Question

Case Study, Chapter 44, 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 develop of pain with eating and bloody loose bowel movements. He has generalized abdominal co pain that radiates to his right shoulder. At times, he vomits bile; before the bloody stools he had episodes of clay -colored stools and tea-colored urine. Currently, his urine is dark a colored. The renal profile is within normal range. The vital signs are T, 100 degrees F; BP, 150/8 Hg; HR, 100beats / (minute) ; RR, 22 breaths/minute. He asked the LPN / (LVN) what he need to prepare for the ordered upper GI, barium enema, and cholecystography, and what to ex (Learning Objective 7) a. Explain the overall prep the client will need to do prior to the scheduled tests and v 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

Preparation of the patient for upper GI barium enema :-

Before a barium enema exam, you'll be instructed to empty your colon. Any residue in your colon may obscure the X-ray images or be mistaken for an abnormality.

To empty your colon, you may be asked to:

Follow a special diet the day before the exam. You 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, you'll be asked not to drink or eat anything after midnight before the exam.

Take a laxative the night before the exam. A laxative, in a pill or liquid form, will help empty your colon.

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

Ask your doctor about your medications. At least a week before your exam, 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 exam.

Barium enema

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

You'll begin the exam 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 exam 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 exam typically takes about 30 to 60 minutes.

After the exam

After the exam, 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 exam. 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 exam or if your stool doesn't return to its normal color within a few days

#. Preparation for cholecystography

Tell the healthcare provider if you are allergic to contrast dye or seafood. Also, tell your provider if you are or may be pregnant.Follow your healthcare provider's instructions. The night before the procedure, eat a light, low-fat meal such as soup and salad. Several hours after the night meal, take the pills your provider provided. Take one pill every 5 minutes until they are gone. The dye in these pills will outline the gallbladder on the X-rays.Do not eat or drink anything the morning of the procedure.

During the procedure :-

A technologist will take several X-rays of your abdomen. The gallbladder and any stones may show up on the X-ray. You may be given something to eat or drink to make the gallbladder contract and release dye into the bile ducts and intestine. The technologist may then take more X-rays of your abdomen.

After the procedure

Risks associated with the procedure :

You may have an allergic reaction to the dye. In an allergic reaction, your body's immune system misreads a harmless substance as harmful. As a result you can have symptoms that vary widely in severity. For example, you could get hives, nausea, fainting or swelling.

The test may not work.

The dye may not pass into the gallbladder.

The pills may give you diarrhea.