MEDSURG – January 20, 2021

Odynophagia

Dysphagia

Melena

Hematochezia

Steatorrhea

Dont eat for 6-8 hrs - Barium Swallow

Low residue diet/Low fiber - Barium Enema

Any invasive test, anesthesia - Informed Consent

Barium enema - pre and post procedure - nurse will assist

but the doctor will do the procedure. Nurse will only verify if the patient understands the procedure for
the informed consent.

Barium sulfate causes constipation as side effect. Laxative and Re-hydrate to eliminate barium sulfate.

Upper GI Endoscopy

- NPO X 6-8 hrs

- Atropine sulfate, prevents mucus secretion to prevent aspiration

- Sedative (Narcotics or tranquilizers) prevent agitation

- Remove Dentures

- Lidocaine spray to counter gag reflex

- Side-lying NPO until gag reflex return, prevent aspiration,

- NSS gargle to soothe throat

Lower GI Endoscopy/Proctosigmoidoscopy

- Enema, good bowel preparation for good visualization of rectum and colon
- Assess for vasovagal stimulation, supine position.

Colonoscopy

- Left Side, Knee flexed

CT Scan

- Radiation

- Plain CT Scan and With contrast medium (assess for iodine allergy)

- Assess for claustrophobia > Panic disorder or anxiety attack

MRI

- NPO for 6-8 hrs

- 60 - 90 mins

- contraindicated for pacemakers, aneurysm clips or ortho screws

Ultrasound of Abdomen

- NPO for 8-12 hrs

- Laxatives to reduce bowel gas

Endocrine tests

Stimulation tests

Suppression tests

Hypothalamus - Releasing or Inhibiting hormones

Pituitary - Stimulating hormones

Thyroid Disorders
Thyroid stimulating hormone assay

Radioactive

T3 T4 Radioimmunossay

Thyroid scan

Basal Metabolic Rate (BMR)

Parathyroid Disorders

- PTH up, Hypercalcemia, Low Posphorus

Adrenocortical Disorders

- Sex, Salt, Sugar

- Androgen or Estrogen, Aldosterone, Cortisol

Cortisol plasma level

- Increased - Pituitary tumor - Cushing's Syndrome

- Decreased - Addison's Disease

Adrenal Medullary Disorders

- Vanillymandelic acid test (VMA)

- VMA - metabolite of Epinephrine

- 24-hr urine is collected

- Bawal coffee, chocolate, tea, banana, vanilla, aspirin

- Normal value: 0.7 to 6.8 mg/24 hr

Clonidine Suppresion Test

- Clonidine (Catapress), a centrally acting adrenergic blocker suppresses the release of catecholamines.

Pancreatic Disorders (DM)

Fasting blood sugar (FBS)

- Normal 70-110 mg/dl for 2 readings

- DM > 140 mg/dl for 2 readings

- NPO x 8 hrs

Two-hour Postprandial Blood Sugar (PPBS) or Random Blood Sugar

- blood specimen is withdrawn

- 100 grams of carbs in diet

- 2hours after withdrawwal blood returns to normal level

Oral Glucose Tolerance Test (OGTT/GTT)

- Consume high CHO diet x 3days

- Human Placental Lactogen counters Insulin

- CNPO 10 to 16 hrs

Glycosylated Hemoglobin (HbA1c)

- glucose level of past 3 - 4 months