GUAIAC TEST

It is an occult (hidden) blood test on the stool. This

involves placing a fecal sample on guaiac paper and
applying hydrogen peroxide which, in the presence of
blood, there is a quick blue color change within
seconds

NURSING RESPONSIBILITIES
Pre-procedure
1. Discuss the test and the procedure with the patient.
2. Instruct the patient to maintain a high residue diet and to
refrain from certain fruits and vegetables, including broccoli
and turnip, also red meat. Also taking Vitamin C supplements,
laxatives, pain relievers, such as aspirin and ibuprofen (Advil,
Motrin IB, others) are not allowed for 48 to 72 hours before
the test as well as throughout the collection period.
3. Assess the patient’s level of comfort. Collecting specimen may give a feeling of embarrassment and
discomfort to the patient.
4. Allow the patient to urinate before collecting to avoid contaminating the stool with urine.
5. Instruct the patient to not mix the sample with urine.
6. Tell patient to flush the remaining stool down the toilet and not to take samples from the toilet bowl
water, to avoid contaminating the fecal specimen with toilet tissue or urine.

Post-procedure
1. Send the sample or
test immediately to
the laboratory.
2. Instruct patient to do
handwashing. Allow
the patient to
thoroughly clean
hands and perineal
area.
3. Resume activities.
The patient may
normal diet and
medication therapy unless otherwise specified.
4. Recommend regular screening.
5. Tell patient not use a test kit after the end date.
6. Advice the patient not to perform the test if blood can be seen in the stool or urine. It may be
menstruation or an infection in the urinary tract.

References:
 https://www.cancer.gov/publications/dictionaries/cancer-terms/def/guaiac-fecal-occult-blood-test
 Mayo Clinic. (2020). Fecal occult blood test. Retrieved from https://www.mayoclinic.org/tests-
procedures/fecal-occult-blood-test/about/pac-20394112
 Clores, L. (2016). Nursing How To’s: Stool Specimen Collection (Stool Specimen and Culture and Guaiac
Fecal Occult Blood Test). Retrieved from https://nursingcrib.com/demo-checklist/nursing-how-tos-
stool-specimen-collection-stool-specimen-and-culture-and-guaiac-fecal-occult-blood-test-gfobt/
 HYDROGEN BREATH TEST
Hydrogen breath tests help to diagnose either
intolerance to sugars or small intestinal bacterial
overgrowth (SIBO). Having a higher level of it
usually indicates a problem, either from sugar
tolerance or bacterial growth in your small
intestine.

NURSING RESPONSIBILITIES
Pre-procedure
4 weeks before the test, instruct patient to avoid:
 Taking antibiotics
 Taking Pepto-Bismol
 Having a procedure performed that requires bowel prep, such as a
colonoscopy
1-2 weeks before the test, instruct patient to avoid taking:
 Antacids  Stool softeners
 Laxatives
24 hours before test, instruct the patient to avoid:
 Dairy, sugars, sodas, sweeteners, and fruits/vegetables (including frozen)
 ALL fruits and vegetables (these contain natural sugars that are not suitable for breath testing)
Emphasize the following to the patient:
 Meals throughout the day should consist of baked or broiled chicken, turkey, or fish (salt and pepper
ok), eggs, plain steamed white rice, and/or plain chicken or beef broth (accepted foods listed on
back of sheet)
The day of the test – Instruct patient:
 To have nothing by mouth eight 8 hours before the test.
 Not to eat, drink, or smoke until the examination is completed. This includes any type of gum or
candy.
 Not to sleep or exercise for at least 1 hour before taking the test or at any time during the test.

Post-procedure
 Tell patient that he/she can resume normal
activities and diet after a hydrogen breath test.

Patient Care Consideration

 Allow patient to take critical medicines, such
as those for the heart, blood pressure,
breathing, or seizures, with sips of water on
the morning of the test.
 Instruct patient not to take noncritical
medicines, including over-the-counter medicines (non-prescription) and supplements unless
advised.

References:
 Schulman, J. (2020). What Is a Hydrogen Breath Test? Retrieved from
https://www.healthline.com/health/hydrogen-breath-test
 Ku, M. (2015). Hydrogen/Methane Breath Test. Retrieved from
https://www.nationaljewish.org/conditions/tests-procedures/gastroenterology/hydrogen-methane-
breath-test
 Michigan Medicine. (2020). Hydrogen Breath Test
 Upper GI and Small Bowel Series
An upper GI and small bowel series is a set of
x-rays taken to examine the esophagus, stomach,
and small intestine. Barium enema is a related
test that examines the large intestine.

NURSING RESPONSIBILITIES
Pre-procedure
1. Precautions: Confirm if the patient is pregnant (if female). Notify the radiologist if the patient had a
recent barium X-ray or cholangiography procedure, as this may interfere with obtaining an optimal X-
ray exposure of the upper GI series.
2. Clothing: Have the patient change into a gown. Provide a locker to secure personal belongings. Ask
patient to remove all piercings and leave all jewelry and valuables at home.
3. Eat/Drink: Advice patient, not to eat or drink anything after midnight until the exam is over. Based
on the patient’s medical condition, the doctor may request other specific preparation.
4. Restrict food and fluids for at least 6 hours before the test.
5. If the test is an emergency procedure, inform the patient that his/her stomach contents will be
suctioned to permit better visualization.
6. Explain that the patient will be given I.V. sedation.

Post-procedure
1. Inform patient that he/she may resume
normal diet and activities after an upper
GI series, unless the doctor advises
differently.
2. Tell patient that barium may cause
constipation or possible impaction after
the procedure if it isn't completely
eliminated from the body. Patient may
also be advised to drink plenty of fluids
and eat foods high in fiber to expel the
barium from the body. Administer
laxative as advised to help expel the
barium.
3. Inform patient since barium isn't
absorbed into the body but passes
through the entire gastrointestinal tract,
bowel movements may be lighter in color
until all of the barium has been excreted.

Notify the doctor if the patient reports any of the following:

 Difficulty with bowel movements or inability to have a bowel movement
 Pain and/or distention of the abdomen
 Stools that are smaller in diameter than normal

Reference:
Johns Hopkins Medicine. (2020). Retrieved from https://www.hopkinsmedicine.org/health/treatment-
tests-and-therapies/upper-gastrointestinal-series
 A barium enema is an X-ray exam that
can detect changes or abnormalities in
the large intestine (colon). The
procedure is also called a colon X-ray.

NURSING RESPONSIBILITIES
Pre-procedure
1. Discuss the test and the procedure with
the patient.
2. Instruct the patient not to eat and to drink
only clear liquids such as water, tea or
coffee without milk or cream, broth, and
clear carbonated beverages.
3. Instruct the patient to fast after midnight.
4. Inform the patient that taking laxative the
day before the exam may be needed. Also
enema kit provides a cleansing solution to
remove any residue in the colon.

Post-procedure
1. Inform the patient that any abdominal cramping
after the procedure usually ends quickly and
patient will be able to return to his/her usual
diet and activities right away.
2. Inform patient that he/she may have white
stools for a few days as his/her body naturally
removes any remaining barium from his/her
colon.
3. Inform patient that barium may cause
constipation, encourage patient to drink extra
fluids in the days following the exam.
4. Inform patient that he/she must report if
unable to have a bowel movement or pass gas
more than two days after the exam or if the stool doesn't return to its normal color within a few
days.
5. Watch out for allergic reactions

References:
 Mayo Clinic. (2020). Barium enema. Retrieved from https://www.mayoclinic.org/tests-
procedures/barium-enema/about/pac-20393008
 Cancer.net. (2018). Barium enema. Retrieved from https://www.cancer.net/navigating-cancer-
care/diagnosing-cancer/tests-and-procedures/barium-enema
 Pathak, N. (2020). Barium Enema. Retrieved from https://www.webmd.com/a-to-z-guides/what-is-a-
barium-enema
 ULTRASONOGRAPHY
A procedure that uses high-energy
sound waves to look at tissues and
organs inside the body

NURSING RESPONSIBILITIES
Pre-procedure
Most ultrasound exams require no
preparation. However, there are a few
exceptions:
 For some scans, such as a gallbladder
ultrasound, instruct the patient not eat
or drink for certain period of time
before the exam.
 Young children may need additional
preparation.
Before the procedure begins, ask/instruct
the patient to do the following:
 Remove any jewelry from the area to
be examined.
 Remove some or all of the clothing.
 Change into a gown.
 Lie on an examination table.

Post-procedure
 When the exam is complete, let the
patient know that a radiologist will analyze
the images and sends a report his/her doctor.
The doctor will then share the results with
the patient.
 The patient should be able to return
to normal activities immediately after an
ultrasound.

Reference:
 Mayo Clinic. (2020). Ultrasound. Retrieved from https://www.mayoclinic.org/tests-
procedures/ultrasound/about/pac-20395177
 Magnetic Resonance
Imaging (MRI)
Magnetic resonance imaging (MRI) is a
test that uses powerful magnets, radio
waves, and a computer to make detailed
pictures of the inside of your body

NURSING RESPONSIBILITIES
Pre-procedure
1. Ask patient not to eat or drink anything for 4 - 6 hours before the scan.

2. Ask patient if they are afraid of close spaces or claustrophobia and inform the doctor. Patient may be
given a medicine to help them feel sleepy and less anxious, or the doctor may suggest an "open" MRI,
in which the machine is not as close to the body.

3. Ask the patient if they have the following:

Artificial heart valves Brain aneurysm clips

Pacemaker Inner ear (cochlear) implants

Kidney disease Recently placed artificial joints

Worked with sheet metal in the past

Vascular stents (patient may need tests to check for metal
pieces in their eyes)

4. Ask patient to remove the following:

 Items such as jewelry, watches, credit cards,
and hearing aids - may be damaged.
 Pens, pocketknives, and eyeglasses - may fly
across the room.
 Pins, hairpins, metal zippers, and similar
metallic items - can distort the images.
 Removable dental work should be taken out
just before the scan.
 Because the MRI contains strong magnets,
metal objects are not allowed into the room
with the MRI scanner.

Post-procedure
1. If patient is sedated, transfer patient to the recovery room for continue monitoring. Especially
important for pediatric patients because certain medications have relatively long half-lives
2. Prior to allowing the patient to leave the MRI facility, the patient should be alert, oriented, and have
stable vital signs. Written instructions that include an emergency telephone number should be
provided to the patient.

Reference:
Nursing Lounge. (2013). Nursing Responsibilities: MRI Pre Procedure and Post Procedure. Retrieved
from http://nursing-health-tips.blogspot.com/2013/04/nursing-responsibilities-mri-pre-and.html
ENDOSCOPY
Endoscopy is a nonsurgical procedure used to
examine a person’s digestive tract. Using an
endoscope, a flexible tube with a light and
camera attached to it, your doctor can view
pictures of your digestive tract on a color TV
monitor.

NURSING RESPONSIBILITIES
Pre-procedure
1. Assist the patient to the patient care area. One family member or friend may also accompany the
patient.
2. Provide patient privacy and let the patient change
into a hospital gown and wait on a comfortable Duodenum
stretcher.
3. Conduct a brief interview about the patient’s
Endoscope
medical history and medications, and will verify
procedure.
4. Tell patient to use the restroom at any time before
going into the procedure room.
5. Ensure that the informed consent is signed prior to
premedication.
Esophagus
6. Encourage questions, and provide answers and
Stomach
support.
7. For upper GI endoscopy, withhold food and fluids
for 6 to 8 hours before the procedure. Remove
dentures and eyewear. Provide mouth care.
8. For colon endoscopy (proctoscopy, sigmoidoscopy, and colonoscopy), it is required that the bowel be
free of stool to enhance visualization. This is normally accomplished with laxatives and cleansing
enemas.
Post-procedure
Accidental perforation of the esophagus or colon may
occur during endoscopy. Instruct patient if pain or
bleeding occur following the procedure, notify the
professional nurse to note the presence of the following:
(a) Mouth or throat pain.
(b) Rectal pain.
(c) Abdominal pain.
(d) Bleeding from rectum.
(e) Bleeding from mouth or throat.
Withhold foods, fluids, and P.O. medications until the
patient is fully alert and gag reflex has returned.
Take vital signs per SOP.

References:
 Standford Health Care. (2020). Endoscopy. Retrieved from https://stanfordhealthcare.org/medical-
treatments/e/endoscopy/procedures/after.html
 Mayo Clinic. (2020). Upper endoscopy. Retrieved from
 https://www.mayoclinic.org/tests-procedures/endoscopy/about/pac-20395197
 Hughey. (2015). Endoscopy. Retrieved from https://brooksidepress.org/giu/lessons/lesson-1-
nursing-care-related-to-the-gastrointestinal-system/section-iii-diagnostic-procedures/1-23-
endoscopy/
Esophagogastroduodenoscopy
(EGD)
During an upper endoscopy or EGD, an image of the
esophagus, stomach, and duodenum (the first part of
the small intestine) is transmitted through a thin,
flexible, lighted tube called an endoscope. The
procedure can be used to diagnose upper GI
conditions.

NURSING RESPONSIBILITIES
Pre-procedure
1. Instruct patient to avoid eating all solid
foods 8 hours before the procedure. Clear
liquids are acceptable to drink.
2. If the patient is taking oral diabetes medicine
(pills): do not allow the patient to take
medicine the morning of the test.
3. 2 hours before the procedure, do not allow
the patient to chew gums and/or drink clear
liquids. The physician may give medication
to help patient to relax and better tolerate
the exam.
4. Ensure the informed consent is signed prior
to premedication.
5. Encourage questions, and provide answers
and support.
6. Withhold food and fluids for 6 to 8 hours before the procedure. Remove dentures and eyewear.
Provide mouth care.
7. Inform the patient that during the exam, there is often a feeling of pressure in the abdominal area.
8. Patient may have an intravenous line placed, since the EGD procedure is usually performed with
intravenous sedation.

Post-procedure
1. Inform that the patient may experience a sore
throat after the procedure.
2. Tell patient that once the discharge criteria are
met, the physician will discuss the preliminary
findings.
3. Inform patient that diet and/or medication
restrictions may be given depending on the
findings of the exam.

Watch out for:

 Bleeding
 Perforation
 Infection
 Aspiration

References:
 NorthShore. (2020). EGD Test. Retrieved from
https://www.northshore.org/gastroenterology/procedures/egd-test/
 https://www.med.umich.edu/1libr/MPU/UpperEndoscopyPrep.pdf
 https://wps.prenhall.com/wps/media/objects/737/755395/upper_endoscopy.pdf
Proctosigmoidoscopy/
Colonoscopy
It is an exam used to detect changes or abnormalities
in the large intestine (colon) and rectum.

A long, flexible tube is inserted into the rectum. A

tiny video camera at the tip of the tube allows the
doctor to view the inside of the entire colon.

NURSING RESPONSIBILITIES
Pre-procedure
1. Instruct the patient not to eat solid food the
day before the exam. Drinks may be limited to
clear liquids — plain water, tea and coffee
without milk or cream, broth, and carbonated
beverages, also red liquids, which can be
confused with blood during the colonoscopy.
Patient may not be able to eat or drink
anything after midnight the night before the
exam.
2. Instruct patient to take the laxative the night
before the colonoscopy, or ask patient to use
the laxative both the night before and the
morning of the procedure.
3. Encourage patient to use an enema kit (in
some cases)
4. Secure an informed consent.
5. Provide information about the procedure.
6. Ensure that the patient has complied with the bowel preparation.
7. Establish an IV line.
8. Explain to the patient that air may be introduced through the colonoscope.
9. Instruct the patient to remove all metallic objects from the area to be examined.

Post-procedure
1. If the doctor removed a polyp during the colonoscopy, the patient may be advised to eat a special diet
temporarily.
2. Inform patient that he/she may feel bloated or pass gas for a few hours after the exam, as air is
cleared from the colon. Encourage patient to walk to help relieve any discomfort.
3. Also inform patient that small amount of blood may be present with first bowel movement after the
exam. Usually this isn't cause for alarm. Consult doctor if the patient continues to pass blood or blood
clots or if persistent abdominal pain or a fever is present. While unlikely, this may occur immediately
or in the first few days after the procedure, but may be delayed for up to one to two weeks.

Relative Patient Care Considerations

After the exam, it takes about an hour to begin to recover from the sedative. The patient will need a
family member to take him/her home because it can take up to a day for the full effects of the sedative
to wear off. The nurse should not let the patient drive or make important decisions or go back to work
for the rest of the day.

Reference:
Mayo Clinic. (2020). Colonoscopy. Retrieved from https://www.mayoclinic.org/tests-
procedures/colonoscopy/about/pac-20393569
 Carcinoembryonic
Antigen (CEA) Test
This test measures the CEA in the blood, and
sometimes in other body fluids. CEA is a protein
found in the tissues of a developing baby.
Healthy adults should have very little or no CEA
in their body.

NURSING RESPONSIBILITIES
Pre-procedure
There are no special preparations for CEA
blood test or a pleural fluid test. However, the
patient may be asked to empty bladder and
bowels prior to a CSF or peritoneal fluid test.

A high level of CEA can be a sign of certain

types of cancers. These include cancers of the
colon and rectum, prostate, ovary, lung,
thyroid, or liver. High CEA levels may also be a
sign of some noncancerous conditions, such as
cirrhosis, noncancerous breast disease, and
emphysema.

Post-procedure
As with any blood test, there’s a risk of
bleeding, bruising, or infection at the
puncture site. Inform patient that
moderate pain or a sharp pricking
sensation may be felt when the needle is
inserted.

References:
 Han, S. (2020). Carcinoembryonic Antigen (CEA) Test. Retrieved from
https://www.healthline.com/health/cea
 MedicinePlus. (2020). CEA Test. Retrieved from https://medlineplus.gov/lab-tests/cea-test/
 A fecalysis is a series of tests done on a stool (feces)
sample to help diagnose certain conditions
affecting the digestive tract. These conditions can
include infection (such as from parasites, viruses,
or bacteria), poor nutrient absorption, or cancer.

NURSING CONSIDERATIONS
Pre-procedure
1. Assess the patient’s level of comfort. This may
produce a feeling of embarrassment and discomfort
to the patient.
2. Encourage the patient to urinate to avoid
contaminating the stool with urine.
3. Advice patient to avoid laxatives. Advise patient that
laxatives, enemas, or suppositories are avoided three
days prior to collection.
4. Instruct a red-meat free and high residue diet. The
patient is indicated for an occult blood test, must
follow a special diet that includes generous amounts of chicken, turkey, and tuna, raw and uncooked
vegetables and fruits such as spinach, celery, prunes and bran containing cereal for two (2) days
before the test.

Post-procedure
1. Instruct patient to do handwashing. Allow the patient to
thoroughly clean his or her hands and perineal area.
2. Resume activities. Tell that the patient may resume his or
her normal diet and medication therapy unless otherwise
specified.
3. Recommend regular screening.

Reference:
Martin, P. (2019). Fecal Analysis (Stool Analysis). Retrieved from https://nurseslabs.com/fecal-analysis-
stool-analysis
 GASTRIC ANALYSIS
It is performed to evaluate gastric function
by measuring the contents of a fasting
patient’s stomach for the acidity,
appearance, and volume.

NURSING RESPONSIBILITIES
Pre-procedure
1. Educate patient about the procedure, the
significance of the preparation, and any significant
post-procedural sequelae.
2. Ask the patient to sign an informed consent.
3. Instruct the patient to be NPO for 8-10 hours prior
to the test.
4. General care and precautions associated with
gastric intubation should be implemented.
5. If ordered by the physician, withdraw the stomach
contents and save for lab analysis.
6. The patient should be allowed to rest for 20 to 30
minutes after insertion of the tube before
beginning the test. This allows time for the
patient’s body to return to a rested, basal state.

Post-procedure
1. Monitor the patient’s vital signs in accordance with the SOP.
2. Observe for signs of throat irritation secondary to tube placement.
3. Observe for signs of bleeding from the throat or stomach.
4. Resume diet and medication in accordance with the physician’s orders.

Complications such as nausea, vomiting,

abdominal distention or pain are possible
following removal of the gastric tube. If the
patient has sore throat, soothing lozenges may
be given. The patient may also resume the usual
diet and any medications that were withheld
for the test(s).

Reference:
 Hughey. (2015). Gastric Analysis. Retrieved from https://brooksidepress.org/giu/lessons/lesson-1-
nursing-care-related-to-the-gastrointestinal-system/section-iii-diagnostic-procedures/1-21-gastric-
analysis
BSN 3 – Imogene King
February 28, 2021

CALUZA, Hermaine M.
CASILLA, Rocela Marie Y.
CASUGAY, Margie Audrey C.
COMBALICER, Maria Hyacenth L.
CUELLO, Shania Irish M.
NABUA, Sophia Marie E.

Clinical Instructor: MS. MARISOL JANE T. JOMAYA