Patient care in gastrointestinal nursing

The role of gastrointestinal nurses involves meeting the physical, psychosocial and emotional needs of their patients. As the gastrointestinal system comprises several organs with a range of functions, gastrointestinal disorders can produce a range of diverse symptoms, including those shown in Box 1.3.

Many of these symptoms cause considerable embarrassment and can lead to major disruption of the quality of life of patients. It is important to provide all patients with clear, understandable information and reassurance. Nursing assessment will provide vital information about specific fears and concerns of the patient prior to and during potentially unpleasant and often undignified investigations or treatments.

Box 1.3 Gastrointestinal symptoms.

• Abdominal pain

• Constipation

Box 1.4 Pre-procedural documentation in gastroenterology.

Pre-procedural documentation includes:

• Presenting gastrointestinal complaint/symptoms

• Patient vital observations

• Physical assessment of patient

• Psychosocial assessment of the patient (i.e. levels of anxiety)

• Current medications

• Past medical history

• Risk factors (i.e. previous allergic reactions)/anaesthetic history

• Prophilactic medication (i.e. antibiotic pre-ERCP)

• Consent for treatment/investigation

If a patient requires sedation during a procedure, such as endoscopy, the gastrointestinal nurse should be on hand to assess the patient's response to the sedation and the procedure and intervene where necessary. Patient monitoring continues for the nurse after the procedure, as patients will often require time to recover from the possible effects of sedation or from the potential complications that may be related to treatment or investigation of gastrointestinal conditions. Another responsibility relates to the documentation of nursing practice via records, care plans and reports (NMC 2002b). Documentation requirements may vary from one hospital to the next according to specific institutional policies. For the purpose of this text documentation is examined for a gastrointestinal outpatient at three specific stages of the patient journey, pre-procedural, procedural and post-procedural. Pre-procedural documentation is summarised in Box 1.4, procedural documentation in Box 1.5 and several elements of post-procedural documentation in Box 1.6.

Box 1.5 Procedural documentation.

• Nature of procedure

• Staff involved in procedure

• Equipment used in procedure (i.e. endoscope log number)

• Medication and fluids administered during procedure

• Unusual events

• Vital observations throughout procedure

• Type of specimen/biopsy obtained

• Post-procedural assessment

Box 1.6 Post-procedural documentation.

• Physical condition

• Psychosocial status (emotional well-being)

• Wound status (if applicable)

• Level of consciousness (if sedation has been given)

• Post-procedural medication

• Post-procedural intravenous fluids

• Unusual events following procedure

• Discharge instructions for patients

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