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COLONOSCOPY SYNONYMS/ACRONYM: Full colonoscopy, lower endoscopy, lower panendoscopy. AREA OF APPLICATION: Colon. CONTRAST: Air. DESCRIPTION: Colonoscopy allows inspection of the mucosa of the entire colon, ileocecal valve, and terminal ileum using a flexible fiberoptic colonoscope inserted through the anus and advanced to the terminal ileum. The colonoscope is a multichannel instrument that allows viewing of the gastrointestinal (GI) tract lining, insufflation of air, aspiration of fluid, obtain
  COLONOSCOPY  SYNONYMS/ACRONYM: Full colonoscopy,lower endoscopy, lower panendoscopy.  AREA OF APPLICATION: Colon.  CONTRAST: Air.  DESCRIPTION: Colonoscopy allowsinspection of the mucosa of the entirecolon, ileocecal valve, and terminalileum using a flexible fiberopticcolonoscope inserted through theanus and advanced to the terminalileum. The colonoscope is a multichannelinstrument that allows viewingof the gastrointestinal (GI) tractlining, insufflation of air, aspiration of fluid, obtaining of tissue biopsysamples, and passage of a laser beamfor obliteration of tissue and controlof bleeding. Mucosal surfaces of thelower GI tract are examined for ulcerations,polyps, chronic diarrhea,hemorrhagic sites, neoplasms, andstrictures. During the procedure,tissue samples may be obtained for cytology, and some therapeutic proceduresmay be performed, such as excisionof small tumors or polyps,coagulation of bleeding sites, andremoval of foreign bodies. ■  INDICATIONS:  ã Determine cause of lower GI disorders,especially when barium enema andproctosigmoidoscopy are inconclusiveã Determine source of rectal bleedingand perform hemostasis by coagulationã Remove foreign bodies and sclerosingstrictures by laser ã Confirm diagnosis of colon cancer andinflammatory bowel diseaseã Follow up on previously diagnosed andtreated colon cancer ã Detect Hirschsprung’s disease anddetermine the areas affected by thediseaseã Reduce volvulus and intussusceptionin childrenã Remove colon polypsã Investigate iron-deficiency anemia of unknown srcinã Evaluate postsurgical status of colonResection· Evaluate stools that show a positiveoccult blood test, lower-GI bleeding,or change in bowel habitsã Assess GI function in a patient with apersonal or family history of coloncancer, polyps, or ulcerative colitis  RESULT  Normal Findings: ã Normal intestinal mucosa with noabnormalities of structure, function, or mucosal surface in the colon or terminalileum  Abnormal Findings: ã Bleeding sitesã Benign lesionsã Bowel distentionã Bowel infection or inflammationã Colon cancer ã Crohn’s diseaseã Colitisã Diverticulaã Foreign bodiesã Hemorrhoidsã Polypsã Proctitisã Tumorsã Vascular abnormalities  CRITICAL VALUES: N/A  INTERFERING FACTORS:  This procedure is contraindicated for: ã Patients with bleeding disorders or cardiac conditionsã Patients with bowel perforation, acuteperitonitis, acute colitis, ischemicbowel necrosis, toxic colitis, recentbowel surgery, advanced pregnancy,severe cardiac or pulmonary disease,recent myocardial infarction, known or suspected pulmonary embolus, andlarge abdominal aortic or iliacaneurysmã Patients who have had a colonanastomosiswithin the past 14 to 21 days,because an anastomosis may breakdown with gas insufflation  Factors that may impair clear imaging: ã Inability of the patient to cooperate or remain still during the procedurebecause of age, significant pain, or mental statusã Patients who are very obese, who mayexceed the weight limit for the equipmentã Incorrect positioning of the patient,which may produce poor visualizationof the area to be examinedã Strictures or other abnormalitiespreventing passage of the scopeã Barium swallow or upper GI serieswithin the preceding 48 hours, whichcan hinder adequate visualizationã Severe lower GI bleeding or the presenceof feces, barium, blood, or bloodclots, which can interfere with visualization Other considerations: ã Failure to follow dietary restrictionsbefore the procedure may causethe procedure to be canceled or repeated.ã Bowel preparations that includelaxatives or enemas should be avoidedin pregnant patients or patientswith inflammatory bowel disease,unless specifically directed by a physician Nursing Implications andProcedure   ➤ Explain to the patient the purpose of the study and how the procedure isperformed. ➤   Obtain a written, informed consent for the procedure from the patient. ➤ Obtain a history of GI disorders,noting any information relating tolower bowel, anal, rectal, or coagulationdisorders. ➤ Note use of drugs that affect bleeding,such as aspirin and other salicylates. ➤ Note intake of oral iron preparations1 week before the procedurebecause these cause black, stickyfeces that are difficult to removewith bowel preparation. ➤ Obtain the results of other tests(particularly hematologic or coagulationtests), treatments, surgeries,medication usage, and proceduresdone to diagnose or treat disordersof the intestinal system. For relatedtests, refer to the gastrointestinalsystem table. ➤ Determine date of last menstrualperiod and possibility of pregnancyin perimenopausal women. ➤ Explain that the procedure usuallytakes 30 to 60 minutes to completeand is generally performed in anendoscopy suite by a physician andsupport staff. ➤ Restrict the diet to clear liquids for 48 hours before beginning oralbowel preparation. ➤ Ensure that ordered laxatives havebeen administered late in the afternoonof the day before the procedure. ➤ Inform the patient that it is importantthat the bowel be cleaned thoroughlyso that the physician canvisualize the colon and that thepatient will have to receive enemasbefore the test. ➤ Note recent administration of barium because it can obscure thearea to be examined. ➤ Resuscitation equipment should bereadily available. Intratest: ➤ Two hours before the procedure,administer a warm tap water or saline enema until the returns areclear or as ordered. ➤ Have the patient put on a hospitalgown and void. ➤ An intravenous (IV) line may bestarted to allow infusion of a sedativeor IV fluids. ➤ Obtain baseline vital signs. ➤ Administer ordered sedation. ➤ The patient is placed on an examinationtable in the left lateral decubitusposition and draped with thebuttocks exposed. ➤ The physician performs a visualinspection of the perianal area and adigital rectal examination. ➤ The patient is requested to bear down as if having a bowel movementas the fiberoptic tube isinserted through the rectum. ➤ The scope is advanced through thesigmoid. The patient’s position ischanged to supine to facilitatepassage into the transverse colon.Air is insufflated through the tubeduring passage to aid in visualization. ➤ The patient is instructed to take  deep breaths to aid in movement of the scope downward through theascending colon to the cecum andinto the terminal portion of theileum. ➤ Air is insufflated to distend the GItract, as needed. Biopsies, cultures,or any endoscopic surgery isperformed. ➤ Foreign bodies or polyps areremoved and placed in appropriatespecimen containers, labeled properly,and sent to the laboratory. ➤ Photographs are obtained for futurereference. ➤ At the end of the procedure, excessair and secretions are aspiratedthrough the scope, and the colonoscopeis removed. ➤ Gloves and gowns are worn by theexaminer throughout the procedure. ➤ Monitor the patient for signs of respiratory depression. Resuscitationequipment should be available. Post-test: ➤ Monitor for any rectal bleeding.Instruct the patient to expect slightrectal bleeding for 2 days after removal of polyps or biopsy specimens,but that an increasing amountof bleeding or sustained bleedingshould be reported to the physicianimmediately. ➤ Observe the patient until the effectsof the sedation have worn off. ➤ Observe the patient for indicationsof chest pain, abdominal pain or tenderness, or breathing problems.If these symptoms are present or increase in frequency or severity, thechange should be reported to aphysician immediately. ➤ Inform the patient that belching,bloating, or flatulence is the result of air insufflation. ➤ Emphasize that any severe pain,fever, difficulty breathing, or GIbleeding must be reported to thephysician immediately. ➤ Resume normal activity, medication,and diet 2 hours after the procedureor as tolerated, unless otherwiseindicated. ➤ Encourage the patient to drinkseveral glasses of water to helpreplace fluids lost during the preparationfor the test. ➤ A physician specializing in thisbranch of medicine sends a writtenreport to the ordering provider, whodiscusses the results with thepatient. ➤ Inform the patient that an abnormalexamination may indicate the needfor further studies. ➤ Evaluate test results in relation tothe patient’s symptoms and other tests performed. Related diagnostictests include barium enema andproctosigmoidoscopy.
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