Scribd Logo
Upload

Welcome to Scribd!

  • 23 views

    Nursing Assessment: Gastrointestinal System: Tuti Seniwati

    Uploaded by

    Slamet Katib
    This document provides an overview of gastrointestinal system assessment, including health history, physical assessment, laboratory assessment, and diagnostic procedures. Physical assessment involves inspection, auscultation, and palpation of the abdomen, as well as examination of the mouth, pharynx, rectum, and anus. Common laboratory tests include complete blood count, liver enzymes, stool tests, and fecal occult blood test. Key diagnostic procedures described are barium swallow, barium enema, endoscopy, colonoscopy, ultrasound, and laparoscopy.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd

    Nursing Assessment: Gastrointestinal System: Tuti Seniwati

    Uploaded by

    Slamet Katib
    23 views42 pages
    This document provides an overview of gastrointestinal system assessment, including health history, physical assessment, laboratory assessment, and diagnostic procedures. Physical assessment involves inspection, auscultation, and palpation of the abdomen, as well as examination of the mouth, pharynx, rectum, and anus. Common laboratory tests include complete blood count, liver enzymes, stool tests, and fecal occult blood test. Key diagnostic procedures described are barium swallow, barium enema, endoscopy, colonoscopy, ultrasound, and laparoscopy.

    Original Description:

    GI system 2

    Original Title

    GI System2

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document provides an overview of gastrointestinal system assessment, including health history, physical assessment, laboratory assessment, and diagnostic procedures. Physical assessment involves inspection, auscultation, and palpation of the abdomen, as well as examination of the mouth, pharynx, rectum, and anus. Common laboratory tests include complete blood count, liver enzymes, stool tests, and fecal occult blood test. Key diagnostic procedures described are barium swallow, barium enema, endoscopy, colonoscopy, ultrasound, and laparoscopy.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    23 views42 pages

    Nursing Assessment: Gastrointestinal System: Tuti Seniwati

    Uploaded by

    Slamet Katib
    This document provides an overview of gastrointestinal system assessment, including health history, physical assessment, laboratory assessment, and diagnostic procedures. Physical assessment involves inspection, auscultation, and palpation of the abdomen, as well as examination of the mouth, pharynx, rectum, and anus. Common laboratory tests include complete blood count, liver enzymes, stool tests, and fecal occult blood test. Key diagnostic procedures described are barium swallow, barium enema, endoscopy, colonoscopy, ultrasound, and laparoscopy.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 42

    NURSING ASSESSMENT:

    GASTROINTESTINAL SYSTEM

    TUTI SENIWATI
    PSIK FK-UNHAS

    Gastrointestinal System: Assessment

    Halth History
    Physical assessment
    Laboratory assessment
    Diagnostic Procedures

    ASSEMBLE A PATIENT HISTORY

    Past disease
    History of Current Illness
    Surgeries
    Weight
    Trauma

    Assess the following areas in the


    health history:

    Pain
    Teeth/Gums
    Throat
    Appetite
    Lower GI: Assess for problems with
    flatulence, hemorrhoids, hernia.

    Physical assessment
    1.

    Mouth and Pharynx


    The lips should be pink and smooth
    The teeth should be white; gums
    should be pink and moist.
    Look for inflammation, swelling, and
    bleeding
    The tongue should look velvety and
    pink
    The palate should be firm and white
    The pharynx should look pink and
    smooth in nonsmokers and yellowishred with small nodules in smokers
    5

    Abdomen
    Regionisasi sistem 4 membagi
    abdomen atas :
    Kuadran kanan atas, terdapat organ
    hati, empedu, duodenum, pankreas,
    ginjal kanan dan fleksura hepatika
    Kuadran kiri atas, terdapat organ
    lambung, lien, pankreas, ginjal kiri
    dan fleksura lienalis
    Kuadran kanan bawah, terdapat
    organ caecum, apendix, ovarium
    dan tuba falopii kanan
    Kuadran kiri bawah, terdapat organ
    sigmoid, ovarium dan tuba falopii
    kiri
    6

    Regionisasi sistem 9 membagi


    abdomen atas :
    Area epigastrium
    Area Hipokondrium kiri
    Area Hipokondrium kanan
    Area Umbilikus
    Area Lumbal kiri
    Area Lumbal kanan
    Area Supra Pubik
    Area Inguinal kiri
    Area Inguinal kanan

    Inspeksi

    Symmetry
    Abdominal distention
    Herniation
    Masses
    Discoloration

    Auscultation

    Bowel sounds
    Normal sounds occur five to 34 times per
    minute
    Hyperactive sounds occur 34 or more
    times per minute
    No sounds for five minutes may indicate
    peritonitis or paralytic ileus

    10

    Perkusi
    Lakukan perkusi di semua kuadran
    terhadap timpani atau pekak
    Lakukan secara sistematika

    11

    12

    Normal:
    Timpani terutama di atas lambung , usus,
    kandung kemih Pekak di atas kandung kemih
    yang penuh (area suprapubik),hati, limpa,
    pankreas, ginjal
    Penyimpangan:
    Pekak nyata pada area lain

    13

    Bunyi Perkusi

    Intensitas

    Nada

    Durasi

    Kualitas

    Lokasi anatomis di
    mana pemeriksa
    mendengarkan bunyi

    Timpani

    Keras

    Tinggi

    Menengah

    Seperti
    Drum

    Ruang udara tertutup,


    gelembung udara
    lambung, pipi
    menggembung

    Resonan

    Menengah
    sampai keras

    Rendah

    Panjang

    Bergema

    Paru normal

    Hiperesonan

    Amat keras

    Amat
    rendah

    Lebih panjang
    dari resonan

    Ledakan

    Empisema paru

    Pekak

    Lembut
    sampai
    menengah

    Tinggi

    Menengah

    Seperti
    petir

    Hati

    Kempes/gembos

    Lembut

    Tinggi

    Pendek

    Datar

    Otot
    14

    PALPASI

    Setiap kuadran palpasi terhadap tonus, adanya


    nyeri tekan, massa
    Mulai dengan palpasi ringan dengan cara
    sistemik sebelum melanjutkan palpasi dalam
    Tanyakan klien tentang area nyeri tekan dan
    palpasi area ini terakhir
    Lihat penempatan umum isi abdominal untuk
    membantu membedakan dari kondisi abnormal

    15

    Normal:
    Tonus abdomen lemah, tak nyeri tekan selama
    palpasi ringan, agak tak nyaman di atas sekum,
    kolon, sigmoid, aorta
    Tidak ada massa
    Penyimpangan:Tahanan involunter, kekakuan
    lokal (perhatikan lokasi, ukuran, bentuk,
    konsistensi, nyeri tekan, pulsasi dan gerakan
    pada pernafasan bila masa teraba)

    16

    17

    18

    Rectum and Anus

    Hemorrhoids

    Tenesmus

    Thrombosed veins in rectum and anus


    Internal or external
    Painful and ineffective straining at stool

    Steatorrhea

    Fatty, frothy, foul smelling stool

    19

    Blood Tests

    Complete blood count


    Clotting factors
    Electrolytes
    Assays of liver enzymesaspartate and
    alanine aminotransferase
    Serum amylase and lipase
    Bilirubinthe primary pigment in bile
    Serum ammonia

    20

    Laboratory Tests

    Stool testsfecal occult blood test,


    steatorrhea, Clostridium difficile infection

    21

    COMMON LABORATORY
    PROCEDURES
    FECALYSIS
    Examination of stool consistency,
    color and the presence of occult
    blood.
    Special tests for fat, nitrogen,
    parasites,pathogens and others

    22

    COMMON LABORATORY
    PROCEDURES
    FECALYSIS: Occult Blood Testing
    Instruct the patient to adhere to a 3day meatless diet
    No intake of NSAIDS, aspirin and
    anti-coagulant
    Screening test for colonic cancer
    23

    Diagnostic Procedures

    24

    Barium swallow/upper GI

    Oesophagografi/Barium Swallow adalah


    suatu pemeriksaan radiografi pada bagian
    oesophagus dan pharynx dengan
    menggunakan sinar-x dan bantuan media
    kontras positif untuk menegakkan
    diagnosa.

    Preparation
    NPO after midnight 8-12 hours
    No smoking after midnight
    Swallow Barium Contrast medium
    Various positions by tilt table
    25

    Barium Swallow

    26

    Barium Enema/ Lower GI

    Examination of rectum and colon


    Tumors, polyps, diverticula, filling defects
    associated with Crohns and ulcerative colitis.
    Preparation

    Bowel prep
    Day before

    Tape water enemas till clear


    Oral cathartic
    Clear Liquid evening meal
    NPO 8 + hours

    27

    Day of procedure

    Suppository or enema

    Barium instilled into large


    intestines through the rectum
    patient is placed in different
    positions
    Post
    Oral cathartic, laxative,
    suppository
    Remove residual barium
    Stools will be white

    28

    Barium enema

    29

    Endoscopy

    Visualization of the Upper and lower


    GI tract by fiberopitc tube
    Endoscopi artinya adalah melihat
    kedalam, yang dalam hal ini berarti
    melihat kedalam tubuh manusia
    untuk suatu alasan medis.
    T.d EGD dan kolonoskopi
    EGD
    Esophagogastroduodenoscopy
    Esophagus, stomach, duodenum
    Fiberoptic tube passing through
    the mouth
    Indikasi :

    30

    Esophagogastroduodenoscopy
    (EGD)

    Esophagus, stomach, duodenum


    Fiberoptic tube passing through the mouth
    Indikasi :
    Perdarahan saluran cerna bagian atas (SCBA)
    Dispepsia
    Disfagia
    Nyeri Epigastrium Kronis
    Survey Endoscopi curiga keganasan
    Nyeri dada tak khas

    31

    Preparation
    NPO for 8 hours
    Sedative for anxiety
    Versed, diaxepam
    Patient will be sedated during procedure
    Throat anesthetized with oral anesthetic
    Diminished gag reflex
    Lateral recumbent position
    Instructed to swallow as tube is advanced
    Post procedure
    NPO until gag reflex returns
    Assess for return of gag reflex (1-2 H)
    place patient in SIMS position until he awakens
    monitor for complications
    saline gargles for mild oral discomfort
    Complication
    Aspiration, bleeding from trauma, infection, and pain

    32

    Esophagogastroduodenoscopy/ER
    CP

    33

    34

    Colonoscopy

    Visualization of the large


    intestines to the ileocecal
    value by fiberoptic tube via
    rectum
    Dengan pemeriksaan ini
    memungkinkan pengamatan
    seluruh colon,rectum serta
    ileum terminalis

    35

    36

    Indikasi :

    Hematemesis melena yang belum diketahui dengan jelas.


    Penyakit inflamasi usus kronis hubungannya dengan survailen
    kanker kolorektal.
    Diare kronis
    Nyeri perut yang belum jelas kausanya.
    Evaluasi abnormalitas pada pemeriksaan barium enema.
    Survailen kanker,Colitis Ulseratif,Sindrom Poliposis.
    Penelitian penyakit colon pada penderita tua & penurunan berat
    badan yang tak jelas penyebabnya.
    Terapeutik, polipektomi, perdarahan, mengambil benda asing,
    dekompensasi megakolon atau vovulus dan dilatasi stenosis.

    37

    Persiapan kolonoskopi

    Makan bubur saring/sumsum tanpa santan sejak 2 hari


    sebelum tindakan Colonoscopy.
    Minum air putih sebanyak 2-3 liter sehari, makanan lain
    tidak diperbolehkan.
    Bila pasien susah buang air besar,diberikan sirup laxadin
    3x1sendok makan atau minum laxadin 3x1 tablet.
    Malam terakhir sebelum hari pemeriksaan colonoscopy,
    pasien makan bubur sumsum terakhir jam 19:00 setelah itu
    pasien puasa tetapi boleh minum.
    Pada jam 20:00 diberikan garam inggris 30 gr dalam
    gelas air hangat.
    Pagi jam 05:00 saat sebelum colonoscopy, masukkan
    dulcolax supp 1 buah kedalam anus atau obat-obatan cair
    yang lain (misalnya : fosen, yal, dll)
    38

    Proktoskopi & sigmoidoskopi

    Untuk melihat rektum dan


    sigmoid
    Kolon diperiksa sampai 40-50
    cm (16-20 inchi) dari anus
    Bisa untuk memeriksa ulserasi,
    tumor, polip, atau patologis lain

    39

    USG Perut

    USG bisa menunjukkan ukuran dan


    bentuk berbagai organ (misalnya hati dan
    pankreas) dan juga bisa menunjukkan
    daerah abnormal di dalamnya
    Menunjukkan adanya cairan
    Bukan alat yang baik untuk menentukan
    permukaan saluran pencernaan

    40

    Tes feses

    Jumlah
    Konsistensi
    Warna
    Tes skrining untuk darah samar

    41

    Laparoskopi

    Laparoskopi adalah
    pemeriksaan rongga perut
    dengan menggunakan
    endoskop Laparoskopi
    dilakukan dalam keadaan
    penderita terbius total
    Digunakan : penyakit peritoneal,
    nyeri abdomen kronis, massa,
    kelenjar empedu dan hepar

    42

    You might also like