CGRN cheat sheet

Standard pre-procedure fasting intervals are 2 hours for clear liquids, 6 hours for a light meal or nonhuman milk, and 8 hours for a fatty or fried meal.

Split-dose bowel preparation places the second dose 4-6 hours before the colonoscopy and finishes at least 2 hours before the start time; it produces higher adequacy rates than day-before dosing.

Spontaneous bacterial peritonitis is present when the ascitic fluid polymorphonuclear count is 250 cells/mm3 or greater; first-line treatment is a third-generation cephalosporin plus IV albumin.

Paracentesis removing more than 5 L warrants albumin replacement at roughly 6-8 g per liter of ascites removed to limit post-paracentesis circulatory dysfunction.

High-risk bleeding stigmata in peptic ulcer hemorrhage are managed with endoscopic hemostasis plus a proton pump inhibitor bolus followed by continuous infusion for 72 hours.

Acute pancreatitis is supported by lipase at least 3 times the upper limit of normal; initial management is isotonic crystalloid resuscitation and analgesia.

Hepatic encephalopathy is titrated with lactulose to 2-3 soft stools daily; rifaximin is added as secondary prophylaxis after a second episode.

PEG tubes require about 30 mL of water flushing before and after each medication, with medications given one at a time to prevent clogging.

Clostridioides difficile requires soap-and-water handwashing, contact precautions, and sporicidal (bleach-based) environmental cleaning because alcohol does not kill spores.

The Modified Aldrete score rates activity, respiration, circulation, consciousness, and oxygen saturation 0-2 each; a total of 9-10 generally meets discharge criteria.

End-tidal CO2 monitoring reveals apnea and hypoventilation before oxygen saturation falls, particularly when the patient receives supplemental oxygen.

Abdominal assessment order is inspection, auscultation, percussion, then palpation; auscultation precedes palpation so bowel sounds are not altered.

Vital signs and sedation level are documented at baseline and at least every 5 minutes during moderate sedation until the patient is stable.

MELD 3.0 incorporates bilirubin, INR, creatinine, sodium, and albumin to estimate 90-day mortality in cirrhosis.

Child-Pugh class A, B, or C is derived from bilirubin, albumin, INR, ascites, and encephalopathy and predicts peri-procedural and surgical risk.

Delayed post-polypectomy bleeding presents with hematochezia, tachycardia, hypotension, or a falling hemoglobin rather than pain alone.

Perforation after endoscopy presents with sudden severe abdominal pain, board-like rigidity, absent bowel sounds, and free air on imaging.

The Boston Bowel Prep Scale scores three colonic segments 0-3 after washing; a segment score of 2 or greater is considered adequate.

The sedation continuum runs minimal, moderate, deep, and general anesthesia; a patient can pass into a deeper level at any time despite an intended moderate target.

Moderate sedation is a drug-induced depression of consciousness in which the patient responds purposefully to verbal or tactile stimulation and maintains a patent airway without intervention.

IV midazolam onset is 1-3 minutes with peak effect at 3-5 minutes; IV fentanyl onset is 2-3 minutes with peak effect at 5-15 minutes.

Doses are reduced in older adults and in patients with obesity, OSA, or hepatic and renal impairment because of slowed drug clearance.

Flumazenil is titrated at 0.2 mg IV, repeated every minute to 1 mg per dose, with a maximum total of 3 mg.

Naloxone is titrated in 0.04-0.4 mg IV increments to restore adequate ventilation rather than full arousal.

Flumazenil and naloxone have shorter durations than the sedatives they reverse, so monitoring continues at least 2 hours after the last reversal dose for resedation.

Propofol has no reversal agent, causes hypotension and dose-dependent apnea, and is administered by providers trained in airway rescue.

Rescue thresholds requiring provider notification include SpO2 below 90%, apnea longer than 30 seconds, heart rate below 50 or above 120, and systolic pressure change greater than 20%.

Under the Spaulding classification, flexible GI endoscopes contact mucous membranes and are semicritical devices requiring at least high-level disinfection between patients.

Bedside precleaning occurs immediately after endoscope withdrawal and before transport so bioburden does not dry and adhere within channels.

Leak testing is performed before each procedure after bedside cleaning; a leaking endoscope is removed from service to prevent fluid intrusion and patient exposure.

High-level disinfection parameters include glutaraldehyde at 20 degrees C for at least 20 minutes and ortho-phthalaldehyde for about 12 minutes at 20 degrees C.

Minimum effective concentration of the disinfectant is verified before each cycle, and temperature and exposure time are logged for every reprocessing event.

Duodenoscopes carry elevated multidrug-resistant organism transmission risk from the elevator mechanism; mitigation includes culture-and-quarantine programs, enhanced drying, and disposable elevator components.

Endoscopes are stored vertically hanging in a ventilated cabinet to prevent moisture retention and biofilm formation.

Alcohol-based hand rub is ineffective against C. difficile spores, so soap-and-water handwashing with contact precautions and bleach cleaning is used.

Fluoroscopy safety follows ALARA with lead shielding, dosimeter badges, collimation, and maximizing distance from the radiation source.

The performing provider obtains informed consent; the nurse may witness the signature and verify that the patient understands the procedure, risks, and alternatives.

A formal time-out immediately before the procedure confirms patient identity, procedure, site, consent, allergies, and available equipment with the whole team present.

State nurse practice acts define whether registered nurses may administer and monitor moderate sedation and what additional certification is required.

Required documentation includes consent, time-out, baseline assessment, sedation agents with doses and times, monitoring values, interventions, and discharge criteria met.

Teach-back, in which the patient restates the bowel preparation schedule in their own words, identifies comprehension gaps and practical barriers.

SGNA standards define gastroenterology nursing roles and competencies, which are validated at orientation and annually thereafter.

HIPAA requires minimum-necessary disclosure of protected health information, and patients with limited English proficiency require a qualified medical interpreter.