27.3: Diagnostic Evaluation

Learning Objectives

By the end of this section, you will be able to:

• Discuss diagnostic testing options for determining proper bowel functioning
• Identify the nurse’s role in diagnostic testing for functional bowel elimination

Diagnostic testing serves as a cornerstone in the assessment of proper bowel functioning. From stool analyses to sophisticated imaging procedures, a range of diagnostic modalities empower healthcare professionals to delve into the intricacies of GI health. Nurses play an integral role in patient care, so understanding these diagnostic tests is essential for recognizing and addressing functional bowel disorders effectively. This section explores various diagnostic testing methodologies employed to evaluate bowel function, shedding light on their significance, procedures, and implications for patient care. Additionally, it underscores the crucial role that nurses play in the diagnostic process, emphasizing their contributions in supporting patients, collaborating with healthcare teams, and advocating for optimal outcomes in functional bowel assessment.

Diagnostic Testing for Bowel Functioning

Diagnostic testing plays a pivotal role in the comprehensive evaluation of bowel functioning, offering invaluable insights into the health and integrity of the GI tract. From noninvasive procedures (e.g., stool analysis) to more invasive/surgical techniques (e.g., endoscopic examinations, laparoscopy), a wide array of diagnostic modalities are employed to assess bowel function, identify abnormalities, and guide appropriate management strategies. These diagnostic tests encompass various approaches (e.g., imaging studies, laboratory analyses, direct visualization) to the GI tract, each providing unique advantages in identifying the underlying causes of bowel dysfunction. With a thorough understanding of these diagnostic tools, nurses can effectively assist in the diagnosis of GI disorders, collaborate in the development of comprehensive treatment plans, and play a crucial role in promoting optimal patient outcomes.

Serum Laboratory Studies

Serum laboratory studies provide valuable insights into various aspects of bowel health by analyzing blood samples for specific markers and indicators. These tests can help healthcare providers identify underlying conditions, monitor disease progression, and guide treatment decisions. Table 27.2 summarizes common serum laboratory studies used to assess bowel functioning, including normal ranges, as well as associated bowel conditions.

Serum Laboratory Study	Normal Range	Associated Bowel Conditions
Complete blood count (CBC)	Red blood cells (RBC): Male: 4.5–6.1 million cells/mcL Female: 4.0–5.4 million cells/mcL Children: 4.0–5.5 cells/mcL Hemoglobin (Hgb): Male: 13–17 g/dL Female: 11.5–15.5 g/dL Children: 11.5–14.5 g/dL Hematocrit (Hct): Male: 40–55 percent Female: 36–48 percent Children: 33–43 percent White blood cells (WBC): Adults: 4,000–10,000 cells/mcL Children: 4,000–15,500 cells/mcL Platelets: Adults: 150,000–400,000 cells/mcL Children: 150,000–450,000 cells/mcL	Anemia (low RBC, Hgb, and Hct) Infection (elevated WBC) Bleeding (low platelet count) Inflammatory bowel disease [IBD] (elevated WBC and platelet count, low Hgb and Hct)
Electrolyte panel	Adults: Sodium (Na): 136–144 mEq/L Potassium (K): 3.7–5.1 mEq/L Chloride (Cl): 97–105 mEq/L Bicarbonate (HCO^3^-): 22–30 mmol/L Children ≥1 year of age: Sodium (Na): 130–147 mEq/L Potassium (K): 3.5–5.1 mEq/L Chloride (Cl): 95–108 mEq/L Bicarbonate (HCO3): 19–25 mmol/L	Dehydration (high Na, K, Cl) Diarrhea (low Na, K, Cl) Vomiting (low Na, K, Cl)
Liver function tests (LFTs)	Adults: Alanine aminotransferase (ALT): 0–45 U/L Aspartate aminotransferase (AST): 0–35 U/L Alkaline phosphatase (ALP): 30–120 U/L Total bilirubin: 0.2–1.7 mg/dL Children ≥1 year of age: ALT: 5–55 U/L AST: 20–60 U/L ALP: 100–420 U/L Total bilirubin: <1.5 mg/dL	IBD (elevated ALT, AST, ALP, and bilirubin) Biliary obstruction (elevated ALP and bilirubin) Liver involvement in GI disorders (elevated ALT, AST, ALP, and bilirubin)
Inflammatory markers	C-reactive protein (CRP): <0.9 mg/dL Erythrocyte sedimentation rate (ESR): varies by age and gender	IBD (elevated CRP and ESR) Perforation (elevated CRP and ESR) Infectious gastroenteritis (elevated CRP and ESR)
Serum albumin	Adults 3.5–5.5 g/dL Children ≥1 year of age 3.4–5.2 g/dL	Malnutrition (low albumin) Malabsorption disorders (low albumin) IBD (low albumin) Liver disease (low albumin)
Thyroid function tests	Adults: Thyroid-stimulating hormone (TSH): 0.27–4.2 mIU/L Children ≥1 year of age 0.55–5.31 g/dL	IBD (low TSH)

Table 27.2 Lab Values (Sources: American College of Clinical Pharmacy, n.d.; Cleveland Clinic, 2024, 2022a, 2022c, 2022d, 2022e, 2022f, 2022g; Jewell, 2020.)

A complete blood count (CBC) provides information about the number and types of blood cells present in the bloodstream. Abnormalities in the CBC, such as anemia (low red blood cell count), may indicate GI bleeding, IBD, or malabsorption disorders affecting nutrient absorption. An elevated white blood cell (WBC) count may suggest an inflammatory response in the body, which can occur in conditions like IBD where there is chronic inflammation of the GI tract. Increased platelet count, known as thrombocytosis, may occur in response to inflammation, infection, or bleeding associated with IBD. Low hemoglobin and hematocrit levels may indicate anemia, which is common in IBD and is caused by chronic blood loss from intestinal inflammation and ulceration.

An electrolyte panel measures the levels of electrolytes (e.g., sodium, potassium, chloride, bicarbonate) in the blood. It helps assess electrolyte balance, hydration status, and kidney function. Dehydration can lead to electrolyte disturbances, particularly hypernatremia. When water loss exceeds sodium loss, sodium concentrations in the blood rise, leading to hypernatremia. Conversely, diarrhea can result in hyponatremia caused by excessive loss of sodium-rich fluids in the stool. Potassium levels may also be affected by dehydration, causing hyperkalemia and diarrhea and leading to hypokalemia due to potassium losses in stool.

Vomiting, a common symptom of various GI disorders (e.g., gastroenteritis, gastritis, GI obstruction) can disrupt electrolyte balance through loss of gastric fluid containing electrolytes. Chronic vomiting may lead to hypochloremic metabolic alkalosis, characterized by low chloride levels, and metabolic alkalosis, caused by loss of hydrochloric (HCl) acid in vomit. Potassium losses in vomit can exacerbate electrolyte imbalances, leading to hypokalemia, which can manifest as muscle weakness and cardiac arrhythmias.

Furthermore, electrolyte imbalances can arise secondary to underlying GI disorders, such as IBD, malabsorption syndromes, or GI bleeding. In IBD, chronic inflammation of the bowel can impair electrolyte absorption and secretion, resulting in abnormalities such as hypokalemia, hypomagnesemia, and hypocalcemia. Gastrointestinal bleeding, a complication of conditions like peptic ulcers or colorectal cancer, can lead to iron-deficiency anemia and subsequent electrolyte disturbances, including hypokalemia and hyponatremia, caused by blood loss and fluid shifts.

Liver function tests (LFTs) assess the liver’s health and function by measuring levels of enzymes, proteins, and bilirubin in the blood. They help diagnose liver diseases, monitor treatment response, and evaluate liver function. Abnormal LFT results may indicate liver diseases (e.g., hepatitis, cirrhosis, bile duct obstruction), which can affect bowel functioning and digestion. Biliary obstruction caused by certain conditions (e.g., gallstones, tumors, strictures in the bile ducts) can lead to elevated levels of alkaline phosphatase (ALP). This obstruction impedes the free flow of bile, causing its accumulation and subsequent elevation of ALP levels. Concurrently, total bilirubin levels may rise, resulting in jaundice, dark urine, and pale stools. Inflammatory bowel disease, including conditions like Crohn disease and ulcerative colitis, can adversely affect liver function. This manifests as elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels indicative of hepatocellular injury. Additionally, elevated ALP levels in IBD may reflect bile duct injury or obstruction, while elevated total bilirubin levels may signify severe disease, suggesting impaired bilirubin metabolism or excretion due to liver dysfunction or bile duct involvement. Liver involvement in GI disorders (e.g., primary sclerosing cholangitis [PSC], autoimmune hepatitis) can further elevate liver enzymes (ALT, AST, ALP), caused by hepatocellular injury, bile duct inflammation, or cholestasis. Elevated total bilirubin levels in advanced liver diseases associated with GI disorders may indicate impaired bilirubin metabolism or excretion caused by liver dysfunction or bile duct obstruction.

C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are markers of inflammation that can change in response to bowel-related diseases. The CRP levels tend to rise in the presence of inflammation, making CRP a useful marker for assessing disease activity in bowel-related conditions such as IBD, Crohn disease, and ulcerative colitis. The CRP levels often correlate with the severity of inflammation and disease activity, making it a useful laboratory test result to monitor over time to assess response to treatment and guide therapeutic decisions in managing bowel-related diseases. Elevated CRP levels can also indicate complications of bowel-related diseases (e.g., abscesses, perforation, fistulas) that can trigger an acute inflammatory response. Like CRP, ESR tends to increase in the presence of inflammation, including bowel-related diseases such as IBD. An ESR elevation may be more pronounced in chronic inflammatory conditions like IBD compared to acute inflammatory processes. However, ESR changes are less specific than CRP and may be influenced by other factors such as anemia or infection, limiting its utility as a stand-alone marker for assessing disease activity in bowel-related diseases. Despite its limitations, ESR can still provide valuable information when interpreted in conjunction with other clinical findings and laboratory tests.

Albumin, a protein synthesized by the liver, serves as a crucial marker of nutritional status and liver function. In various GI conditions (e.g., malnutrition, malabsorption disorders, IBD, liver disease), albumin levels can undergo characteristic changes. In instances of malnutrition, insufficient intake of protein and calories leads to decreased albumin synthesis by the liver, resulting in hypoalbuminemia. Similarly, malabsorption disorders impair nutrient absorption, including protein, exacerbating hypoalbuminemia. Inflammatory bowel disease, marked by chronic GI inflammation, further contributes to decreased albumin synthesis and increased loss through the gut. Liver disease (e.g., cirrhosis hepatitis) significantly impairs albumin production because of chronic liver damage and inflammation, leading to hypoalbuminemia and associated complications. Monitoring albumin levels in these conditions offers valuable insights into nutritional status, disease severity, and liver function, guiding appropriate management strategies. However, interpretation of albumin levels should take into consideration other clinical findings to ensure comprehensive patient care.

Thyroid function tests assess thyroid-stimulating hormone (TSH) levels in the blood, which play a role in regulating metabolism and bowel motility. Malabsorption disorders (e.g., celiac disease, IBD) can disrupt the absorption of essential nutrients, including iodine and selenium, which are crucial for thyroid hormone synthesis. Consequently, inadequate levels of these nutrients may lead to hypothyroidism, characterized by elevated TSH levels as the body attempts to stimulate thyroid hormone production. Additionally, medications commonly used to manage GI conditions, such as PPIs or certain antibiotics, may interfere with thyroid hormone absorption or metabolism, further altering thyroid hormone levels and subsequently affecting TSH levels.

By interpreting the results of these serum laboratory studies in conjunction with clinical findings and patient history, healthcare providers can gain valuable insights into proper bowel functioning, diagnose underlying conditions affecting bowel health, and develop targeted treatment plans to optimize GI function and overall well-being. Additionally, serial monitoring of these laboratory parameters allows for ongoing assessment of bowel health and treatment response over time.

Stool Tests

Stool tests, also known as fecal tests or stool analyses, are diagnostic tools used to assess various aspects of bowel functioning by analyzing the composition, characteristics, and contents of stool samples. Examples of stool tests include Cologuard, fecal occult blood test (FOBT), fecal immunochemical test (FIT), stool culture, and ova and parasite examination. These tests are valuable diagnostic tools in assessing bowel function by detecting occult blood, identifying pathogens, and diagnosing intestinal infections. Stool tests play a crucial role in the evaluation and management of various GI conditions, aiding in early detection, diagnosis, and treatment decisions. Table 27.3 provides an overview of the purpose, procedure, and interpretation of each stool test commonly used to evaluate bowel functioning.

Stool Test	Purpose	Procedure	Interpretation
Cologuard	Screen for colorectal cancer and precancerous polyps.	A Cologuard kit is mailed to the patient’s home. The patient collects a stool sample using the provided materials and mails the sample back to the laboratory in a prepaid, prelabeled box.	Positive results indicate abnormal DNA and/or blood in the stool, warranting follow-up with a colonoscopy to further investigate and confirm findings.
Fecal occult blood test (FOBT)	Detect occult blood in stool samples, indicating gastrointestinal (GI) bleeding.	Collect stool sample and test for the presence of blood using chemical reagents.	Positive results may indicate GI bleeding, warranting further investigation (e.g., colonoscopy).
Fecal immunochemical test (FIT)	Detect occult blood in stool samples with improved sensitivity and specificity compared to FOBT.	Collect stool sample and test for human hemoglobin using immunochemical methods.	Positive results indicate the presence of blood in the stool, necessitating further evaluation to identify potential sources of bleeding.
Stool culture	Identify pathogenic bacteria, viruses, or parasites responsible for GI infections.	Collect stool sample and culture on specific media to facilitate the growth of microorganisms. Perform biochemical tests to characterize isolates.	Positive cultures reveal the presence of pathogens (e.g., Salmonella, Shigella, parasites), which guides appropriate antimicrobial therapy.
Ova and parasite examination	Detect parasite eggs, larvae, or cysts in stool samples, indicating intestinal parasitic infections.	Examine stool sample microscopically for the presence of parasite ova, larvae, or cysts using staining techniques.	Positive findings of parasites or their eggs confirm the diagnosis of intestinal parasitic infections, prompting initiation of appropriate treatment.

Table 27.3 Stool Tests (Sources: Nemours Kids Health, 2023; Cologuard, 2024.)

Breath Tests

A breath test is a noninvasive diagnostic tool used to assess various aspects of bowel functioning, particularly related to carbohydrate metabolism and bacterial overgrowth in the GI tract. Breath tests involve measuring the levels of specific gases exhaled in breath samples following the ingestion of a substrate, typically a sugar or other fermentable carbohydrate.

The hydrogen breath test is primarily used to detect bacterial overgrowth in the small intestine and assess carbohydrate malabsorption, particularly lactose intolerance. For this procedure, the patient ingests a substrate (a substance or compound that undergoes a chemical reaction or is acted on by an enzyme to produce a specific product) containing a fermentable carbohydrate, such as lactose or glucose. If bacterial overgrowth or malabsorption is present, bacteria in the small intestine ferment the carbohydrate, producing hydrogen gas, which is absorbed into the bloodstream and eventually exhaled through the lungs. Breath samples are collected at regular intervals over several hours, and the levels of hydrogen in the breath are measured. A significant increase in hydrogen levels compared to baseline suggests bacterial overgrowth or malabsorption, indicating improper bowel functioning.

The methane breath test, similar to the hydrogen breath test, evaluates bacterial overgrowth and carbohydrate malabsorption, focusing on methane-producing bacteria. After ingesting a fermentable carbohydrate substrate, breath samples are collected and analyzed for methane levels. Methane is produced by certain bacteria during carbohydrate fermentation in the gut. Elevated methane levels indicate the presence of methane-producing bacteria and can suggest bacterial overgrowth or carbohydrate malabsorption.

The lactulose breath test is specifically designed to diagnose small intestinal bacterial overgrowth by assessing the transit time and bacterial fermentation in the small intestine. The patient ingests a solution containing lactulose, a nonabsorbable sugar. As lactulose passes through the small intestine, it is fermented by bacteria, producing hydrogen and/or methane gas. Breath samples are collected at regular intervals to measure gas levels. Elevated levels of hydrogen and/or methane indicate bacterial overgrowth in the small intestine, suggesting improper bowel functioning.

Genetic Testing

By identifying genetic mutations associated with specific GI disorders, genetic testing serves as a valuable diagnostic tool in evaluating proper bowel functioning. Primarily used in hereditary GI conditions like familial adenomatous polyposis and Lynch syndrome, genetic testing targets specific genes linked to these disorders. By detecting mutations in these genes, healthcare providers can assess an individual’s risk of developing colorectal cancer or other GI malignancies, facilitating early intervention and surveillance measures.

Additionally, genetic testing plays a role in clarifying the genetic basis of IBD, including Crohn disease and ulcerative colitis. While the genetic landscape of IBD remains complex, specific susceptibility genes can be identified through genetic testing, aiding in risk assessment and treatment decision-making. Moreover, in conditions like celiac disease, genetic testing helps identify individuals predisposed to gluten intolerance and autoimmune damage to the small intestine. Advancements in genomic technology offer promise in assessing an individual’s overall genetic risk for GI disorders by aggregating information from multiple genetic variants across the genome.

Imaging Studies

Imaging studies are essential diagnostic tools used to assess proper bowel functioning by providing detailed visualization of the GI tract and surrounding structures. They play a crucial role in diagnosing various GI disorders and assessing bowel functioning by providing detailed anatomical information and identifying structural abnormalities or pathological changes. Interpretation of imaging results requires collaboration between radiologists and gastroenterologists to guide appropriate management and treatment decisions for patients. Table 27.4 provides an overview of the purpose, procedure, and interpretation of each imaging study commonly used to evaluate bowel functioning.

Imaging Study	Purpose	Procedure	Interpretation
X-ray	Evaluate bowel obstruction, perforation, or other structural abnormalities.	Patient may ingest contrast material before and/or during x-rays or undergo abdominal x-rays without contrast.	Abnormal findings (e.g., air-fluid levels, dilated loops of bowel, free air under the diaphragm) may indicate pathology.
Computed tomography (CT) scan	Assess bowel wall thickness, inflammation, tumors, or other abnormalities.	Patient may receive oral or intravenous contrast to enhance visualization of the gastrointestinal (GI) tract.	Abnormal findings may reveal signs of inflammatory bowel disease, tumors, strictures, or other pathologies affecting bowel functioning.
Magnetic resonance imaging (MRI)	Provide detailed imaging of the GI tract without ionizing radiation.	Patient may receive oral contrast or undergo MRI without contrast.	MRI scans can identify bowel wall thickening, inflammation, fistulas, or abscesses, aiding in the diagnosis of various GI disorders.
Barium swallow/upper GI series	Evaluate the upper GI tract, including the esophagus, stomach, and duodenum.	Patient ingests barium contrast, followed by x-rays to observe the passage of contrast through the upper G tract.	Abnormalities (e.g., ulcers, strictures, tumors, motility disorders) may be detected in the upper GI tract.
Barium enema/lower GI series	Examine the lower GI tract, including the colon and rectum.	Barium contrast is introduced into the colon via an enema, followed by x-rays to visualize the colon and rectum.	Findings (e.g., polyps, diverticula, strictures, tumors) may be identified in the colon and rectum, aiding in the diagnosis of colorectal conditions.

Table 27.4 Imaging Studies (Source: Sun et al., 2023.)

A special dye, called contrast, is administered to patients before some tests so that certain areas show up better on the x-rays, MRIs, and CT scans (Figure 27.5). If contrast is used, the patient may be required to remain NPO (nothing passed orally/by mouth) for four to six hours before the test. Contrast can be administered orally or intravenously (IV). Oral contrast has a chalky taste and will pass out of the body through the stools. Patients receiving IV contrast may feel a slight burning sensation, metallic taste in the mouth, or warm flushing of the body that resolves in a few seconds.

Figure 27.5 During a barium enema, the barium coats the lining of the colon, making it visible on the x-ray images. This allows the radiologist to evaluate the size, shape, and contour of the colon, as well as the presence of any abnormalities, such as polyps, tumors, or areas of inflammation. (credit: “Human intestinal tract, as imaged via double-contrast barium enema” by “Glitzy queen00”/Wikimedia Commons, Public Domain)

Before sending the patient for a procedure using contrast, check for previous allergies to iodine or other contrast dyes. Some patients may be prescribed diphenhydramine or corticosteroids before receiving the contrast if they have had a previous allergic reaction. Verify the patient’s kidney status because IV contrast can worsen kidney function. If the patient is currently taking the antidiabetic medication metformin, there may be restrictions placed on the administration of metformin before or after the procedure. This is because the contrast dye used in these imaging tests can affect kidney function, and metformin can accumulate in the body if the kidneys are not working properly, potentially leading to a serious condition called lactic acidosis. For example, patients may be advised to stop taking metformin forty-eight hours before the procedure and to refrain from resuming it until forty-eight hours after the procedure, pending the confirmation of normal kidney function. Jewelry should be removed before the procedure. After the procedure, encourage patients who have received contrast to increase their fluid intake to help eliminate it from their body, as appropriate (Medline Plus, 2022).

After undergoing a barium enema study, patients may experience a sense of relief after the enema is complete, and they can typically resume their normal activities shortly afterward. In the hours following the procedure, patients will likely pass the barium contrast material during bowel movements, resulting in stools that are white or light-colored because of the presence of the contrast material. This is a normal part of the process, and it is essential for the patient to stay hydrated to help flush the barium out of the system. Some patients may experience mild abdominal discomfort or cramping after the procedure, which should resolve within a few hours. Changes in stool consistency, such as firmer stools, may occur temporarily because of the presence of the contrast material; however, increasing fiber intake and staying hydrated can help normalize stool consistency. While rare, severe side effects such as allergic reactions to the contrast material or bowel complications may occur, requiring immediate medical attention if experienced.

Real RN Stories

Using Imaging Studies to Diagnose Bowel Conditions

Nurse: Marco, BSN
Clinical setting: Emergency department
Years in practice: 3
Facility location: The inner city of a large metropolitan area in Florida

A few year ago, I had a patient named Mr. Garcia who come into the emergency room with severe abdominal pain. You could tell by the look on his face that he was suffering greatly, and I knew immediate action was needed. The provider ordered an abdominal x-ray to get a clearer picture of what was going on inside his abdomen.

As Mr. Garcia underwent the imaging study, I couldn’t help but feel a sense of urgency. The results were crucial; they could shed light on the severity of his condition and what action I needed to take next. The x-ray showed severe fecal impaction and significant colon distension, and we needed to act fast to relieve his suffering and prevent further complications.

With a sense of urgency, I assisted the medical team in implementing treatment strategies, including hydration, laxatives, and gentle disimpaction under the provider’s guidance. Throughout the process, I stayed by Mr. Garcia’s side, offering comfort and support as he endured the discomfort. Witnessing the relief on his face as the treatments took effect was incredibly rewarding, knowing we were making a positive difference in his recovery.

A while later, Mr. Garcia finally found relief, passing a substantial stool. It was a small victory, but it meant the world to him and to us. As he expressed his gratitude for our efforts, I felt a deep sense of satisfaction, knowing we had helped him through a difficult time.

This experience reinforced the importance of swift action, collaboration, and empathy in nursing. It’s moments like these that remind me why I became a nurse—to make a difference in the lives of patients like Mr. Garcia, providing compassionate care when they need it most.

Endoscopic Procedures

Endoscopic procedures are instrumental in assessing proper bowel functioning by allowing direct observation of the GI tract and obtaining tissue samples for analysis. Some examples of endoscopic procedures include esophagogastroduodenoscopy (EGD), colonoscopy, flexible sigmoidoscopy, endoscopic retrograde cholangiopancreatography (ERCP), and capsule endoscopy. Interpretation of endoscopic findings requires expertise and collaboration between endoscopists and pathologists to guide appropriate management and treatment decisions for patients. Table 27.5 provides an overview of the purpose, procedure, and interpretation of each endoscopic procedure commonly used to evaluate bowel functioning.

Endoscopic Procedure	Purpose	Procedure	Interpretation
Esophagogastroduodenoscopy (EGD)	Evaluate the esophagus, stomach, and duodenum for abnormalities such as ulcers, inflammation, or tumors.	A flexible endoscope is passed through the mouth into the esophagus, stomach, and duodenum. Biopsies may be obtained for further analysis.	Findings such as esophageal ulcers, gastritis, peptic ulcers, or duodenal tumors may indicate pathology affecting the upper GI tract.
Colonoscopy	Examine the colon and rectum for abnormalities such as polyps, inflammation, or tumors.	A flexible colonoscope is inserted through the rectum into the colon. Polyps may be removed, and biopsies can be obtained for analysis.	Identification of polyps, inflammation, diverticula, or colorectal tumors can aid in the diagnosis of conditions such as colorectal cancer, inflammatory bowel disease, or diverticulitis.
Flexible sigmoidoscopy	Evaluate the rectum and sigmoid colon for abnormalities such as polyps, inflammation, or tumors.	A flexible sigmoidoscope is inserted through the rectum into the sigmoid colon. Biopsies may be obtained if necessary.	Findings such as sigmoid polyps, proctitis, or rectal tumors may indicate pathology affecting the lower GI tract.
Endoscopic retrograde cholangiopancreatography (ERCP)	Assess the bile ducts and pancreatic duct for abnormalities such as stones, strictures, or tumors.	A flexible endoscope is advanced through the mouth into the duodenum. Contrast dye is injected into the bile and pancreatic ducts for imaging.	Identification of bile duct stones, strictures, or pancreatic tumors can aid in the diagnosis and management of conditions such as choledocholithiasis or pancreatic cancer.
Capsule endoscopy	Evaluate the small intestine for abnormalities such as bleeding, inflammation, or tumors.	Patient swallows a capsule containing a camera, which captures images of the small intestine as it passes through the digestive tract.	Visualizing small intestinal abnormalities (e.g., bleeding sources, Crohn disease, small bowel tumors) can aid in the diagnosis of conditions affecting the small intestine.

Table 27.5 Endoscopic Procedures (Sources: Cleveland Clinic, 2022b, 2023a, 2023b.)

Laparoscopy

A minimally invasive surgical procedure, laparoscopy serves as a valuable diagnostic and therapeutic tool in assessing and addressing various GI conditions that may adversely affect bowel functioning. In a diagnostic laparoscopy, the abdominal cavity and its organs are meticulously examined for abnormalities (e.g., adhesions, tumors, inflammation) that could affect bowel function. This is achieved by inserting a laparoscope, a thin tube equipped with a camera, through small incisions in the abdomen, allowing direct observation of the abdominal organs. Identification of such abnormalities during diagnostic laparoscopy provides crucial insights into the underlying causes of bowel dysfunction, such as adhesion-related bowel obstruction or IBD, guiding subsequent treatment decisions.

Therapeutic laparoscopy extends beyond diagnosis to address the underlying causes of bowel dysfunction identified during the diagnostic procedure. Through additional incisions, surgical instruments are introduced to perform therapeutic interventions such as adhesiolysis (removal of adhesions), tumor resection, or bowel resection. These interventions aim to alleviate obstructions, remove tumors, or address inflammatory processes, ultimately improving bowel functioning and alleviating symptoms associated with GI conditions. Laparoscopy offers several advantages over traditional open surgery, including smaller incisions, reduced postoperative pain, and shorter hospital stays, making it an effective and preferred approach in the evaluation and management of bowel-related issues.

The Nurse’s Role in Diagnostic Testing for Functional Bowel Elimination

Diagnostic testing for functional bowel elimination plays a crucial role in assessing and managing various GI conditions. Nurses, as frontline caregivers, play an integral role in facilitating this process, ensuring effective patient care and treatment outcomes. The nurse’s involvement in diagnostic testing for functional bowel elimination spans a range of duties, including performing assessments, implementing nursing interventions, educating patients, preparing them for procedures, assisting during the procedures, and providing postprocedural care. By fulfilling these responsibilities with compassion, competence, and professionalism, nurses contribute significantly to the delivery of high-quality care and positive patient outcomes in the field of GI health.

Nursing Assessment

In the realm of diagnostic testing for functional bowel elimination, nurses play a pivotal role through their expertise in conducting thorough nursing assessments. Nurses are uniquely positioned to gather comprehensive data regarding a patient’s bowel habits, GI symptoms, dietary patterns, and overall health history. Through skilled assessment techniques, nurses can identify potential risk factors, symptoms of bowel dysfunction, and contributing factors such as dietary habits, stress levels, and medication use. For example, a nurse conducting a nursing assessment may ask a patient about their typical daily intake of fiber-rich foods, hydration status, and any recent changes in diet or lifestyle that could adversely affect bowel function.

Nursing assessment of stool characteristics includes carefully observing and documenting various aspects of the stool to gather valuable information about a patient’s GI health. This comprehensive assessment involves evaluating the consistency, color, and odor of the stool. The texture of the stool is referred to as consistency and ranges from hard and formed to soft and loose, which can provide insights into bowel function and hydration status. Nurses also note the color of the stool, which can indicate different conditions or dietary factors. For instance, black, sticky, tarry stools (melena) may suggest upper GI bleeding, while pale or clay-colored stools may indicate issues with bile production or flow. On the other hand, hematochezia (also known as rectal bleeding), bright red blood in the stools, is a sign of bleeding from the lower GI tract. Any sign of blood should always be reported to the healthcare provider. Additionally, nurses assess the odor of the stool, which can offer clues about digestive processes or bacterial activity in the gut.

By establishing open communication and fostering a trusting relationship with patients, nurses create an environment in which individuals feel comfortable sharing sensitive information related to their bowel habits and GI concerns. By actively listening to patient concerns, validating their experiences, and providing education on healthy bowel habits and lifestyle modifications, nurses empower patients to actively participate in their own care and advocate for their needs. Additionally, nurses employ their clinical judgment and critical-thinking skills to interpret assessment findings, recognize patterns of bowel dysfunction, and determine the need for further diagnostic testing or interventions. For instance, if a patient reports symptoms suggestive of bowel obstruction (e.g., severe abdominal pain, distension, vomiting), the nurse promptly recognizes the need for urgent medical evaluation and intervention. Similarly, if a patient presents with chronic constipation or diarrhea, the nurse collaborates with the healthcare team to implement evidence-based interventions, such as dietary modifications, pharmacological therapies, or referral to a gastroenterologist for further evaluation. Through their holistic approach to nursing assessment, nurses not only contribute valuable insights to the diagnostic process but also serve as advocates for patients, ensuring their needs are addressed and promoting optimal bowel health outcomes.

Nursing Interventions to Promote Bowel Elimination

Nurses play a crucial role not only in facilitating the diagnostic process but also in implementing nursing interventions to promote optimal bowel elimination. Through their expertise in GI health and patient-centered care, nurses employ a variety of interventions aimed at improving bowel function, alleviating symptoms, and enhancing overall bowel health. Some nursing interventions commonly used to promote bowel elimination include the following:

• Education and lifestyle modifications: Nurses provide patient education on healthy bowel habits, emphasizing the importance of adequate hydration, dietary fiber intake, regular exercise, optimal positioning to promote bowel elimination, and stress management techniques. By empowering patients with knowledge about factors that influence bowel function, nurses help individuals make informed lifestyle choices to support optimal bowel elimination.
• Nutritional counseling: Nurses collaborate with dietitians to develop individualized dietary plans tailored to each patient’s needs and preferences. For instance, patients with constipation may benefit from increasing fiber-rich foods in their diet, while those with diarrhea may require dietary modifications to reduce irritants such as caffeine or spicy foods. Nurses monitor dietary intake, provide dietary counseling, and reinforce the importance of balanced nutrition for bowel health.
• Medication management: Nurses administer prescribed medications to manage symptoms of bowel dysfunction, such as laxatives for constipation or antidiarrheal agents for diarrhea. They also monitor medication effectiveness, assess for adverse effects, and educate patients on proper medication use and potential side effects. Additionally, nurses collaborate with healthcare providers to adjust medication regimens based on patient response and treatment goals.
• Bowel training programs: For patients with impaired bowel function (e.g., fecal incontinence, constipation), nurses implement bowel training programs to establish regular bowel habits and improve bowel control. These programs may include scheduled toileting routines, biofeedback therapy, pelvic floor exercises, and relaxation techniques to enhance sphincter control and promote efficient bowel evacuation.
• Promotion of physical activity: Nurses encourage patients to engage in regular physical activity because exercise can stimulate bowel motility and promote regular bowel movements. Nurses assess patients’ mobility levels, provide recommendations for safe exercise routines, and collaborate with physical therapists to develop individualized exercise plans tailored to each patient’s abilities and limitations.
• Hygiene and skin care: Nurses provide meticulous perineal care for patients with bowel incontinence to prevent skin breakdown, irritation, and infection. They assist patients with proper hygiene practices, including gentle cleansing, application of protective barrier creams, and frequent changes of incontinence products (disposable briefs, diapers), as needed.

Through these nursing interventions, nurses play a vital role in promoting bowel elimination, enhancing patient comfort, and improving overall quality of life for individuals with functional bowel disorders. By delivering compassionate, patient-centered care and collaborating with interdisciplinary healthcare teams, nurses contribute to positive outcomes and empower patients to achieve optimal bowel health.

Patient Conversations

How to Educate a Patient on Strategies for Promoting Bowel Elimination

Scenario: Mrs. Perkins, a 65-year-old female, arrives at the clinic for her routine checkup. During her check-in process, she mentions that she has been experiencing discomfort caused by constipation lately and has tried various home remedies without much success. The office assistant has the patient complete a questionnaire to describe her diet, fluid consumption, activity levels, and medications taken.

Nurse: Hi Mrs. Perkins. My name is Macey and I’m the nurse who will be working with you today.

Patient: Hi Macey, I’ve been having some trouble with constipation lately, and it’s really been bothering me. Do you have any suggestions to help relieve my constipation?

Nurse: Thank you for completing this questionnaire. It will really help you and I find some ways to relieve your constipation. First, let’s talk about your diet. According to the information you provided, it looks like you should consider increasing your fiber intake by incorporating more fruits, vegetables, and whole grains. This can help add bulk to your stool and promote regular bowel movements. Another thing that I noticed considering your response to the questionnaire, is that you probably ought to be drinking more fluids. It’s important to stay hydrated by drinking plenty of water throughout the day because dehydration can contribute to constipation.

Patient: I’ll definitely try to drink more water but I have trouble finding recipes that I like for cooking vegetables.

Nurse: Do you like raw vegetables like carrots, celery, radishes, cauliflower, and broccoli?

Patient: Actually, I do, especially if I dip them in salad dressing.

Nurse: That sounds great. Vegetables are even healthier if you eat them raw. You can also cut them up into a salad. By the way, the darker green lettuces are the best for your gut, like romaine and spinach. Do you like fruits?

Patient: I do but they seem to go bad too fast.

Nurse: Maybe try buying only two fruits each week like a container of strawberries and another of blackberries then switch to two different fruits next week like a few bananas and a container of raspberries. That way you should finish them before its time to buy two more.

Patient: You’re right. I get excited about how good they look and buy too many at once. Do you recommend anything else?

Nurse: Physical activity can also help stimulate bowel movements. Regular exercise, such as walking, jogging, or yoga, can help promote bowel motility and alleviate constipation. Additionally, establishing a regular toileting routine can train your body to respond to the urge to defecate. Try to set aside time each day for bowel movements, and don’t ignore the urge when it comes.

Patient: I’ll make sure to incorporate some exercise into my daily routine and try to stick to a regular toileting schedule. Are there any other things I should consider?

Nurse: Yes, for some individuals, over-the-counter laxatives or stool softeners may be helpful in relieving constipation. However, it’s important to use these medications under the guidance of a healthcare professional because they can have side effects and may not be suitable for everyone. Finally, managing stress and anxiety through relaxation techniques, such as deep breathing or meditation, can also help improve bowel function.

Patient: Thank you so much, Macey. I feel better knowing there are steps I can take to deal with my constipation. I’ll definitely give these suggestions a try and let you know how it goes.

Nurse: You’re welcome. Remember, everyone’s body is different, so it may take some time to find the right combination of interventions that work for you. I’ve been taking notes on my computer while we’ve been talking so I’ll print out a condensed description of all the things we talked about. That way you’ll have something to review; but, don’t hesitate to reach out if you have any questions or concerns along the way.

Education for a Gastrointestinal Procedure

Nurses assume a critical role in educating patients about the procedures involved in diagnostic testing and therapeutic treatment for functional bowel elimination. As frontline healthcare providers, nurses serve as primary sources of information, guiding patients through the diagnostic and therapeutic processes and addressing their concerns and apprehensions. Before undergoing a GI procedure, nurses may reiterate explanations of the procedure, including its purpose, expected outcomes, potential risks, and any preparatory steps required. Through clear and concise communication, nurses ensure that patients understand what to expect before, during, and after the procedure, helping to alleviate anxiety and promote informed decision-making.

For example, when preparing a patient for a colonoscopy, nurses explain the necessity of bowel preparation to cleanse the colon and facilitate optimal visualization during the procedure. They provide detailed instructions on dietary restrictions, laxative use, and fluid intake, ensuring that patients adhere to the prescribed regimen for effective bowel cleansing. Nurses also discuss the sedation process, potential side effects, and postprocedure care instructions, empowering patients to actively participate in their own care and minimize procedural complications.

Patient Conversations

Educating a Patient on Bowel Preparation

Nurse: Good morning, Mr. Johnson. My name is Jen. I’m a nurse here and ready to go over the details of your colonoscopy preparation with you. How are you feeling today?

Patient: Good morning, Jen. I’m a bit nervous about the whole process, to be honest.

Nurse: That’s completely understandable. Let’s take it step by step, and I’ll make sure you have all the information you need. First, the purpose of the colonoscopy is to examine your colon for any abnormalities, such as polyps or signs of disease.

Patient: Okay, I understand. But what do I need to do to prepare for it?

Nurse: The preparation involves thoroughly cleansing your colon so that the provider can get a clear view during the procedure. You will need to follow a special diet for a few days before the colonoscopy, which typically involves avoiding solid foods and consuming only clear liquids. Then, the day before the procedure, you’ll need to take a laxative solution to empty your bowels completely.

Patient: That sounds like a lot to manage. Will I be able to eat or drink anything before the colonoscopy?

Nurse: Unfortunately, no solid foods will be allowed the day before the procedure. You’ll only be able to consume clear liquids like broth, water, and juice without pulp. You may also have sports drinks (Gatorade), popsicles, and gelatin dessert (Jell-O), but nothing you eat or drink can be red or purple. It is essential to stay hydrated, so please consume plenty of these fluids. But remember, you must avoid milk, smoothies, and soup even though they are liquids.

Patient: Got it. Is there anything else I should know or do to prepare?

Nurse: Yes, it’s crucial to follow the instructions provided by your healthcare provider precisely. This includes when to start and stop eating and drinking as well as when to take the laxative solution. It’s also important to arrange for someone to drive you home after the procedure because you’ll be under the effects of sedation.

Patient: Thank you for explaining everything, Jen. I think I understand now and I’m not so nervous.

Nurse: You’re welcome, Mr. Johnson. Here’s description of all the things we talked about for you to take with you. Remember, we’re here to support you every step of the way. If you have any more questions or concerns, don’t hesitate to call.

In addition to procedural education, nurses play a key role in addressing patients’ emotional and psychological needs throughout the process. They offer empathetic support, answer questions, and provide reassurance to alleviate anxiety and enhance patient comfort. By fostering a supportive and compassionate environment, nurses help patients feel more confident and empowered as they undergo GI procedures for functional bowel elimination.

Administration of Bowel Prep

Nurses play a vital role in administering bowel prep to ensure optimal conditions for accurate examination of the GI tract. Often abbreviated as “bowel prep,” bowel preparation (bowel prep) is a medical procedure that involves cleansing the GI tract, particularly the colon, in preparation for certain medical procedures or surgeries (e.g., colonoscopy, sigmoidoscopy, barium enema). The purpose of a bowel prep is to ensure that the colon is empty and free of stool, allowing for better visualization and examination of the intestinal lining during these procedures (Cleveland Clinic, 2022c; Patel et al., 2023). Bowel prep typically involves consuming a special liquid diet or taking laxatives to induce bowel movements and clear the colon of any remaining feces (Patel et al., 2023).

Nurses are responsible for guiding patients through the bowel preparation process, ensuring compliance with prescribed protocols, and providing support and education to facilitate successful bowel cleansing. Nurses begin by assessing patients’ understanding of the bowel prep regimen and addressing any concerns or questions they may have. They provide detailed instructions on the type of bowel prep solution to be used, dosage, timing of administration, dietary restrictions, and fluid intake requirements. Additionally, nurses discuss potential side effects of the bowel prep (e.g., nausea, bloating, diarrhea) and offer strategies to manage these symptoms effectively.

During administration of the bowel prep, nurses closely monitor patients’ adherence to the prescribed regimen and provide ongoing support and encouragement. They offer reminders and guidance to ensure patients follow the recommended schedule for consuming bowel prep solutions and adhere to dietary restrictions. For example, patients may be instructed to eat a low-fiber diet for several days before beginning their bowel prep, followed by a clear liquid diet the day before the scheduled procedure. Nurses also assess patients’ tolerance to the bowel prep and promptly address any concerns or complications that may arise, such as dehydration or electrolyte imbalances.

Moreover, nurses play a crucial role in assessing patients’ readiness for the procedure following completion of the bowel prep. They monitor patients’ hydration status, vital signs, and overall well-being, and communicate any pertinent information to the healthcare team. Nurses provide reassurance and emotional support to alleviate anxiety and discomfort associated with the bowel preparation process, helping patients feel more at ease as they undergo diagnostic testing for functional bowel elimination.

A key component of preprocedural education for a GI test or procedure under moderate sedation is to ensure that the patient will have a responsible adult available to take them home and stay with them for twenty-four hours. It is important to make sure that the patient understands that using a taxi or rideshare option (e.g., Lyft, Uber) is not an allowed method of going home after the procedure unless a responsible adult accompanies the patient on the ride home. Many patients ask why this is not allowed. The nurse must explain that the driver cannot be held accountable for providing care on the ride home; therefore, a responsible adult must accompany the patient.

Link to Learning

Resources for learning about the types of bowel prep kits and their instructions for use are provided by the Cleveland Clinic. This information can also be shared with patients who are undergoing bowel preparation.

Through their expertise in patient education, assessment, and support, nurses contribute significantly to the successful administration of bowel preparation and facilitate optimal conditions for GI procedures. Their compassionate care and attention to detail help ensure patient safety, comfort, and adherence to treatment protocols, ultimately enhancing the accuracy and effectiveness of diagnostic testing or therapeutic procedure for functional bowel elimination.

Monitoring After Moderate Sedation

Also known as conscious sedation, moderate sedation is a medical technique used to induce a state of reduced consciousness and relaxation in patients undergoing certain medical procedures or interventions. Unlike general anesthesia, in which the patient is completely unconscious, moderate sedation aims to keep patients in a state where they can respond to verbal commands and physical stimulation. During moderate sedation, patients may experience drowsiness, reduced anxiety, and a decreased awareness of their surroundings. This sedation level is commonly used for procedures such as minor surgeries, endoscopies, and colonoscopies.

Before the procedure, nurses assess patients’ medical history, current medications, allergies, and fasting status to determine their suitability for moderate sedation. They educate patients about the sedation process, including its purpose, potential side effects, and instructions to follow before and after the procedure. Nurses participate in the informed consent process by ensuring that all necessary preparations (e.g., placing IV access, initiating monitoring) are in place before sedation administration. The proceduralist is responsible for obtaining the patient’s consent and signature.

During the procedure, nurses continuously monitor the patient’s vital signs (e.g., heart rate, blood pressure, respiratory rate, oxygen saturation), observe their response to sedation, and watch for any signs of adverse reactions or complications. They maintain open communication with the procedural team, providing updates on the patient’s condition and intervening promptly if necessary to ensure patient safety.

After the procedure, nurses monitor patients closely during the recovery period, assessing their level of consciousness, airway patency, and response to stimuli. They provide supportive care, such as positioning patients to maintain airway patency and administering supplemental oxygen as needed. Nurses assess for signs of respiratory depression, hypotension, or allergic reactions to sedative medications and intervene promptly to address any complications that may arise.

Moreover, nurses provide thorough education and discharge instructions to patients and their caregivers before discharge from the recovery area. They review potential side effects of sedation, instructions for postprocedure care, and signs of complications to watch for at home. Nurses ensure that patients are stable, alert, and able to tolerate oral fluids before discharge, and ensure that the patient has safe transportation home with a responsible adult.