discussion response
Colonoscopy
Wendy Serrano, SN BSN
Importance of a colonoscopy
To visualize the lining of the colon and rectum in order to:
Help detect colon and rectal cancer
Help locate low GI bleeding
Evaluate for recurrence of polyps or lesions
Evaluate abnormal results for tests other than colonoscopies
Investigate rectal bleeding and abdominal pain
Colonoscopy. (2018, May 22). Retrieved from https:// www.mayoclinic.org/tests- procedures/colonoscopy/about/pac-20393569.
Normal and Abnormal results
Normal results are light pink mucosa with folds and pits.
Abnormal results:
Hemorrhoids- vein clumps near the rectum
Polyps- growths of tissue in the mucosal lining
Inflammation and ulcers- can result from NSAID’s, inflammatory bowel diseases, and cancers.
Bleeding- can come from tumors and ulcers.
Can also see foreign bodies or fistulas if present
Shmerling, R. H. (2018, April). Understanding the results of your colonoscopy. Retrieved from https :// www.health.harvard.edu/staying-healthy/understanding-the-results-of-your- colonoscopy.
What may affect results?
Decreased or no visualization due to:
Soapsuds because they irritate the lining and cause an increase in mucus
Barium from previous diagnostic tests
Not cleaning the intestines correctly
Some previous surgeries, radiation or chronic inflammatory diseases may not allow the colonoscope to be inserted.
Chernecky, C. C. (2013). Laboratory tests and diagnostic procedures. Missouri: Elsevier. Page 358
Patient care and teaching
Prep: typically there is a clear liquid diet requirement the day before, no red liquids. Then the patient is typically NPO after midnight. Laxatives or enemas may be required as well.
During: A sedative is typical. The doctor will position the patient in a side lying position with their legs to their chest. The tube that will be inserted has a light and a camera on the end of it. The camera will allow the doctor to see the images on an external monitor like a computer screen. They may also take pictures of abnormalities. The doctor can also insert instruments to take samples or remove polyps. The procedure is about 30-60 minutes long.
Post: The sedative effects will take all day to completely wear off so the patient will need a driver to drive them home. The nurse will take vitals every 15-30 minutes until the patient is fully recovered. A special diet may be required for certain procedures, such as when removing polyps. If not they may resume normal diet. The patient may have gas or bloat that can be resolved by walking. A small amount of blood is not worrisome but blood clots, a large amount of blood, pain and a fever are.
Colonoscopy. (2018, May 22). Retrieved from https:// www.mayoclinic.org/tests-procedures/colonoscopy/about/pac-20393569.
Chernecky, C. C. (2013). Laboratory tests and diagnostic procedures. Missouri: Elsevier.
Nursing diagnosis
Acute pain related to GI tissue irritation as evidenced by reports of chronic abdominal pain that does not go away with any medication, guarding and grimacing.
Anxiety related to a new and unfamiliar procedure as evidenced by verbally reporting not understanding the procedure and being worried about sedation as well as increased tension and a worried facial expression.
Follow up tests
Through conducting research the only article that contained anything about follow up testing or treatment is this quote by mayoclinic “If you have had polyps before, your doctor may recommend a follow-up colonoscopy to look for and remove any additional polyps. This is done to reduce your risk of colon cancer.” If there are no abnormalities there is no follow up required.
Colonoscopy. (2018, May 22). Retrieved from https:// www.mayoclinic.org/tests- procedures/colonoscopy/about/pac-20393569.
Ethical issue
An ethical issue encountered with colonoscopies involves people feeling they are not informed correctly or are not fully aware of what the procedure entails. This is an ethical issue because the patient is in a vulnerable situation due to being unconscious (most of the time) as well as undergoing an invasive procedure via the anal canal which is considered a private area to most. Proper teaching is required to correctly attain a fully educated informed consent. Agre, McKee, Gargon and Kurtz (1997) ran a study on 204 patients and their families to study the success of preoperational education for endoscopies and colonoscopies. All patients were older than 19, spoke English and were mentally competent. During this trial participants were given both an instructional video and verbal teaching alone, then together. According to the study and a post teaching 10 question survey, the patients felt fully informed when given a review via a video before teaching with healthcare providers began. This issue may be resolved using a method which combines both a video and the typical method which involves a printed packet reinforced by verbal instruction.
Agre, P., McKee, K., Gargon, N., & Kurtz, R. C. (1997, January 1). Division of Nursing, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. Retrieved from https://europepmc.org/abstract/med/9171552.
Peer reviewed journal
Summary: This article is useful for both patients and healthcare professionals because it provides an overview of what a colonoscopy is and what it entails including risks, definitions of results and care before, during and after the procedure. A colonoscopy is performed by inserting a scope into the rectum in order to be able to examine the colon. Colonoscopies are indicated for GI complications such as chronic abdominal pain, rectal bleeding, for colon cancer screening, or as a follow up for previous polyps. Risks associated with a colonoscopy include reactions to sedation, bleeding or perforation. There is some preparation involved such as taking a laxative, using an enema and following a special diet. During the procedure the patient will be sedated, placed in a side-lying position with their knees to their chest and a scope will be inserted through the rectum. This tube allows to visualize the lining of the colon, to scrape for samples, or to remove polyps. After the procedure the patient will need a driver due to the sedation. Bleeding, bloat and gas is normal. Negative results means there are no abnormalities. Positive results mean that there are polyps or abnormal tissue present.
Colonoscopy. (2018, May 22). Retrieved from https:// www.mayoclinic.org/tests-procedures/colonoscopy/about/pac-20393569.
References
Agre, P., McKee, K., Gargon, N., & Kurtz, R. C. (1997, January 1). Division of Nursing, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. Retrieved from https://europepmc.org/abstract/med/9171552.
Chernecky, C. C. (2013). Laboratory tests and diagnostic procedures. Missouri: Elsevier.
Colonoscopy. (2018, May 22). Retrieved from https://www.mayoclinic.org/tests-procedures/colonoscopy/about/pac-20393569.
Shmerling, R. H. (2018, April). Understanding the results of your colonoscopy. Retrieved from https:// www.health.harvard.edu/staying-healthy/understanding-the-results-of-your-colonoscopy.