GI therapeutic procedures that nurses should be knowledgeable about
Bariatric surgeries, Nasogastric decompresstion, Ostomies, Enteral feedings, total parenteral nutrition (TPN), paracentesis
Bariatric surgeries
*Done as tx for morbid obesity when all other weight control methods failed.
*decrease functional size of stomach via stapling, gastric band intestinal bypass
post bariatric procedure
* Monitor for development of postop complications that are increased risk due to obesity (ateletasis, thromboemboli, incisional hernia,peritonitis.)
*monitor breathing, bowel sounds and apply abdominal binder to prevent dehiscence
*Ambulate asap, 6 small
Pre bariatric procedure
*ensure client understands dietary changes that will be required
*arrange for bariatric bed
Nasogastric Decompression
*procedure done for pt with intestinal obstruction
*bowel sounds may be absent(paralytic ilius), hyperactive and high pitched, hypoactive(obstruction)
Pre/Post procedure NG tube
*instruct the client on the purpose of NG tube and its role in its placement
**assess and maintain equipment, monitor I&O, bowel sounds, abdominal pain, rigidity, fever, tachycardia,hypotension
Ostomy
Surgical opening from the inside of body to the outside. can be permanent or temporary and located on various parts of the body
ileostomy
a surgical opening into to the ilium to drain stool--performed when the entire colon must be removed due to disease (Chron's Disease)
colostomy
a surgical opening into the large intestine to drain stool--performed when colon cancer necessitates removal of portion of the bowel
Ileostomy output
*less than 1000ml/day, may be bile colored and liquid
*after several days, output decreases to 500 - 1000ml, becomes more continuous and paste like
Transverse colostomy output
* small semi liquid with some mucus 2-3 days after, blood may be present after surgery
*after several days/weeks stool becomes more stool like semi formed, eventually resuming similar pattern as preop
Sigmoid Colostomy output
*small to moderate amounts of mucus with semi formed stool 4-5 days after surgery
*after several days/weeks stool will resemble semi-formed stool, resuming similar pattern as preop
Healthy stomas
should appear pink and moist, if the stoma appears black or purple, this indicates a serious impairment of blood flow and requires immediate attention
Enteral Feedings
instituted when client can no longer take adequate nutrition orally
*patients that are intubated, have difficulty swallowing, or at risk for aspiration(stroke, advanced parkinsons and MS)
**RISK for aspiration pneumonia!
Total Parenteral Nurtrition (TPN)
Hypertonic IV bolus solution that provides complete nutrition to pt that has no functioning GI tract or needs additional nutrition (burn victim)
*indicated for patients with prolonged recovery, chronic pancreatitis, diffuse peritonitis, short bowel syndro
Paracentesis
Therapeutically, a paracentisis is performed by inserting a needle or trocar through the abd wall into the peritoneal cavity and withdrawing ascitic fluid to relieve abdominal pressure from ascites
ascites
*abnormal accumulation of protein-rich fluid in abdominal cavity most often caused by cirrhosis of the liver
*Respiratory distress is the determining factor in the use of a paracenteis in the treatment of ascites
Signs-Compromised lung expansion
Preprocedure paracentesis
*have patient empty bladder, explain that there may be pressure or pain when needle insertion & that local anesthetics will be used
intraprocedure paracentesis
*monitor vital signs, between 4L& 6L are being slowly drained. Send specimen to lab, monitor drainage and report any complications
Postprocedure paracentesis
*Maintain pressure at needle site for several minutes and dry gauze if still leaking.
*take vitals, weigh patient and measure abdominal girth for comparison
Complications with TPN include
hyperglycemia,hypoglycemia, & vitamin deficiencies , Air embolism, infection, fluid imbalance