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Exam study book Forensic Medicine For Medical Students of nandinibooks - ISBN: 9780340550731 (M)
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Medical & Surgical Nursing1. Barium Swallow (Oesophagography)
2. Bell’s Palsy
3. Benign Prostatic Hypertrophy or Hyperplasia Nursing Care Plan &
Management
4. Bill Roth Surgery
5. Bladder Cancer Nursing Care Plan & Management
6. Blalock-Taussig Operation
7. Blepharoplasty Surgery
8. Blood Chemistry
9. Blood Urea Nitrogen (BUN)
10. Barium Swallow (Oesophagography)
11. Bone Marrow Aspiration and Biopsy
12. Brain Abscess
13. Acute Bronchitis Nursing Care Plan & Management
, 14. Chronic Bronchitis Nursing Care Plan & Management
15. Berger’s Disease Nursing Care Plan & Management
16. Burns Nursing Care Plan & Management
Breast Cancer Nursing Care Plan &
Management
Definition
Barium swallow, also known as esophagography, is the radiographic or
fluoroscopic examination of the pharynx and the fluoroscopic examination
,of the esophagus after ingestion of thick and thin mixtures of barium
sulfate.
This test, is commonly performed as part of the upper GI series, is
indicated for patients with history of dysphagia and regurgitation. Further
testing is usually required for a definitive diagnosis.
After the barium is swallowed, it pours over the base of the tongue into the
pharynx. A peristaltic wave propels it through the entire length of the
esophagus in about 2 seconds. When the peristaltic wave reaches the
base of the esophagus, the cardiac sphincter opens, allowing the barium to
enter the stomach. After passage of the barium, the cardiac sphincter
closes. Normally, it evenly fills and distends the lumen of the pharynx and
esophagus, and the mucosa appears smooth and regular.
Purpose
▪ To diagnose hiatal hernia, diverticula, and varices.
▪ To detect strictures, ulcers, tumors, polyps, and motility disorders.
Procedure
Patient Preparation
1. Explain to the patient that this test evaluates the function of the pharynx
and esophagus.
2. Instruct the patient to fast after midnight before the test.
3. If the patient is infant, delay the feeding to ensure complete digestion of
the barium.
4. Explain that the test takes approximately 30 minutes.
5. Describe the milkshake consistency and chalky taste of the barium
preparation the patient will ingest; although it’s flavored, it may be
unpleasant to swallow.
6. Tell him he’ll first receive a thick mixture and then a thin one and that
he must drink 12 to 14 oz (355 to 414 ml) during the examination.
7. Inform him that he’ll be placed in various positions on a tilting
radiograph table and that radiographs will be taken.
8. If gastric reflux is suspected, withhold antacids, histamine-2 (H2)
blockers, and proton pump inhibitors, as ordered.
9. Just before the procedure, instruct the patient to put a hospital gown
without snap closures and to remove jewelry, dentures, hairpins, and
other radiopaque objects from the radiograph field.
10. Check the patient history for contraindications to the barium swallow,
such as intestinal obstruction and pregnancy. Radiation may have
teratogenic effects.
Implementation
, 1. The patient is placed in an upright position behind the fluoroscopic
screen, and his heart, lungs, and abdomen are examined.
2. The patient is instructed to take one swallow of the thick barium
mixture; pharyngeal action is recorded using cineradiography.
3. The patient is instructed to take several swallows of the thin barium
mixture. Passage of the barium is examined fluoroscopically; spot films
of the esophageal region are taken from lateral angles and from the
right and left posteroanterior angles.
4. To accentuate small strictures or demonstrate dysphagia, the patient
may be asked to swallow a “barium marshmallow” (soft white bread
soaked in barium) or a barium pill.
5. The patient is then secured to the X-ray table and rotated to
trendelenburg position to evaluate esophageal peristalsis or
demonstrate hiatal hernia and gastric reflux.
6. The patient is instructed to take several swallows of barium while the
esophagus is examined fluoroscopically; spot films are taken.
7. After the table is rotated to a horizontal position, the patient takes
several swallows of the barium so that the esophageal junction and
peristalsis may be evaluated.
8. Passage of the barium is fluoroscopically observed and the spot films
are taken with the patient in the supine and prone position.
9. During fluoroscopic examination of the esophagus, the stomach and
the duodenum are also carefully studied because neoplasms in these
areas may invade the esophagus and cause obstruction.
Nursing Interventions for Barium Swallow
1. Check the additional films and fluoroscopic evaluations haven’t been
ordered before allowing the patient to resume his usual diet.
2. Instruct the patient to drink plenty of fluids, unless contraindicated, to
help eliminate the barium.
3. Give cathartic as prescribed.
4. Tell the patient to notify the physician if he fails to expel the barium in 2
to 3 days.
5. Inform the patient that stools will be chalky and light colored for 24 to 72
hours.
Interpretation
Normal Results
▪ The swallowed barium bolus pours over the base of the tongue into the
pharynx.
▪ A peristaltic wave reaches the base of the esophagus, the cardiac
sphincter opens, allowing the bolus to enter the stomach. After the
passage of the bolus, the cardiac sphincter closes.
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