so instruct the patient to take the pre medications and the instructed medicine according to the doctor's instruction.

Tell the patient to inform the nurse if he failed to follow the instructions,because it can cause wrong diagnosis and wrong treatment.

Instruct the client to inform if he or she has any allergy to iodine content,because certain diagnostic test need to use dye which has iodine content.