Procedure

Definiton

Indication / Significance >Barium should fill the colon evenly, showing normal bowel shape and position and no blockages. >Abnormal test results may be a sign of: -Acute appendicitis -Colitis due to Crohn's disease -Colorectal cancer -Colorectal polyps -Diverticulitis - Volvulus
Reference:

Pre

Nursing Responsibilities Intra >It takes approximately 1 hour >The barium will be instilled through a lubricated tube inserted to the rectum >Patient will experience a sensation of fullness, and may feel the need to defecate

Post

Barium Enema or Lower gastrointestinal (GI) tract series

>An X-ray examination of the large intestine to detect the presence of polyps, tumors, and other lesions and to demonstrate any abnormal anatomy or malfunction of the bowel wherein barium (chalky chemical solution) is instilled into the large intestine and X-rays are taken.

>Ensure presence of a signed consent >Provide or instruct to follow a clear liquid diet for 24 hours prior to the test. >Administer or instruct to use laxatives, enemas, or suppositories as ordered the evening prior to the procedure. > Additional bowel preparation may be ordered for the morning just prior to the procedure. >Position on the left side, on back, and prone

>Patients should follow several steps immediately after undergoing a barium enema, including: -Drinking plenty of fluids to help counteract the dehydrating effects of the bowel preparation. -Taking time to rest. A barium enema and the bowel preparation taken before it can be exhausting.

-A cleansing enema or laxative may be given >A fluoroscope to eliminate any will be used to remaining barium. follow the White stools containing progress of the barium are normal for barium, and Xtwo or three days rays will be taken following a barium enema.

Reference:

MS by Smeltzer & Bare, p.

MS by Smeltzer & Bare, p. 950 MS by Lemone & Burke, p. 623

950

Reference: MS by Smeltzer & Bare, p. 950 MS by Lemone & Burke, p. 623

-Ulcerative colitis >Other conditions under which the test may be performed: -Hirschsprung's disease -Intestinal obstruction -Intussusception
Reference: http://www.nlm.nih.g ov/medlineplus/ency /article/

MS by Lemone & Burke, p. 623

Reference: MS by Smeltzer & Bare, p. 950 MS by Lemone & Burke, p. 623

Procedure

Definiton

Indication / Significance >Normal findings are healthy intestinal tissues. >Abnormal test results may be a sign of: -Diverticulosis -Inflammatory bowel disease -Lower gastrointestina l (GI) bleeding -Polyps -Tumor

Pre

Nursing Responsibilities Intra >Monitor for changes in oxygen saturation, vital signs, color and temperature of the skin, level of consciousn ess, abdominal distention, vagal response, and pain intensity

Post

Colonoscopy

>An endoscopic (to visualize a hollow organ's interior) medical procedure that uses a long, flexible, tubular instrument called a colonoscope to view the rectum and the entire inner lining of the colon.

>Ensure presence of a signed informed consent >A liquid diet may be prescribed for 2 days prior to the procedure, and the client is usually NPO for 8 hours just before the procedure >Only clear liquid such as juices, broth, and Jello are allowed >Red or purple juices should be avoided, since they can cause coloring of the colon that may be misinterpreted during the colonoscopy >The patient is advised to drink plenty of water to avoid dehydration except contraindicated

>Sedated clients are maintained on bed rest until fully alert >Observe for signs and symptoms of bowel perforation >Explain that client may have increased flatus as air is instilled into the bowel during the procedure >Instruct to report any abdominal pain, chills, fever, rectal bleeding, or mucopurulent discharge >If a polyp has been removed, instruct to avoid heavy lifting for 7 days, and avoid high fiber food for 1-2 days

Reference: MS by Smeltzer & Bare, p. 953 MS by Lemone & Burke, p. 624

Reference: MS by Smeltzer & Bare, p. 953 MS by Lemone & Burke, p. 624

>Other uses include the evaluation of patients with diarrhea of unknown cause, occult bleeding, or anemia; further study of abnormalities detected on barium enema; and diagnosis,

>Administer or instruct the client in bowel preparation procedures such as taking citrate of magnesia or polyethylene the evening before procedure >Explain that sedation is usually given >Explain dietary restrictions and their purpose

Reference: MS by Smeltzer & Bare, p. 953 MS by Lemone & Burke, p. 624

Procedure

Definiton

Indication / Significance >Many different problems may lead to the need for this surgery. Some are: -Inflammatory bowel disease (ulcerative colitis or Crohn's disease), the most common reason -Colon or rectal cancer -A condition called familial polyposis -Birth defects that involve your intestines

Preoperative >A period of preparation with intensive replacement of fluid, blood, and protein is necessary >Antibiotics may be prescribed >Usually the client is given a low-residue diet, provided in frequent, small feedings >All other pre-op measures are similar to those for general abdominal surgery

Nursing Responsibilities Postoperative >General abdominal surgery wound care is required; apply an ostomy pouch over the stoma >Assess frequently for bleeding, stomach viability, and function; in the early post-op small amounts of blood in the pouch are expected >A healthy stomach appears pink or red and moist as a result of mucus production; it should protrude approximately 2 cm from the abdominal wall >As the stoma starts to function, empty the pouch, explaining the procedure to the client >Initial drainage is dark green, viscid, and usually odorless; drainage gradually thickens and becomes yellow-brown >Empty the pouch when it is one-third full measuring drainage and include it as output in the records >An accurate record of fluid intake, urinary output and fecal discharge is necessary >Encourage to engage in early ambulation >Assess the peristomal skin, should remain clean and pink and free of irritation, rashes, inflammation or excoriation >Protect peristomal skin from enzyme and bile salts in the effluent; using a skin barrier on the pouch is essential >Change the pouch if leakage occurs or if the client complains of burning or itching skin >Teach to manage the pouch clamp, to empty, to rinse, and to perform pouch changes >Emphasize the importance of adequate fluid and salt intake; the risk for dehydration and hyponatremia is

Total Colectomy with Ileostomy

>The surgical creation of an opening into the ileum of the small intestine commonly performed after a total colectomy, an excision of the entire colon

Reference: MS by Smeltzer & Bare, p.1047 MS by Lemone & Burke, p. 656

Reference: MS by Smeltzer & Bare, p.1047

-An accident that damages MS by Lemone & your Burke, p. 656 intestines or another intestinal emergency
Reference:

Prepared by: Alfie C. Panisan, BSN 3A