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01.13 Endoscopy & EGD

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Overview

  1. Endoscopy
    1. Camera to view inside body
    2. Diagnose and treat
  2.  EGD
    1. Camera view of upper GI tract
    2. Diagnose and treat

Nursing Points

General

  1. Endoscopy and EGD
    1. Camera through mouth and down esophagus, stomach, small intestines
    2. Look for irregularities
      1. Inflammation
      2. Bleeding/ulcers
      3. Unusual objects
    3. Treat or remove objects as deemed appropriate by gastroenterologist (GI doctor)
  2. Purpose
    1. Find and diagnose cause of symptoms
    2. Treat disease
      1. Remove polyps
      2. Biopsy tissue
      3. Stretch strictures
      4. Peg tube placement
      5. Stop bleed (clip or cauterize)
  3. Indications
    1. Suspected GI bleed
      1. Vomiting blood (or coffee ground emesis)
      2. Black stools
      3. Anemia
    2. Abdominal pain
    3. Difficulty swallowing
    4. Nausea/vomiting
    5. Severe GERD

Assessment

  1. Before
    1. Explain procedure
    2. Signed consent
    3. NPO midnight before

Therapeutic Management

  1. During
    1. IV medication to sedate patient
    2. GI doctor blows air into gut
    3. Vital signs
  2. After
    1. Vital signs
    2. Advance diet as tolerated per doctor order
    3. Assess abdomen (bloating from air should slowly reside)
    4. Monitor stool color for bleeding

Nursing Concepts

  1. Gastrointestinal/Liver Metabolism -> EGD views upper GI tract
  2. Elimination -> bloody or black stools may indicate EGD

Patient Education

  1. Educate patient on results and treatment (after sedation wears off)

Reference Links

Study Tools

Video Transcript

Hey guys! Welcome to the lesson on the endoscopy and EGD.

An endoscopy procedure is where a camera is used to look inside the body. An EGD is shown in this picture where the GI doctor places a camera into the patient’s mouth and down their esophagus, stomach, and small intestines to look for irregularities like inflammation, bleeding, or unusual objects. The doctor may treat or remove objects during the EGD. Let’s talk about the purpose of the EGD. 

The purpose of the endoscopy is to diagnose and treat as indicated. Treatment may include removing polyps, taking a biopsy of tissue, or stopping a bleed by clipping or cauterizing. The doctor may stretch strictures that make it hard for patients to swallow or place a peg tube for the delivery of medications or feedings into the stomach if they cannot swallow or eat. This picture shows an ulcer found in the stomach during an EGD procedure. Let’s explore the indications for an EGD procedure. 

An endoscopy or EGD may be indicated if the doctor suspects that the patient may have an upper GI bleed. The doctor might suspect this if they’re vomiting blood, have black stools, or anemia. The procedure may also be done if the patient is having abdominal pain, difficulty swallowing, or nausea and vomiting. Next let’s explore what your role may be before, during and after the procedure. 

So when the procedure is ordered, you will notify the patient and explain to them what to expect during. Have them sign the consent form after they have been notified of any risks. The patient should be NPO the midnight before the procedure so that food matter is not in the way of the camera. 

During the procedure, the patient will be given sedation through the IV and throat numbing spray. The GI doctor will blow air into the gut so they can see inside with the camera. You will be checking vital signs during to make sure the patient remains stable. 

After the procedure, you will monitor the vital signs as the doctor orders them until stable. The doctor will also enter a diet order, such as advance diet as tolerated to general. Assess the patient’s belly to make sure it’s not distended or painful. Keep an eye on their stools for bleeding which usually shows as black when from the upper GI tract. Educate your patient on the results and any treatment that was provided after their sedation wears off. Often the post op nurse will tell them but they won’t remember because of the sedation. 

The priority nursing concepts for the patient with an endoscopy and EGD are gastrointestinal metabolism and elimination. 

Alright guys, let’s review the key points. An endoscopy is where a camera is used to view inside the body. The EGD procedure is where the GI doctor uses a camera to view the upper GI tract. The purpose is to diagnose and treat disease in the upper GI tract. The EGD may be indicated if the doctor suspects a bleed, or if the patient has abdominal pain, nausea, or vomiting. It’s also used for the placement of a peg tube for feedings or medication administration. Before the procedure, explain what will happen and have the patient sign a consent. The patient should be kept NPO midnight before the procedure. During, sedation will be given in the IV and vital signs will be monitored. After it’s over, continue checking vitals and assess the abdomen for distention and pain. Keep an eye on the patient’s stools for changes in color because remember that black stools can indicate an upper GI bleed. 

Okay guys, that’s it on the endoscopy and EGD! Now go out and be your best self today, and as always, happy nursing!

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