RTRMF – BSN LEVEL III BATCH TOPAZ

NCM 116 (MEDICAL-SURGICAL NURSING II) LECTURER: MRS. REBECCA DE ASIS

- inability to control bowel movements

DIAGNOSTIC - uncontrollable passage of stool due to the
absence of contractions

EXAMINATIONS
FOR GATROINTESTINAL
SYSTEM
- H i g h - r
TOPIC OUTLINE

IMAGING STUDIES barium defecography (lower panel) in 3 constipated

1. Anorectal Manometry patients. Different colors represent the differences in
2. Esophageal Manometry pressure wherein yellow indicates low pressure.
3. Gastric Manometry - It can detect patterns of muscle activity, including the
LABORATORY STUDIES contractions that are too weak or too powerful
1. Blood Chemistry - It measures:
a. Serum Sodium  Resting tone of the internal anal sphincter
b. Serum Potassium  Contractibility of the external anal sphincter
c. Total Serum Calcium  The anorectal sensory response, anorectal
d. Serum Phosphorus Test reflexes, rectal compliance, and defecatory
e. Serum Magnesium Test function
f. Serum Chloride - This test indicates if your anorectal muscles are still active
g. Total Protein or constricted.
h. Serum Amylase INDICATIONS
i. Serum Lipase  Constipation, particularly difficult with stool evacuation
j. Total Lymphocyte Count (dyssynergic defecation)
ABSORPTION TEST  Dyssynergic defecation
1. D-Axylose Absorption Test - occurs when there is pelvic floor dysfunction
2. Fecal Analysis - stool is not excreted because the muscles do not
3. Quantitative Fecal Fat Studies contract
OTHER LABORATORY STUDIES - leads to chronic constipation
2. Fecal Leukocytes  Stool leakage of fecal incontinence. This means that the
3. Stool Electrolyte Test patient has an uncontrolled anal sphincter. The patient has an
4. Exfoliative Cytologic Analysis inability to control bowel movements.
5. Gastric Analysis  Hirschsprung’s disease or Megacolon – a childhood
disorder
 Hirschsprung’s disease/Congenital Aganglionic
Megacolon
IMAGING STUDIES
- occurs when the baby’s intestinal nerve cells or
ganglion cells are underdeveloped delaying the
1) ANORECTAL MANOMETRY
progression of stool through the intestines
- A test that evaluates bowel function in patients with - causes the stool to stay in the colon
chronic constipation or stool leakage  Megacolon
- A thin tube called a manometry probe, is inserted into - abnormal dilation of the colon
the anal canal. The probe is attached to a pressure - also causes the stool to stay in the colon
transducer that measures the pressure exerted by the - colon increases in size
rectal and anal sphincter muscle, which relaxes and  Anorectal function test before or after bowel surgery. This
contracts to control bowel movements test shows if the anus is still functioning properly before or
 Manometry after bowel surgery.
Probe CONTRAINDICATIONS
- has a There are minimal risks associated to this procedure. However, there
deflated is a low risk of rectal bleeding/infection.
tube which  Anal sphincter obstruction. This impedes the insertion of the
will be manometry probe.
inflated to  Inflamed anus/proctitis. This procedure does not usually
test the cause pain. During the procedure, the balloon will be inflated
anal which might cause pain to the patient.
sphincter PREPARATION OF THE PROCEDURE
and muscle  Patient may take an enema (or 2) 2 hours before the
tone procedure
- just like a  In most cases, this test will not interfere with any
catheter medications patient may be taking. Ask the doctor if it is
wherein okay to take prescribed medications the morning of the
you inflate the tube exam
 Fecal Incontinence

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NCM 116 (MEDICAL-SURGICAL NURSING II)
 Inform patient that the procedure does not cause pain but
may feel a little discomfort
 Patient should be on NPO after midnight if the procedure
is done in the morning
 Place patient on left lateral position with knees and hips
bet at 90 degrees
Remember to ask the consent of the patient before you start the
procedure. Before the procedure, you should prepare an enema
placed on a container. Then, you insert it into the rectum. This is
done to empty the bowels before the procedure. Usually, one Fleet
enema is enough. You can also use a suppository such as
Bisacodyl/Dulcolax.
NURSING RESPONSIBILITIES
A. PRE-PROCEDURE
 Explain the procedure and answer questions. Inform
the patient that the procedure is not painful but there will
be discomfort.
 Obtain the patient’s health history. Also, ask about
consent. Ask the patient about recent illnesses, medical
conditions or medications taken.
 Ask for any allergies. Specifically, ask if there are any
latex allergies since the balloon used for the procedure is
made of latex. This can be changed to a latex-free
material.
 Instruct the patient to not eat or drink anything for 4-6
hours
 Patient may be given enema to clear the rectum. This
ensures that the digestive tract is empty before the test.
B. POST-PROCEDURE
 Inform the patient that he/she may return home
immediately and resume normal activities
2) ESOPHAGEAL MONOMETRY
- Esophageal
manometry
provides
information
about the
movement of
food through
the esophagus
into the
stomach.
- Example charting for FDAR: The day before: Order was
made by ROD for Rectal Manometry, NPO post-midnight.
Inform X-ray department taking of steroids(?). The next
day: D> Esophageal Manometry ordered @9:00 AM.
(Inaudible)
- The test measures how well the muscles at the top and
bottom of your esophagus (sphincter muscles) open and
close, as well as the pressure, speed and pattern of the
wave of esophageal muscle contractions that moves food
along. Used to detect motility disorders of the esophagus,
and upper esophageal sphincter.
MT#: 3
BATCH TOPAZ
LECTURER: MRS. REBECCA DE ASIS
- During esophageal manometry, a thin, flexible tube
(catheter) that contains pressure sensors is passed
through your nose, down your esophagus and into your
stomach. Esophageal manometry can be helpful in
diagnosing certain disorders that can affect your
esophagus. This catheter is connected to a transducer and
a video recorder. Patient swallows small amount of water
while the resulting pressure are recorded. Also used to
assess GERD.
INDICATION
 Achalasia. Esophagus
muscles don’t help move food down and prevent food from
entering the stomach.
 Diffuse esophageal spasm.
Esophagus muscles contract
randomly and interfere with
swallowing.
 Scleroderma. A rare disease that may cause some esophagus
muscles to stop moving. Esophagus is damaged forming and
replaced by scar tissue. Tendency is difficulty of swallowing
resulting to acid reflux disease such as GERD.
 Gastroesophageal Reflux. Esophageal manometry is the gold
standard test for detecting Esophageal dysmotility.
 Noncardiac chest pain. Results from problems in esophagus
and food going to the stomach.
CONTRAINDICATION
 Patients with altered mental status or obtundation. Altered
consciousness of patient is contraindicated because we need
the cooperation of the patient.
 Patients who cannot understand or follow instructions
 Suspected or known pharyngeal or upper esophageal
obstruction (eg, tumors)
PREPARATION OF THE PROCEDURE
 Patient must be on NPO for 8-12 hours.
 Medications that could have a direct effect on motility (e.g.,
calcium channel blockers, anticholinergic agents, sedatives)
are withheld for 24 to 48 hours. This affects the results.
 The procedure takes approximately 30 to 45 minutes to
complete.
 Assess for history of esophageal bleeding, esophageal
varices.
NURSING RESPONSIBILITIES
A. PRE-PROCEDURE
 Explain the procedure to the patient. Outpatient
procedure, requiring no sedation.
 Get the health history of the patient. Ask for recent
illnesses, and contraindications.
 Under medical direction, the patient should withhold
medications for 24 hr. before the study.
 Instruct the patient to fast and restrict fluids for 6 hr.
prior to the procedure to reduce the risk of aspiration
related to nausea and vomiting. Patient may be
required to be NPO after midnight.
B. POST-PROCEDURE
 Once the test is completed, the patient will be given a
tissue to blow his/her nose but otherwise will be well
enough and advised to return home. Advised also that
the patient can resume his/her normal diet and any
medications he/she regularly takes.
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RTRMF – BSN LEVEL III BATCH TOPAZ
NCM 116 (MEDICAL-SURGICAL NURSING II) LECTURER: MRS. REBECCA DE ASIS

 Do not eat or drink (NPO) for at least 8 hours after

midnight prior to the test
 Medications that could have a direct effect on motility (e.g.,
3) GASTRIC MONOMETRY calcium channel blockers, anticholinergic agents,
- A test of the pressure changes which occur within the antispasmodics, sedatives) are withheld 2 days prior to the
stomach and test. During the study, special meals will be given to
upper intestine determine how food affects gastrointestinal tract motility.
during digestion. The first meal with the catheter is given usually in the late
The test is similar morning often an egg sandwich (2 eggs with 2 pieces of
to esophageal toast)
manometry, but  Women need to inform if they are pregnant or think they
takes longer and may be pregnant
requires some  Usually, this test lasts approximately 6 hours (stationary
sedation because recording) or for 24 hours (ambulatory recording)
of the NURSING RESPONSIBILITIES
manipulation. A. PRE-PROCEDURE
- The pressure-  Explain to the patient about the procedure
sensitive plastic  Medications that are not essential should not be taken
tube is placed for two days until after the test is completed.
with an  Instruct the patient not to eat or drink after midnight
endoscope the night before the test 6-8 hrs before the exam
which is passed B. POST-PROCEDURE
into the small  Instruct patient that he/she may be able to go home
intestine immediately after the test is completed
(upper  Instruct to resume normal feeding and medication
endoscopy). activities.
The position of  Provide comfort measures
the manometry  Monitor the patient for the adverse reaction. If there is
testing tube is adverse reactions, inform the healthcare provider
checked with X-
ray, and the LABORATORY STUDIES

endoscope is removed. The tube is left coming out through
the nose for one or two hours. 1) BLOOD CHEMISTRY
- The tube is connected to a computer which detects and a. SERUM SODIUM TEST
analyzes muscular contractions. - Measures the amount of sodium in the fluid
- These are tested in the resting state. After the test, the tube portion (serum) of the blood.
is gently removed. - To assess electrolyte balance related to hydration
INDICATION levels and disorders such as diarrhea and
 This test is usually used in patients who have symptoms vomiting and to monitor the effect of diuretic
suggestive of dysmotility but have normal gastric emptying use.
study results or who are unresponsive to therapy - Sodium aids in the digestion and absorption of
 It can help determine whether the patient's symptoms or nutrients.
dysmotility result from a muscular disorder (abnormal  NORMAL VALUES: 135 – 145 mEq/L (135 – 145
contraction amplitude but normal pattern) or nerve mmol/L)
disorder (irregular contraction pattern but normal INDICATION
amplitude).  Determine whole-body stores of sodium because the
 Abnormal gastric motor function ion is predominantly extracellular.
 Gastric motor dysfunction in patients with functional  Monitor the effectiveness of drug therapy, especially
dyspepsia diuretics, on serum sodium levels.
 Assessment of the thoracoabdominal pressure gradient, CONTRAINDICATION
gastric filling and accommodation N/A
 Evaluation of intestinal motility disorders (e.g. Irritable IMPLICATION
Bowel Syndrome and Atonic Colon). Irritable Bowel An increase in sodium may indicate:
Syndrome is a common condition that affects the  Burns. Hemoconcentration related to excessive loss of free
Gastrointestinal System it causes symptoms such as stomach water.
cramps, bloating, diarrhea, and perforation, this can go  Dehydration
overtime and can and for days, weeks or months. Atonic Colon  Diabetes. Dehydration related to frequent urination.
occurs when there is a lack of muscle tone or strength in the  Diarrhea related to waterloss in excess of salt loss.
colon, also known as lazy colon or colon stasis, it may result in  Excessive intake
chronic constipation.  Excessive saline therapy related to administration of IV
CONTRAINDICATION fluids.
 Pregnancy because it uses X-ray  Excessive sweating related to loss of free water, which
 Patients with altered mental status or obtundation can cause hemoconcentration.
 Patients who cannot understand or follow instructions  Fever related to loss of free water through sweating.
 Suspected or known pharyngeal or upper esophageal  Lactic acidosis related to diabetes.
obstruction (eg, tumors). If there is obstruction, dire  Nasogastric feeding with inadequate fluid related to
makakapass an food para ma monitor an gastric motility dehydration and hemoconcentration.
PREPARATION OF THE PROCEDURE  Vomiting related to dehydration.
A decreased in sodium may indicate:

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NCM 116 (MEDICAL-SURGICAL NURSING II)
 Cystic fibrosis related to loss from chronic diarrhea and
poor intestinal absorption.
 Excessive use of diuretics related to excessive loss
through renal excretion; renal absorption is blocked.
 Hepatic failure. Hemodilution related to fluid retention.
 Hypoproteinemia related to fluid retention.
 Insufficient intake
 IV glucose infusion. Hypertonic glucose draws water into
extracellular fluid and sodium is diluted.
b. SERUM POTASSIUM TEST
- Measures the amount of potassium in the fluid
portion (serum) of the blood.
 NORMAL VALUES: 3.5 – 5 mEq/L
INDICATION
 Assess a known or suspected disorder associated with
kidney disease, glucose metabolism, trauma, or burns.
 Assist in the evaluation of electrolyte imbalances; this
test is especially indicated in older adult patients,
patients receiving hyperalimentation supplements,
patients on hemodialysis, and patients with
hypertension.
 Evaluate cardiac dysrhythmia to determine whether
altered potassium levels are contributing to the
problem, especially during digoxin therapy, which leads
to ventricular irritability.
 Evaluate the effects of drug therapy, especially
diuretics.
 Evaluate the response to treatment for abnormal
potassium levels.
 Monitor known or suspected acidosis, because
potassium moves from RBCs into the extracellular fluid
in acidotic states.
 Routine screen of electrolytes in acute and chronic
illness.
CONTRAINDICATION
 You usually don't need any special preparations for a
potassium blood test.
 You may need to fast for a few hours before if there are
other tests done during blood withdrawal.
IMPLICATION
An increase in potassium may indicate:
 Injuries, burns, or surgery cause your cells to release
extra potassium into your blood.
 Type 1 diabetes that is not well controlled.
 The side effects of certain medicines, such as diuretics
("water pills") or antibiotics.
 A diet too high in potassium (not common). Bananas,
apricots, green leafy vegetables, avocados, and many
other foods are good sources of potassium that are part of
a healthy diet. But eating very large amounts of
potassium-rich foods or taking potassium supplements
can lead to health problems.
A decreased in amylase may indicate:
 Use of prescription diuretics
 Fluid loss from diarrhea, vomiting, or heavy sweating.
 Using too many laxatives
 Alcohol use disorder (AUD)
 A diet too low in potassium (not common)
c. TOTAL SERUM CALCIUM
- Measures the amount of calcium in the blood.
 NORMAL VALUES: 8.5 – 10.5 mg/dL (2.1-2.6
mmol/L SI units)
INDICATION
 Detect parathyroid gland loss after thyroid or other
neck surgery, as indicated by decreased levels.
MT#: 3
BATCH TOPAZ
LECTURER: MRS. REBECCA DE ASIS
 Evaluate cardiac arrhythmias and coagulation disorders
to determine if altered serum calcium level is
contributing to the problem.
 Evaluate the effects of various disorders on calcium
metabolism, especially diseases involving bone.
 Monitor the effects of renal failure and various drugs
on calcium levels.
 Monitor the effectiveness of therapy being
administered to correct abnormal calcium levels,
especially calcium deficiencies.
CONTRAINDICATION
 You usually don't need any special preparations for a
calcium blood test or a basic or comprehensive
metabolic panel.
 Your provider may ask you to stop taking certain
medicines or supplements, such as vitamin D, to make
sure your test results are accurate.
 If your provider has ordered more tests on your blood
sample, you may need to fast (not eat or drink) for
several hours before the test. Your provider will let you
know if there are any special instructions to follow.
IMPLICATION
An increase in calcium may indicate:
 Acromegaly related to alteration in vitamin D metabolism,
resulting in increased calcium.
 Dehydration related to a decrease in the fluid portion of
blood, causing an overall increase in the concentration of
most plasma constituents.
 Hyperparathyroidism related to increased PTH and
vitamin D levels, which increase circulating calcium levels.
 Milk-alkali syndrome (Burnett syndrome) related to
excessive intake of calcium-containing milk or antacids,
which can increase calcium levels.
 Paget disease related to calcium released from bone.
 Pheochromocytoma. Hyperparathyroidism related to
multiple endocrine neoplasia type 2A [MEN2A] syndrome
associated with some pheochromocytomas; PTH increases
calcium levels.
 Sarcoidosis related to activity by macrophages in the
granulomas that interfere with vitamin D regulation by
converting it to its active form; vitamin D increases
circulating calcium levels.
 Vitamin D toxicity. Vitamin D increases circulating
calcium levels.
A decreased in calcium may indicate:
 Acute pancreatitis. Complication of pancreatitis related to
hypoalbuminemia and calcium binding by excessive fats.
 Alcohol misuse related to insufficient nutrition.
 Hepatic cirrhosis related to impaired metabolism of
vitamin D and calcium.
 Hyperphosphatemia. Phosphorus and calcium have an
inverse relationship.
 Hypoalbuminemia related to insufficient levels of
albumin, an important carrier protein.
 Hypomagnesemia. Lack of magnesium inhibits PTH and
thereby decreases calcium levels.
 Inadequate nutrition
 Magnesium deficiency inhibits release of PTH.
 Malabsorption (celiac disease, tropical sprue,
pancreatic insufficiency) related to insufficient
absorption.
 Vitamin D deficiency (rickets) related to insufficient
amounts of vitamin D, resulting in decreased calcium
metabolism.
d. SERUM PHOSPHORUS TEST
- Measures the amount of phosphorus in the
blood.
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RTRMF – BSN LEVEL III BATCH TOPAZ
NCM 116 (MEDICAL-SURGICAL NURSING II) LECTURER: MRS. REBECCA DE ASIS

- Phosphorus, in the form of phosphate, is  Kidney problems

distributed throughout the body.  Gastrointestinal disorders (such as diabetes)
- Phosphorus is essential for the body's use of CONTRAINDICATION
carbs and lipids.  Taking pain medications and in combination with
- Phosphorus is required for the body to produce enemas and laxatives before the test may alter the
protein for cell and tissue development, result.
maintenance, and repair. IMPLICATION
- Phosphorus aids in the production of ATP, a  An increase in calcium may indicate:
chemical used by the body to store energy, and it  Too much dietary supplements containing magnesium.
interacts with the B vitamins.  Diabetic acidosis
 NORMAL VALUES: 2.4 – 4.1 mg/dL  Tissue trauma
INDICATION  Prolonged use of aspirin
 Hyperparathyroidism  A decreased in calcium may indicate:
 Kidney Disease  Low dietary intake of magnesium
 Too much vitamin D  Crohn’s disease
 Bone Disease  Celiac disease
CONTRAINDICATION  Enteric Fistula
 Specimens should never be collected above an IV  Uncontrolled diabetes
because of the potential for dilution when the  Hypoparathyroidism
specimen and the IV solution combine in the collection  Long-term diuretic use
container, thereby falsely decreasing the result.
 Hemolysis will falsely increase phosphate values. f. SERUM CHLORIDE TEST
 Antacids - Measures the amount of chloride in the blood.
 Vitamin D Supplements, when taken in excess - Chloride maintains proper pH levels, stimulates
 Intravenous Glucose stomach acid needed for digestion.
IMPLICATION  NORMAL VALUES: 8.5 – 10.5 mg/dl (2.1 to 2.6
An increase in calcium may indicate: mmol/L SI units)
 Acromegaly INDICATION
 Acute and chronic kidney disease  Dehydration
 Conditions involving cell lysis  Kidney Disease
 Diabetic ketoacidosis. Acid-base imbalance causes  Metabolic Acidosis
intracellular phosphorus to move into the extracellular CONTRAINDICATION
fluid.  NSAIDs
 Excessive levels of vitamin D. Vitamin d promotes  Diuretics
intestinal absorption of phosphorus and excessive levels IMPLICATION
promotes phosphorus release from bone stores An increase in calcium may indicate:
 Hypocalcemia. Calcium and phosphorus have an  Acute Renal Failure
inverse relationship.  Dehydration
 Hypoparathyroidism  Cushing’s disease
 Increased intake. Overuse of phosphate-containing  Diabetes Insipidus
laxatives or enemas.  Excessive infusion of normal saline
 Lactic acidosis  Salicylate intoxication
 Respiratory Acidosis  Respiratory alkalosis (hyperventilation)
A decreased in calcium may indicate: A decreased in calcium may indicate:
 Acute gout related to decreased circulating calcium in  Addison’s disease
calcium crystal–induced gout; calcium and phosphorus  Burns
have an inverse relationship.  Congestive heart failure
 Alcohol misuse or withdrawal related to malnutrition.  Excessive sweating
 Malabsorption syndrome related to insufficient intestinal  GI loss from severe vomiting and diarrhea
absorption of phosphorus.  Salt-losing nephritis
 Metabolic acidosis  SIADH secretion
 Steatorrhea related to decreased absorption of vitamin D.
 Vitamin D deficiency or resistance related to vitamin D g. TOTAL PROTEIN TEST
deficiency, which reduces intestinal and renal tubular - Measures the sum of all types of proteins in the
absorption of phosphorus. blood. Measuring the total protein level as well
 Severe vomiting or diarrhea related to excessive loss. as the ratio of albumin to globulin can help
 Hyperinsulinism insulin increases intracellular movement detect several kinds of health problems, including
of phosphorus. liver and kidney disease as well as nutritional
 Hyperalimentation therapy related to increased deficiencies.
intracellular movement of phosphorus.  NORMAL VALUES: 6.0 – 8.3 g/dl or 60 to 83 g/L.
 PURPOSE: To check the levels of proteins in the
e. SERUM MAGNESIUM TEST blood. Too much or too little protein can reflect
- Measures the amount of magnesium in the conditions including liver or kidney disease,
blood. infection, inflammation, malnutrition, and cancer.
- Magnesium helps the digestion process by INDICATION
producing enzymes in your saliva that break  Investigate the cause of hypercoagulable states.
down food into tiny pieces. CONTRAINDICATION
 NORMAL VALUES: 1.5 – 2.5 mEq/L  Placement of tourniquet for longer than 1 minute can
INDICATION result in venous stasis and changes in the

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RTRMF – BSN LEVEL III BATCH TOPAZ
NCM 116 (MEDICAL-SURGICAL NURSING II) LECTURER: MRS. REBECCA DE ASIS

concentration of plasma proteins to be measured. - To evaluate possible pancreatic injury

Platelet activation may also occur under these
conditions, causing erroneous results.
 Vascular injury during phlebotomy can activate
platelets and coagulation factors, causing erroneous
results.
 Hemolyzed specimens must be rejected because
hemolysis is an indication of platelet and coagulation
factor activation.
 Incompletely filled tubes contaminated with heparin or
clotted specimens must be rejected.
 Icteric or lipemic specimens interfere with optical
testing methods, producing erroneous results.
 Drugs which may alter test results include aspirin,
corticosteroids, estrogens, penicillin, phenytoin,
procainamide, oral contraceptives, progestins.
 Immunization within the previous 6 months can
increase immunoglobulins.
IMPLICATION
An increase in protein may indicate:
 Chronic infection or inflammation related to increased
production of inflammatory proteins.
 Dehydration related to hemoconcentration.
 Monoclonal and polyclonal gammopathies related to
excessive g-globulin protein synthesis.
 Myeloma related to excessive g-globulin protein synthesis.
 Sarcoidosis related to excessive g-globulin protein
synthesis.
 Some types of chronic liver disease
 Tropical diseases (e.g., leprosy) related to inflammatory
reaction.
 Waldenström macroglobulinemia related to excessive g-
globulin protein synthesis.
A decrease in protein may indicate:
 Administration of IV fluids related to hemodilution.
 Burns related to fluid retention, loss of albumin from
chronic open burns.
 Chronic alcohol misuse related to insufficient dietary
intake, diminished protein synthesis by damaged liver.
 Chronic ulcerative colitis related to poor intestinal
absorption.
 Cirrhosis related to damaged liver, which cannot
synthesize an adequate amount of protein.
 Crohn’s disease related to poor intestinal absorption.
 Glomerulonephritis related to alteration in permeability
that results in excessive loss by kidneys.
 Heart failure related to fluid retention.
 Hyperthyroidism possibly related to increased
metabolism and corresponding protein synthesis.
 Malabsorption related to insufficient intestinal
absorption.
 Malnutrition related to insufficient intake.
 Starvation related to insufficient intake.
Q: What do you call the protein in the blood?
A: Globulin and Albumin. Plasma proteins, such as albumin and
globulin, helps maintain the colloidal osmotic pressure at about
25 mmHg.
h. SERUM AMYLASE TEST
- Measures the amount of amylase in your blood
or urine.
 NORMAL VALUES: 40 – 140 units per liter (U/L)
 PURPOSE:
Serum
- To diagnose acute pancreatitis
- To distinguish between acute pancreatitis
and other causes of abdominal pain that
require immediate surgery.
caused by abdominal trauma or surgery.
Urine
- To diagnose acute pancreatitis when serum
amylase levels are normal or borderline.
- To aid in the diagnosis of chronic
pancreatitis and salivary gland disorders
INDICATION
 Assist in the diagnosis of early acute pancreatitis.
 Assist in the diagnosis of macroamylasemia.
Macroamylasemia is characterized by an increase in
serum amylase activity caused by complex
macromolecules whose enormous size precludes urine
elimination. This does not cause any symptoms.
 Assist in the diagnosis of pancreatic duct obstruction.
 Detect blunt trauma or inadvertent surgical trauma to
the pancreas.
 Differentiate between acute pancreatitis and other
causes of abdominal pain that require surgery.
CONTRAINDICATION
 There are no absolute contraindications but inform the
doctor if you’re on medication or any prevailing medical
conditions or allergies which can alter the test results.
IMPLICATION
An increase in amylase may indicate:
 Acute Pancreatitis
 Pancreatic, ovarian, lung cancer
 Gallbladder
 Gastroenteritis
 Infection or blockage of salivary glands
 Intestinal blockage
 Macroamylasemia
 Pancreatic bile duct
 Perforated ulcer
A decreased in amylase may indicate:
 Damage to the pancreas with pancreatic scarring
i. SERUM LIPASE TEST
- This test is used to measure serum lipase levels.
- It’s most useful when performed with a serum or
urine amylase test.
 NORMAL VALUES:
0 – 160 units per liter (U/L)
(SI = < 2.72 µkat/L).
 PURPOSE: To aid in the diagnosis of acute
pancreatitis.
INDICATION
 Damage to bile ducts
 Gallstones
 Inflammation of the gallbladder (cholecystitis)
 Kidney Failure
 Cirrhosis (liver failure)
CONTRAINDICATION
 Currently, there are no contraindications in getting a
lipase test. But they may ask you to stop taking certain
medications as they may interfere with the results.
IMPLICATION
 High lipase levels suggest acute pancreatitis or
pancreatic duct obstruction.
 After an acute attack, levels remain elevated for up to
14 days.
PREPARATION OF PROCEDURE (ELECTROLYTES, TOTAL
PROTEIN, SERUM AMYLASE, SERUM LIPASE)
 Prepare the materials needed.
 Identify the right patient using the hospital protocol or ask
for their name and date of birth and confirm it with their
wristband.
 Discuss everything about the procedure.

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NCM 116 (MEDICAL-SURGICAL NURSING II) LECTURER: MRS. REBECCA DE ASIS

 Identify the vein that you will be using (most common vein is  Low levels of lymphocytes in your blood are called
the antecubital fossa; however, the median cephalic and lymphocytopenia (or lymphopenia).
median basilic veins are also used).  The flu or other mild infections can cause
 Place a tourniquet and clean the area for 30 seconds with an lymphocytopenia.
alcohol wipe. PREPARATION OF THE PROCEDURE
 Insert the beveled needle at a 30-degree angle into the  Explain to the patient that the Total lymphocyte count
vessel. measures certain white blood cells.
 Once blood is seen in the tubing, use a syringe to drawback.  Tell the patient that this test requires a blood sample.
 Tourniquet is removed and needle is withdrawn.  Explain who will perform the venipuncture and when.
 Properly label the tubes and send them to the laboratory for  Explain to the patient that he may experience slight
analysis discomfort from the tourniquet and the needle
puncture.
NURSING RESPONSIBILITIES (ELECTROLYTES, TOTAL PROTEIN,  Usually there is no special preparation necessary for a
SERUM AMYLASE, SERUM LIPASE) complete blood count. But if your provider ordered
A. PRE-PROCEDURE other tests on your blood sample, you may need to fast
 Report to the doctor any medications, herbs or (not eat or drink) for several hours, usually 6-8 hours,
supplements the patient is/are taking. before the test. Your provider will let you know if there
 No special precautions are needed before testing. are any special instructions to follow.
 Do not drink alcohol before this test. NURSING RESPONSIBILITIES
 Report results after it has been released. A. PRE-PROCEDURE
B. POST-PROCEDURE  Explain test procedure. Explain that slight
 Immediately after blood is drawn, pressure is applied discomfort may be felt when the skin is punctured.
(with cotton or gauze) to the puncture site.  Encourage to avoid stress if possible because
 Instruct patient to resume normal diet and any altered physiologic status influences and changes
medications that were withheld before the test, normal hematologic values.
according to the doctor's order.  Explain that fasting is not necessary. However,
 Blood may collect and clot under the skin (hematoma) fatty meals may alter some test results as a result
at the puncture site; this is harmless and will resolve on of lipidemia.
its own. For a large hematoma that causes swelling and  Apply manual pressure and dressings over the
discomfort. May apply ice or warm compress to puncture site upon removal of needle
dissolve it. B. POST-PROCEDURE
 Monitor the puncture site for oozing or hematoma
j. TOTAL LYMPHOCYTE COUNT formation.
- Total Lymphocyte Count Test measures the level  Instruct to resume normal activities and diet.
of lymphocytes (white blood cell) in the blood.  Encourage to do preventive strategies that help
 NORMAL VALUES reduce the risk of infection such as:
 In adults, 1,000 and 4,800 lymphocytes in  Frequently washing hands with soap or
every 1 microliter of blood. sanitizer
 In children, 3,000 and 9,500 lymphocytes in  Avoiding contact with ill people or sharing
every 1 microliter of blood. objects with them
 About 20% to 40% of your white blood cells  Disinfecting surfaces and commonly used
are lymphocytes. objects
 PURPOSE: To detect lymphocytopenia,
lymphocytosis, infectious mononucleosis, ABSORPTION STUDIES
leukemia, lymphoma
INDICATION 1) D-AXYLOSE ABSORPTION TEST
A decrease in lymphocyte may indicate: - Also called xylose tolerance test
 HIV or AIDs. - Measures the level of D-xylose, a type of sugar, in a
 Tuberculosis or typhoid fever. blood or urine sample.
 Viral hepatitis.  NORMAL VALUES
 Blood diseases such as Hodgkin’s disease Serum
 Autoimmune diseases  > 25 mg/dl (adults)
 immunodeficiency  > 15 mg/dl (children 6 months old)
 Radiation or chemotherapy Urine
An increase in lymphocyte may indicate:  > 4g (5-hour urine collection)
 Hepatitis  PURPOSE:
 Syphilis  To help diagnose problems that prevent the small
 Mononucleosis intestine from absorbing nutrients in food.
 Underactive thyroid  To screen for intestinal malabsorption of
 Infections carbohydrates.
 Blood cancers INDICATION
CONTRAINDICATION Assist in the diagnosis of malabsorption syndromes:
 There are no absolute contraindications but inform the  Celiac Disease
doctor if you’re on medication or any prevailing medical  Cystic Fibrosis
conditions or allergies which can alter the test results.  Persistent Diarrhea
IMPLICATION  Unexplained Weight Loss or
 High levels of lymphocytes in your blood are called  The Inability to Gain Weight
lymphocytosis. CONTRAINDICATION
 Lymphocytosis is usually due to an infection or illness.

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There is no absolute contraindication to this test but inform the
doctor about the current medications taken as some may
interfere with the test result.
IMPLICATION
Low Results:
 Celiac Disease. An inherited autoimmune disorder that causes
a reaction to the body when eating the protein, gluten. This will
damage the small intestine so the person with this disease is
able to take in nutrients.
 Crohn’s Disease or also called regional enteritis or ileitis is a
type of inflammatory bowel disease that causes swelling of the
tissues of the digestive tract. This may cause lack of essential
nutrients including iron, calcium, and vitamin D due to
malabsorption, limited diet, and diarrhea.
 Hookworm. The larvae infect the small intestine after being
ingested. They mature into adult worms and dwell there for a
year or longer. The worms cling to the intestinal wall and
sucking blood, causing iron deficiency anemia and protein loss,
and release powerful digestive enzyme inhibitors, which may
lead to malabsorption. Malnutrition is exacerbated by
malabsorption, which results in hypoproteinemia. In the feces,
adult worms and larvae are expelled.
 Giardiasis. Giardiasis is caused by the protozoan parasite
Giardia. In humans, the parasite clings to the lining of the small
intestine, causing diarrhea and preventing the body from
absorbing fats and carbohydrates from digested meals. This
can cause weight loss and prevent the body from absorbing
nutrients such as fat, lactose, vitamin A, and vitamin B12. Some
Giardia infections cause no symptoms at all.
PREPARATION OF PROCEDURE
 For 24 hours before the test, do not eat any food that is high
in pentose, a type of sugar similar to D-xylose. Examples are
fruits, jams, jellies, and pastries.
 NPO (not eat or drink) 8 hours before the test is needed.
 Children younger than 9 years old should fast for 4 hours
before the test.
 Certain medications such as indomethacin, aspirin, atropine,
isocarboxazid, and phenelzine can also interfere with the
test result. Thus, temporarily stopping the intake of these
medications is also done before the test. However, this
should only be done after talking to your health care
provider.
 The test requires either a blood or urine sample, and there
are many ways to perform the test. However, a typical
procedure will require the patient to drink 8 ounces (240 ml)
of water containing 5 teaspoons (25 g) of a sugar called D-
xylose.
 For the blood test, the sample may be collected at 1 and 3
hours after drinking the liquid. Blood is drawn usually from
the arm using a needle.
 For a urine test, all urine excreted within the next 5 hours
from taking the liquid will be collected.
NURSING RESPONSIBILITIES
A. PRE-PROCEDURE
 Explain the test procedure to the patient and
encourage them to ask any questions that they may
have.
 Instruct the patient to not eat any food high in pentose
for 24 hours before the test.
 For adults, instruct them to fast or not ingest any food
and drink for 8 hours before the test.
 For children younger than 9 years old, instruct their
parents to let the child fast only for 4 hours before the
test.
 Instruct patients taking certain medications such as
indomethacin, aspirin, atropine, isocarboxazid, and
phenelzine to consult their doctor regarding
temporarily stopping the intake of the said medications
before the test.
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 For blood tests, inform the patient that when the
needle is inserted, they may feel moderate pain, a
pricking, or a stinging sensation. Afterwards, throbbing
may also be felt.
 For urine tests, instruct the patient that they should
keep the container for the specimen in the refrigerator
during the collection period. Instruct them to also not
get the urine sample contaminated with any foreign
materials such as toilet paper, hair, or menstrual blood.
B. POST-PROCEDURE
 After the test, instruct the patient to resume normal
diet and any medication that were withheld before the
test, according to the doctor's order
 The test takes time to complete and requires more fluid
output. Instruct the patient to have sufficient fluid
intake once it’s finished.
 For the blood test:
 Immediately after blood is drawn, pressure is
applied (with cotton or gauze) to the puncture site.
 In cases of large hematoma at the puncture site
that causes swelling and discomfort, apply cold
compress to the area.
2) FECAL ANALYSIS (OCCULT, OVA, AND PARASITE)
Basic examination of the stool includes inspecting the specimen
for consistency, color, and occult (not visible) blood. Additional
studies, including fecal urobilinogen, fecal fat, nitrogen,
Clostridium difficile, fecal leukocytes, calculation of stool
osmolar gap, parasites, pathogens, food residues, and other
substances, require laboratory evaluation.
a. FECAL OCCULT BLOOD TESTING
- is one of the most commonly performed stool
tests. It can be useful in initial screening for
several disorders, although it is used most
frequently in early cancer detection programs.
- FOBT can be performed at the bedside, in the
laboratory, or at home. Probably the most widely
used in-office or at-home occult blood test is the
Hemoccult II because it is inexpensive, noninvasive,
and carries minimal risk to the patient. However, it
should not be performed when there is
hemorrhoidal bleeding
INDICATION
 Anemia
 Colon cancer screening. Colon cancer is the third most
commonly diagnosed cancer worldwide. It occurs in all
populations regardless of race, ethnicity, gender, or
socioeconomic status. The absence of appropriate
screening leads to the delay of both diagnosis and
treatment. Fecal occult blood testing is one of many
methods used for colon cancer screening, and its use is
valid in asymptomatic patients. It helps improve the
detection of early-stage cancers by guiding patient
selection for follow-up tests such as colonoscopies.
 Concern for gastrointestinal bleeding
 Help discriminate irritable bowel syndrome (IBS) from
inflammatory bowel disease (IBD), which is likely to
yield a positive test result.
CONTRAINDICATION
 Menstruation
 Bleeding from hemorrhoids
 Bleeding from the urinary tract
PREPARATION OF THE PROCEDURE
 Various foods, dietary supplements and medications
can affect the results of some fecal occult blood tests —
either indicating that blood is present when it isn't
(false-positive) or missing the presence of blood that's
actually there (false-negative). Your doctor may ask you
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to avoid certain foods or medicines. To ensure accurate
test results, follow your doctor's instructions carefully.
 Starting 3 days before you begin collecting your stool
samples, avoid:
 Red meat, such as beef, lamb, or liver
 Raw fruits and vegetables
 Vitamin C, such as fruit juices with vitamin C and
vitamin C supplements in doses higher than 250
mg per day
 Antacids (medications to relieve heartburn or
stomach pain)
 Medications to stop diarrhea (loose or watery
bowel movements)
 Iron supplements
You can start eating these things again after your FOBT.
 Most people will need to stop taking aspirin, other
nonsteroidal anti-inflammatory drugs (NSAIDs), and
vitamin E before and during the 3-day collection period.
These medications may cause small amounts of blood
to appear in your stool.
 Your healthcare provider will give you the resource
Common Medications Containing Aspirin, Other
Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or
Vitamin E, which lists common medications that
have these products in them. It also lists
medications you can take instead.
 If you take aspirin to prevent a heart attack or
stroke, don’t stop taking it unless your healthcare
provider tells you to.
 If you have any of the following during the 3 days,
you’re planning to collect your stool samples, talk with
your healthcare provider. They may tell you to wait to
collect your samples because this could alter the
results.
 Menstrual period
 Bleeding hemorrhoids
 Blood in your urine
Collecting the Specimen:
1. You will need the following supplies:
 Hemoccult slide
 Applicator stick
 A clean, dry container
 Trash can
2. Gather your supplies. Place them in the bathroom
where you can reach them easily.
 Remove the Hemoccult slide from its paper
envelope. Set the envelope aside.
 Don’t set the Hemoccult slide or applicator stick on
the edge of the sink, bath tub, or toilet tank. They
shouldn’t get wet.
 Always keep the Hemoccult slides at room
temperature, away from heat and light.
 Make sure your name, date of birth, and Medical
Record Number (MRN) are on the card. If this
information isn’t on the card, write it in.
3. Open the large front flap of the Hemoccult slide. You
may notice a light blue discoloration on the paper in
the squares above boxes A and B. The discoloration
won’t affect the test.
4. Sit on the toilet like you usually do to have a bowel
movement (poop). Use the clean, dry container to
catch your stool before it touches the water in the
toilet.
5. Take a sample of your stool with one end of an
applicator stick. Apply a thin smear of stool inside the
square marked “A” on the Hemoccult slide.
6. Use the stick to collect a second sample from a
different part of your stool. Apply a thin smear of stool
inside the square marked “B”.
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LECTURER: MRS. REBECCA DE ASIS
7. Throw out the stick in the trash.
8. Close the cover of the Hemoccult slide and put it back
into its paper envelope. Don’t put it in anything
waterproof, such as a plastic bag. Store it at room
temperature, away from light, children, and pets
9. Empty the container that holds the stool into the toilet.
Flush the toilet.
10. Wash your hands. Wet your hands with warm water
and then rub your hands with soap for at least 20
seconds. Rinse your hands.
11. Repeat these steps to collect your samples on days 2
and 3. Write the date of collection next to each sample.
b. OVA AND PARASITE TESTING
- looks for parasites and their eggs (ova) in a
sample of your stool.
- used to find out if parasites are infecting your
digestive system. If you've already been
diagnosed with a parasite infection, the test may
be used to see if your treatment is working.
- A parasite is a tiny plant or animal that gets
nutrients by living off another creature. Parasites
can live in your digestive system and cause illness
and are known as intestinal parasites. Intestinal
parasites affect tens of millions of people around
the world. They are more common in countries
where sanitation is poor.
INDICATION
Parasitic infections are exceedingly common worldwide. It has
been estimated that nearly 25% of the population in less
developed countries harbor the roundworm Ascaris
lumbricoides. Ova and Parasite tests are indicated to the
following precursors below:
 Persistent or recurring diarrheal conditions, including
patients with bloody diarrhea
 Chronic bowel dysfunction or persisting irritable bowel
like symptoms, particularly if it can be related to travel
or rural residence
 Variety of systemic conditions such as anemia, weight
loss, chronic cough, particularly if associated with past
ingestion of potentially contaminated food;
eosinophilia and/or serum IgE elevation
 Persistent diarrhea with exposure to infants in day care
centers (associated with giardia lamblia,
cryptosporidium parvum); chronic diarrhea and history
of HIV infection or other risk factors causing
immunosuppression
 Chronic diarrhea and a history of raw fish ingestion.
 Symptomatic patients with a history of extended
residence in developing areas of the world.
 Diarrhea is a man who has sex with a man (MSM). MSM
status is associated with Giardia Lamblia and
Entamoeba Histolytica.
Make sure if you collect your specimen especially for amoeba
make sure it is the mucoid part of the stool. Usually if infants or
children an diaper man la an gindadala para madali la an
pagkuha.
CONTRAINDICATION
Administration of:
 Barium
 Bismuth
 Castor oil
 Mineral oil
 Tetracycline therapy
 Anti-amoebic drugs
 Pregnancy
 Ulcerative colitis
 Cardiovascular disease
 Child younger than five years of age
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 Appendicitis or possible appendicitis
PREPARATION OF THE PROCEDURE
In most cases, an O&P test doesn’t require special
preparation. In some cases, your doctor may ask you to
avoid using certain products before collecting a sample of
your stool. For example, they may ask you to avoid taking:
 Laxatives
 Antidiarrheal medications
 Antibiotics
 Contrast dyes, which are used in imaging studies and x-
ray
Collecting the Specimen
Your doctor or lab will send you home with a collection
bottle and a toilet pan. The bottle often has a type of spoon
attached to the lid that helps you collect stool.
1. Place the pan in your toilet and use the washroom as
normal. If they didn’t give you a pan, you can tape a
plastic bag to the toilet.
2. Put on rubber gloves and collect a sample as directed.
Make sure there's no urine, water, toilet paper, or
wipes in the sample.
3. Seal the container and label it.
4. Empty the pan and discard it and your gloves.
5. Wash your hands.
NURSING RESPONSIBILITIES
A. PRE-PROCEDURE
 Discuss the test and the procedure with the patient.
Allow him/her to ask questions.
 Instruct the patient to maintain a high-fiber diet and
avoid eating food such as red meat, turnips and
horseradish 2-3 days before the test. The diet will allow
the patient to defecate and not be constipated. Avoiding
these are important because it can create false results.
 Ask the patient if he/she is taking any current
medications. Some medications can change test results of
test. (Barium (make stool milky white), and Pepto Bismol,
antacid medication used to treat temporary discomforts of
the stomach and gastrointestinal tract, such as nausea,
heartburn, indigestion, upset stomach, and diarrhea, (can
cause stool to be black or grayish black).
 Inform the patient how to catch stool sample with a
clean dry container or clean material. Patient can also
use clean gloves when collecting stool sample. Patient
should obtain at least 2-5 grams of stool sample.
 Stress the importance of not contaminating the
specimen. Do not mix with urine or toilet water. Inform
the patient to urinate before taking a sample. This is
why a clean container or material is used to avoid altering
the results.
 Instruct the patient to immediately submit a stool
sample. Best time to submit is within 1-2 hours. This is
important because if it is not fresh, bacteria can multiply
which alter the results of the test.
B. POST-PROCEDURE
 Inform the patient that results may take 1-2 days.
 Document date, time and any unusual characteristics
of stool sample.
 Inform patients that follow up tests may be needed
and medication if there are abnormal results.
3) QUANTITATIVE FECAL FAT STUDIES
- Fecal fat is the gold standard test for diagnosing
steatorrhea (malabsorption). If stool appears yellow or
greasy-looking, it contains too much fat. The three
major causes of steatorrhea, which is a pathologic
increase in fecal fat, are impairment of intestinal
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absorption, deficiency of pancreatic digestive enzymes,
and deficiency of bile.
- You can have 2 types of fecal fat tests: qualitative and
quantitative. For a qualitative test, the lab checks a
single stool sample under a microscope to count the
number of fat globules, or droplets. For a quantitative
test, you collect stool samples usually over a period of
3 days. These samples are measured to find the total
amount of fat in your stool each day.
- Lipids included in the microscopic examination of feces
are neutral fats (triglycerides), fatty acid salts (soaps),
fatty acids, and cholesterol. The presence of these
lipids can be observed microscopically by staining with
Sudan III, Sudan IV, or oil red O dye. The staining
procedure consists of two parts: the neutral fat stain
and the split fat stain for fatty acids.
INDICATION
 Malabsorption Disorders
 Celiac Diseases
 Crohn’s Disease
 Cancer
CONTRAINDICATION
 This test should not be performed in individuals who are
taking fat-blocking medications (i.e., Orlistat) or mineral oil
supplementation
 This test can also be impacted in individuals who have
known gastrointestinal co-morbidities (i.e., gastric bypass,
short bowel syndrome).
 Patients on a fat-controlled diet of lesser than 100 grams of
fat per day for several days prior to sample collection.
Inadequate ingestion of sufficient fat in the diet or
incomplete sample collection may result in falsely negative
results
 Use of: laxatives, synthetic fat substitutes, fat-blocking
nutritional supplements, or mineral oils, suppositories,
administration of barium contrast prior to sample collection,
or sample contamination with diaper rash ointment
PREPARATION OF THE PROCEDURE
How to Prepare for the Test
 Have your child eat foods they normally eat. Unlike adults
who get this test, children do not need to load up on fatty
foods in advance.
 Do not give them laxatives that contain oil or mineral oil. Do
not give suppositories.
 For the test to be accurate, do not put any lotions or
ointments on their bottom. However, if your child has a
diaper rash, it is OK to use cornstarch, petroleum jelly. It
does not affect the result
Materials to Prepare
 The right container – it looks like a paint can.
 Several tongue depressors or plastic spoons
 For an older child, a toilet hat (Picture 1) or plastic wrap
 A label to put on the container
 Disposable exam gloves
How to Label the Specimen
 Child’s full legal name – complete first and last names,
correctly spelled
 One of the following unique identifiers:
 Date of birth
 Patient’s ID number
 Date and Time of collection
How to Collect the Specimen
 Collect all stool for 3 days, even if your child has loose,
runny stools or diarrhea.
 Wash hands and put on gloves before handling your child’s
stool. Wash hands after disposing used gloves. Stool can
contain germs that spread
 Use a wooden tongue depressor or spoon to place the stool
specimen in the can.
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 Close the lid of the can tightly after each collection. Put the
can in a clean plastic bag before you put it in the
refrigerator. If you prefer, you may keep the can in a cooler
on ice. Keep the specimen cool until you bring it to the lab.
NURSING RESPONSIBILITIES
A. PRE-PROCEDURE
 Assess the patient’s level of comfort. Collecting stool
specimens may produce a feeling of embarrassment
and discomfort to the patient.
 Ensure the patient has a diet containing 100–150 g of
fat, 100 g of protein, and 180 g of carbohydrate for 6
days before and during the test. Unfortunately, the
dietary fat intake during the testing period influences
the outcome. The clinical usefulness of the test can
thereby be affected.
 Explain the purpose of the test, interfering factors, and
the procedure for the collection of specimens. As
appropriate, provide the required stool collection
container, plastic bag to store container in refrigerator
during the collection period, and specimen collection
instructions
 Do not allow patients to have laxatives for 3 days
before the test.
B. POST-PROCEDURE
 Instruct patient to do handwashing. Allow the patient to
thoroughly clean his or her hands and perianal area
 Resume normal diet.
 Record appearance, color, and odor of all stools in
persons suspected of having steatorrhea. The typical
stool in patients with this condition is foamy, greasy,
soft, pasty, and foul smelling.
 Counsel patient concerning test outcome and possible
need for further testing (e.g., colonoscopy) and
treatment (e.g., elimination of certain foods from the
diet).
OTHER LABORATORY STUDIES
IMING STUDIE
2) FECAL LEUKOCYTES
- Microscopic examination of the feces for the presence
of white blood cells (leukocytes) is performed as a
preliminary procedure in determining the cause of
diarrhea. Leukocytes are normally not present in stools
and are a response to infection or inflammation.
Neutrophils are seen in the feces in conditions that
affect the intestinal wall. The greater the number of
leukocytes, the greater the likelihood that an invasive
pathogen is present. Since it aton is quantitative(?) amo
ito macollect la hin stool sample in a period of 3 days amo
ito igmemeasure hiya kada adlaw. So for comparison,
makaka usa ka la liwat kukuha hin stool sample.
INDICATION
 To rule out the cause of inflammatory diarrhea. If a person
experiences diarrhea, there is probably a causative agent.So the
purpose of fecal leukocytes is to determine the causative agent.
For other disorders, e.g. ulcerative colitis there is a prolonged
inflammation of the GI tract that is why we determine what
bacteria is present.
 Bacillary Dysentery. To determine bacteria present in feces
 Irritable Bowel Disorder
CONTRAINDICATION
 Patients taking antibiotics can affect the result – false
negative result
PREPARATION OF THE PROCEDURE
Methylene Blue Stain for Fecal Leukocyte
- In an examination of preparations under high power, as few
as three neutrophils per high-power field can be indicative
of an invasive condition. Using oil immersion, the finding of
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LECTURER: MRS. REBECCA DE ASIS
any neutrophils has approximately 70% sensitivity for the
presence of invasive bacteria.
1. Verify Doctor’s Order
2. Place mucus or a drop
of liquid stool on a slide
3. Add two drops of
Loffler methylene blue
4. Mix with a wooden
applicator stick
5. Allow to stand for 2 to 3
minutes
6. Examine for neutrophils
under high power
- A positive or abnormal test result means that white blood
cells were found in your stool sample. That means you have
inflammation in your digestive tract. This information helps
rule out conditions that don't cause inflammation, including
viral infections, certain bacteria, and most parasites. Other
tests can help find out what is causing your illness
- A negative or normal test result means that no white
blood cells were found in your stool sample. That may mean
that inflammation isn't causing your illness. But a normal
test result can't rule out conditions that cause inflammation.
That's because white blood cells don't last long in a stool
sample.
NURSING RESPONSIBILITIES
A. PRE-PROCEDURE
 Explain the purpose of the test and the collection
procedure.
 Ensure that the patient avoids barium procedures and
laxatives for 1 week before the test.
 Withhold antibiotic therapy until after collection. Since
it can alter the results.
B. POST-PROCEDURE
 Interpret abnormal test results. Monitor for diarrhea.
 Counsel patients concerning the need for follow-up
tests (stool culture) and treatment (drugs [e.g.,
antibiotics]).
3) STOOL ELECTROLYTE TEST
- This test measures the concentration (osmolality) of
certain particles in a sample of your watery stool. The
sample should only be watery as other forms of stool will
be considered invalid. The amount of sodium,
potassium, and other substances in your stool can
affect its consistency.
- Normal colon function involves absorption of fluid and
electrolytes.
- Stool electrolyte tests are used to assess electrolyte
imbalance in patients with diarrhea. Stool electrolytes
must be evaluated along with the serum and urine
electrolytes as well as clinical findings in the patient.
Stool osmolality is used in conjunction with blood
serum osmolality to calculate the osmotic gap and to
diagnose intestinal disaccharide deficiency.
 NORMAL VALUES
 Sodium: 5.9 - 9.8 mEq/24 hrs. or 1.8 - 9.8
umol/day
 Chloride: 2.5-3.7 mEq/24 hrs or 2.5-3.5 umol/day
 Potassium: 15.7-20.7
 Osmolality: 275-295 mOsm/kg
 Osmotic Gap: <50 mOsm/kg
o Osmotic Gap = 290 mOsm/kg - 2(stool Na
[mmol/L] + stool K [mmol/L])
INDICATION
 Used to evaluate electrolyte loss in diarrhea and
malabsorption states.
 Used to assess electrolyte imbalance in patient with
diarrhea.
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 Stool electrolytes must be evaluated along with the serum and
urine electrolytes as well as clinical findings in the patient.
CONTRAINDICATION
No specific contraindications but it is not recommended to the
following patients:
 Patients receiving perchlorate medication. This is due to an
interference of perchlorate ions with chloride ion-selective
electrode determination which results to falsely high
chloride values.
 Patients taking liposomal drug formulations containing
phospholipids such as Ambisome which may be hydrolyzed
in the test due to the acidic reaction pH and thus lead to
elevated electrolyte (phosphate) results.
 Patients who had barium procedures, laxatives, or enemas.
PREPARATION OF THE PROCEDURE
How to prepare for the test:
 If the healthcare provider suspects that a certain food is
causing diarrhea to the patient, they may need to fast
before the test.
 Ask about all medicines, herbs, vitamins, and supplements
that they are taking. This includes medicines that don't need
a prescription and any illegal drugs they may use.
 Inform the patient to not use or have barium procedures,
laxatives, or enemas for 1 week prior to start of, or during,
collection of specimens.
Materials to prepare:
 Plastic leak-proof Stool containers- 24-, 48-, and 72-Hour Kit.
Note: A random collection is required, but may be submitted
in containers provided for timed collection
How to label specimen:
 Child’s full name – complete first and names, correctly
spelled
 One of the following unique identifiers:
 Date of birth
 Patient’s ID number
 Date and Time of collection
Interfering factors
 This test is only clinically valid if performed on watery
specimens. In the event a formed fecal specimen is
submitted, the test will not be performed.
 Stool cannot be contaminated with urine.
 Surreptitious addition of water in the stool specimen
considerable lowers stool osmolality. Stool osmolality must
be less than 240 mOsm/kg to calculate the osmotic gap.
Collect Stool Specimens at Home Instructions
 Urinate before collecting the stool so that you do not get
any urine in the stool sample. Do not urinate while passing
the stool.
 Stool can contain material that spreads infection, so wash
your hands before and after you collect the specimen.
 Collect a random or 24-hour stool specimen. Only watery
stool should be collected.
 With diarrhea, a plastic bag taped to the toilet seat may
make the collection process easier; the bag is then placed in
a sterile cup.
 Do not collect the sample from the toilet bowl.
 Do not mix toilet paper, water, or soap with the sample.
 Place the lid on the container and label it with your name
and the date the stool was collected.
 Keep the specimen covered and refrigerated.
NURSING RESPONSIBILITIES
A. PRE-PROCEDURE
 Explain purpose of test, procedure for stool collection,
and interfering factors.
 Perform health history. Ask for the dietary intake of the
patient.
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BATCH TOPAZ
LECTURER: MRS. REBECCA DE ASIS
 Ensure the patient avoids barium procedures and
laxatives for 1 week before collection of specimens.
 Ensure that the patient's name is correctly written on
the stool/specimen.
 Name of the patient
 Age of the patient
 Date and Time of collection
 Instruct patient to collect 10 ml-20 ml liquid.
 Attend to the patient's concern.
B. POST-PROCEDURE
 Instruct patient to do handwashing. Allow the patient to
thoroughly clean his or her hands and perianal area.
 Resume activities. The patient may resume his or her
normal diet and medication therapy unless otherwise
specified.
 Interpret abnormal test outcomes. Monitor diarrhea
episodes and record findings. Assess patient for
electrolyte imbalances and counsel regarding further
testing and treatment.
4) EXFOLIATIVE CYTOLOGIC ANALYSIS
- Malignant cells exfoliate more readily than normal cells.
Exfoliative Cytologic Analysis is a medical procedure
performed to distinguish benign from malignant tissue
cells.
- Cells are harvested by rubbing or brushing a lesional
tissue surface.
- Includes cells harvested from mucus membranes and
body fluids, and sent to the laboratory for analysis.
- Stomach contents may also be examined for the
presence of Helicobacter pylori that can cause gastritis
and peptic ulcer disease.
INDICATION
 Multiple or large red lesions
 Lesions located in regions presenting surgical difficulty in
the mouth and in the GIT
 Hesitancy on the dentist’s or patient’s part for biopsy
 Older people who cannot tolerate surgical procedures may
be due to fear and lower pain threshold
 Follow-up for detection of recurrent cancer. Recurrent
cancers such as: Oral Cancer and Gastric Cancer
 Unavailability of embedding and sectioning technology
CONTRAINDICATION
 Leukoplakia is a condition where thickened, white patches
form on the gums, the insides of the cheeks, the bottom of the
mouth and, sometimes, the tongue. These patches can't be
scraped off.
 Homogeneous leukoplakia. The lesion is uniformly white
and the surface is flat or slightly wrinkled.
 Non-homogeneous leukoplakia. There is a mixed white-
and-red color (“erythroleukoplakia”); the surface may be
flat, speckled or nodular.
 Keratotic lesions formed from overgrowth and thickening of
the cornified epithelium. A keratin is a fibrous sulfur-containing
protein that is the primary component of the epidermis, hair,
nails, enamel of teeth, and horny tissues. The protein is
insoluble in most solvents including gastric juice.
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 Exophytic lesions pertaining to growth of a tumor outward.
The proliferating on the exterior or surface epithelium of an
organ or other structure in which the growth originated.
 Submucosal lesions are lesions that originate in the
submucosa, a dense network of connective tissue, blood vessels,
lymphatics, neurons, and esophageal glands, primarily
functions as a secretory layer.
 Condyloma acuminata is a manifestation of human
papillomavirus (HPV) infection. The condition is characterized
by skin-colored, fleshy papules.
If exfoliative cytologic analysis is performed with endoscopy,
the following are the contraindications:
 Acute mycocardial infarction
 Peritonitis
 Patients taking anticoagulants (e.g., aspirin, heparin,
warfarin)
PREPARATION OF THE PROCEDURE
The examination is not uncomfortable for the patient and can be
repeated many times. When properly done, the procedure
provides the most definitive method for the preoperative
diagnosis of cancer. The procedure for obtaining malignant cells
from the GI and digestive system is relatively simple. In
preparation for the procedure.
 The stomach should be empty. Advise patient to avoid eating
after midnight (12:00 am) in preparation for the procedure
 If the patient has gastric retention, perform gastric lavage or
gastric irrigation the night prior to procedure. If the patient
has gastric retention, a preliminary washing of the stomach
should be done the night before. The only adequate way to
cleanse the stomach is to use an Ewald tube and a bulb or
syringe of 100 cc capacity. Several hundred cubic centimeters of
normal saline is introduced through the Ewald tube into the
stomach and then rapidly aspirated. Each syringeful of saline
solution should be injected rapidly in order to loosen barium
and retained food from the gastric mucosa. Sometimes as
much as 2500 cc of saline solution will be required to
completely clean a dilated stomach. If the patient's head and
chest are lowered over the edge of the bed while irrigation and
drainage are being done, the wash will be improved. The
position of the Ewald tube should also be changed frequently.
The use of a small Levin tube and overnight suction will not
empty the stomach adequately.
 Prepare necessary materials for the procedure such as the
container or vial, brush, clear glass slides and marker or
marker for label. Preferred container tube are CytoLyt
specimen pot. Disposable brush(es) in clean black-top tube
containing saline or other balanced electrolyte solution.
 Assist the patient in changing into hospital gown and in lying
into the examination bed or table.
NURSING RESPONSIBILITIES
A. PRE-PROCEDURE
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BATCH TOPAZ
LECTURER: MRS. REBECCA DE ASIS
 Informed consent. Obtain an informed consent properly
signed.
 Educate client. Explain procedure and allow the patient to
ask questions.
 Maintain on NPO. Instruct the patient to not eat or drink
after midnight prior to the procedure. If, because of
retention, the possibility of contamination by food is
present, the stomach should be cleansed prior to the fast
by aspiration with an Ewald tube and washing the
esophagus with Ringer’s solution.
 Assist with mouth care. Assist with mouth care if needed,
before collection so as not to contaminate the specimen by
secretions.
B. POST-PROCEDURE
 Instruct the patient to report any problems
encountered after the procedure.
 Answer any questions or fears by the patient or family.
Anxiety related to the pending test results may occur.
 Inform the patient that test results will take about two
to three days and a follow-up visit may be necessary,
especially if results are abnormal.
 Discussion of the implications of abnormal test results
on the patient’s lifestyle may be provided to the
patient.
5) GASTRIC ANALYSIS
- is a medical procedure used to examine the secretions
and other liquid substances present in the stomach.
- Gastric fluid analysis requires a sample of secretions
present in the stomach (Hydrochloric acid and pepsin)
which is obtained by means of a nasogastric tube passed
through the nose and into the stomach.
- This test can aid in the diagnosis of duodenal cancer,
gastric carcinoma, and pernicious anemia.
- Gastric analysis consists of:
1. the basal cell secretion test (Basal Gastric Analysis)
2. the gastric acid stimulation test. (Stimulation Gastric
Analysis)
 Basal Cell Secretion Test
- NGT attached to a suction
- Stomach Contents being collected every 15 minutes
for 1 hour then analyzed.
 Gastric Acid Stimulation Test
- measures the amount of gastric acid produced after
receiving gastric stimulants (pentagastrin and
betazole or histalog).
RESULTS
 Markedly Increased: Zollinger-Ellison Syndrome
 Moderately Increased: Duodenal Cancer
 Decreased: Gastric Ulcer or Gastric Carcinoma
INDICATION
 To determine the cause of Recurrent Peptic Ulcer Disease.
To detect Zollinger-Ellison (ZE) syndrome: ZE syndrome is a rare
disorder in which multiple mucosal ulcers develop in the
stomach, duodenum, and upper jejunum due to gross
hypersecretion of acid in the stomach. The cause of excess
secretion of acid is a gastrin-producing tumor of pancreas.
Gastric analysis is done to detect markedly increased basal and
pentagastrin stimulated gastric acid output for diagnosis of ZE
syndrome
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stricture narrows the esophagus, making it more difficult for

food to travel down the tube.

 To determine the cause of Raised fasting serum gastric level.

 Esophageal Varices are abnormal, enlarged veins in the tube
Hypergastrinemia can occur in achlorhydria, Zollinger-Ellison
that connects the throat and stomach (esophagus). This
syndrome, and antral G cell hyperplasia
condition occurs most often in people with serious liver
 To support the Diagnosis of Pernicious Anemia. Pernicious
diseases. Esophageal varices develop when normal blood flow
anemia is caused by defective absorption of vitamin B12 due to
to the liver is blocked by a clot or scar tissue in the liver.
failure of synthesis of intrinsic factor secondary to gastric
mucosal atrophy. There is also absence of hydrochloric acid in
the gastric juice (achlorhydria). Gastric analysis is done for
demonstration of achlorhydria it facilities for vitamin assays
and Schilling’s test are not available (Achlorhydria by itself is
insufficient for diagnosis of PA).

 Esophageal Malignancy is a disease in which malignant

(cancer) cells form in the tissues of the esophagus. Smoking,
heavy alcohol use can increase the risk of esophageal cancer.

 To distinguish between benign (not cancerous) and

malignant (cancerous) tumors. Hypersecretion of acid is a
feature of duodenal peptic ulcer, while failure of acid secretion
(achlorhydria) occurs in gastric carcinoma.
 To measure the amount of acid secreted in a patient with
symptoms of peptic ulcer dyspepsia but normal X-ray
findings. Excess acid secretion in such cases is indicative of
duodenal ulcer. However, hypersecretion of acid does not
always occur in duodenal ulcer.  Aortic Aneurysm is called “The Silent Killer” because it can take
 To decide the type of surgery to be performed in a patient people’s lives without any warning signs. It is the bulge or
with peptic ulcer. Raised basal as well as peak acid outputs swelling in the wall of the aorta, the largest artery in the body
indicate increased parietal cell mass and need for gastrectomy. that carries blood from the heart to the rest of the body.
Raised basal acid output with normal peak output is an
indication for vagotomy (cutting one of the branches of your
vagus nerve).

 Cardiac Arrhythmia. An arrhythmia is a problem with the rate

or rhythm of your heartbeat. It means that your heart beats too
quickly, too slowly, or with an irregular pattern. The most
common type of arrhythmia is atrial fibrillation, which causes
an irregular and fast heartbeat.
 Congestive Heart Failure is a long-term condition that
happens when your heart can’t pump blood well enough to give
CONTRAINDICATION
your body a normal supply. It means that the heart muscle has
 Esophageal Stricture is an abnormal tightening or narrowing
become less able to contract over time or has a mechanical
of the esophagus. The esophagus is a muscular tube that
problem that limits its ability to fill with blood. As a result, it
connects the throat to the stomach, carrying food and liquid. A

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can’t keep up with the body’s demand, and blood returns to the C. POST-PROCEDURE
heart faster than it can be pumped out and it becomes After having collected gastric juice under basal conditions
congested, or backed up. This pumping problem means that augmented or stimulated gastric analysis may be carried
not enough oxygen-rich blood can get to the body’s other out as follows:
organs.  After the procedure the inserted tube is removed
PREPARATION OF THE PROCEDURE slowly, check for any possible complications after the
 Secure consent from the patient. procedure. Such complications as vomiting, nausea,
 The client should be on NPO for 8 hours to 12 hours prior to abdominal distention, and/or pain can be possible.Sore
the test. throat also is likely to occur. Instruct the patient to report
 Explain the purpose and procedure of the tube or tubeless any problems encountered after the procedure. The risk
gastric analysis test to the client. Check with the healthcare that the gastric tube may be improperly inserted, entering
providers before you give your explanation to find out whether the trachea instead of the esophagus. If this happens, the
he or she will perform both basal and stimulation gastric patient will have difficulty breathing and/or coughing
analysis. spells. Also, a patient who finds it difficult to swallow the
 Tell the client how the nasogastric tube is inserted (i.e. the tube and has an overactive gag reflex may witness a
tube is lubricated and passes through the nose or mouth) and transient rise in blood pressure (due to anxiety).
that he or she will be asked to swallow or will be given sips of  After completion of basal and stimulated gastric juice
water as the tube is passed into the stomach. The end of the collection, specimen are sent to the laboratory for
tube may be attached to low intermittent suction evaluation of following values
 Notify the healthcare provider if the client is receiving the  After the procedure and the result, the patient may
following categories of drugs; antacids, antispasmodics, seek consultation with a gastroenterologist. A follow-up
anticholinergics, adrenergic blocker, cholinergics and visit may be necessary, especially if results are abnormal
steroids. Drugs from the above groups and a few others should with the gastric test analysis report to understand
be withheld for 24-48 hours before the gastric analysis. Drugs whether he/she is suffering from a problem of high
that cannot be withheld should be listed on the request slip. acidity or not.
And since the patient is on NPO you should not really give the
drug.
 Monitor vital signs. Observe for possible side effects for use END
of stimulants (i.e. dizziness, flushing, tachycardia, headache
and a lower systolic blood pressure)
 Encourage the client to express his or her concerns or fear.
NURSING RESPONSIBILITIES
A. PRE-PROCEDURE
 NPO for 8 hours to 12 hours prior to the test. Smoking
should be restricted on the morning of the test because
it increases gastric secretions
 Certain groups of drugs (i.e. anticholinergics,
cholinergics, adrenergic blockers, antacid, and steroids)
alcohol and coffee should be restricted for atleast 24-
48 hours before the test. It should be notes on the
request slip if the drugs cannot be withheld.
 Baseline vital signs should be recorded
 Loose dentures should be removed
B. INTRA-PROCEDURE
 A lubricated nasogastric tube is inserted through the
nose or mouth. The tube is flexible having a small
diameter and bulbous end which is made heavy by a small
weight. The end is perforated with small holes to allow
entry of gastric juice into the tube. The ends of the tubes
are radiopaque and help in positioning under fluroscope
or x-ray guidance.
 When the tube is at a point less than 50cm it should be
within the stomach lying along the greater curvature. Once
in place, the tube is secured to the patient’s cheek and
the patient is placed in a semi reclining position.
 A residual gastric specimen and four additional
specimens taken 15 minutes apart should be aspirated
and labeled with the client’s name, the time, and a
specimen number. The nasogastric tube may be
attached to low intermittent suction

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