Gastroenterology Nursing Clinical Practice
Scope of GI nursing practice
Candidates must move fluidly between procedure knowledge and bedside judgment. Core content includes upper and lower endoscopy (EGD, colonoscopy, flexible sigmoidoscopy), ERCP, EUS, capsule endoscopy, and therapeutic adjuncts such as polypectomy, argon plasma coagulation, variceal banding, dilation, and stent placement. Know the indications, contraindications, and the complications that show up in questions: bleeding, perforation, aspiration, post-ERCP pancreatitis, and sedation-related respiratory depression.
Pre- and post-procedure care
Bowel preparation adequacy is scored segmentally with the Boston Bowel Preparation Score (0–3 per colonic segment, 0–9 total); a segment score of 2 or higher is generally considered adequate. Know diet resumption (typically after return of gag reflex and passage of flatus or stool) and periprocedural anticoagulation planning - many screening polypectomies require holding clopidogrel but not aspirin unless the endoscopist directs otherwise.
Traps
Questions love to blur upper versus lower bleeding: hematemesis and melena point proximal to the ligament of Treitz, while hematochezia is usually distal but can reflect a brisk upper bleed. Another trap is assuming a "normal" EGD rules out pathology, or that post-polypectomy bleeding is always immediate - delayed bleeding can occur days later, especially with anticoagulants.
Worked example
A patient reports two hours of melena and lightheadedness after starting naproxen. HR 112, BP 98/60. Reasoning: melena indicates an upper source; tachycardia with a narrow pulse pressure suggests intravascular depletion rather than anxiety. Escalate for urgent endoscopy, establish IV access, type and screen, hold NSAIDs, and do not assume a benign cause.
Rule of thumb
New tachycardia plus melena after NSAID use is an upper GI bleed until proven otherwise.