Question

1. Describe the proper physical assessment order for a GI system.

2. Explain the nursing responsibility regarding NGT insertion.

3. Describe the proper assessment for checking the patency of a NG tube?

4. Describe the delegation of care to UAP in regards to NGT care and maintenance.

5. Describe the procedure and differentiate between the nursing care, assessment pre & post procedure and complications for the following diagnostic exams.

Explanation of Procedure	Nursing Care & Assessment Pre- Procedure	Nursing Care & Assessment Post- Procedure	Complications
EGD
Barium Enema
Colonoscopy

Answer 1

there are four areas for physical examination:'

• inspection
• palpation
• percussion
• auscultation

mouth and throat

• Assess for sores
• assess the condition of teeth and gums (irritation)
• tongue- the presence of any tumour or lesions
• the odour of the breath

Abdomen

inspection

• contour, symmetry, abdominal aorta pulsation,
• any distention( due to obesity- soft and rounded with sunken umbilicus,

ascites- shiny and glistening skin with an everted umbilicus, prominent and dilated veins

• obstruction- visible and marked peristalsis; restlessness; lying with knees flexed; grimacing facial expression; and uneven respirations)

Auscultation

• the character of bowel sounds (high-pitched, gurgling, clicking)
• frequency
• hyperactive/hypoactive/normal/ absent of bowel sounds
• vascular sounds: Assess all four quadrants listening for bruits (whooshing, blowing sounds that represent impaired circulation within an artery or an aneurysm

percussion

• tympani ( as air rises to the surface of the abdominal cavity)
• hyper-resonance (in the presence of gaseous distention)
• dullness (overdistended bladder, adipose tissue, fluid or mass)

palpation

• Lightly palpate the abdomen by quadrants. Note any muscle guarding, rigidity, tenderness, or masses.

rectal area

• external haemorrhoids, any masses or evidence of inflammation

nurses responsibility in nasogastric tube insertion

• take consent and explanation about the procedure
• take the right size of the nasogastric tube
• measure the correct length and confirm it is correctly sited
• confirm tube is not misplaced before every use.
• assess patient comfort and safety
• maintain clinical record

patency of nasogastric tube can be checked by:

X-ray method- The nurse took X-ray of the upper portion of the patient’s abdomen, looking for an opaque, white line on the left side under the diaphragm

syringe method- checks the placement of the tube as a syringe instils a 30cc air bolus in to the patient’s stomach a whooshing sound can hear, which can be auscultated by stethoscope just below the xiphias sternum.

pH test- checking pH by aspirating gastric fluid, the tube is in correct position if pH is 5.5 or higher.