Definition
Colonoscopy is the visual examination of the lining of rectum, colon and distal small bowel using a long flexible fiberoptic endoscope.
Purposes for Colonoscopy
- To evaluate active or occult lower intestinal bleeding.
- To identify abnormalities found on radiographic examination.
- To diagnose suspected cecal or ascending colonic diseases, anemia, cancer and inflammatory bowel diseases.
Articles for Colonoscopy
- Light source.
- Endoscope.
- Suction apparatus.
- Lubricant.
- Topical anesthetic agent.
- Endoscopic accessories, such as biopsy forceps, polypectomy snares, and cytology brush.
- Dilatation devices.
- Medications as prescribed by physician.
- Probe and hot biopsy forceps.
- Cardiac monitor.
- Oxygen source.
- Articles for introducing carbon dioxide to distend the colon.
General instruction
Fluid and electrolyte status of elderly patients and those with renal or cardiac disease need to be considered during bowel preparation.
Preparation of the Patient for Colonoscopy
Preparing a patient and assisting with a colonoscopy involves several important steps to ensure the procedure is safe and effective.
- Dietary Restrictions:
- Follow a low-fiber diet for a few days before the procedure.
- Switch to a clear liquid diet the day before the colonoscopy.
- Avoid solid foods, dairy products, and red or purple liquids.
- Bowel Preparation:
- Take prescribed laxatives or bowel-cleansing solutions as directed by the healthcare provider.
- Stay near a restroom, as bowel movements will become frequent.
- Medication Adjustments:
- Inform the healthcare provider about any medications being taken, especially blood thinners or diabetes medications, as adjustments may be necessary.
- Clothing and Accessories:
- Wear loose, comfortable clothing and remove any jewelry or metallic items.
- Consent and Communication:
- Explain the procedure to the patient, addressing any concerns or questions, and obtain informed consent.
Procedure for Colonoscopy
| Nursing action | Rationale | |
| 1. | Explain the procedure to the patient that carbon dioxide will be introduced into the colon and he may experience discomfort or abdominal cramps during procedure. | Allays anxiety and helps in obtaining cooperation of the patient. |
| 2. | Get informed consent from the patient. | Prevents legal problems. |
| 3. | Keep patient on low-residue diet for 3 days before the procedure and NPO for 8 hours prior to the procedure. | |
| 4. | Administer laxatives 1-3 days before and cleansing enema the night before the procedure. | |
| 5. | Provide colonic wash using formula of salts, such as sodium sulfate and polyethylene glycol that is dissolved in 5 L of water (administer on the previous day evening around 9 PM). 2.5 L of the solution has to be administered between 5 and 8 AM on the day of the test. | |
| 6. | Advise patient to take clear fluids, such as glucose water or coconut water along with prepared solution on the day of procedure. | |
| 7. | Avoid premedication unless patient is apprehensive and anxious. Administer sedatives if ordered. | |
| 8. | Make patient to lie in left lateral position with lower limbs flexed at hip and knee and buttocks at table edge. | Helps in insertion of colonoscope into the rectum. |
| 9. | Lubricate the colonoscope and assist doctor in inserting the colonoscope. | Lubrication avoids friction and helps in easy insertion. |
| 10. | Instruct patient to take deep slow breaths while scope is being inserted. | |
| 11. | Apply pressure to areas of abdomen as directed by physician as he passes scope through splenic flexure, ascending colon, and cecum. | |
| 12. | Monitor vital signs, color, warmth, dryness of skin, abdominal distention, level of consciousness, and pain tolerance. | |
| 13. | Explain to patient that he may experience abdominal cramps during the procedure. | Abdominal cramps may be caused by stimulation of peristalsis and inflation with air. |
| 14. | Label and transport specimens to the laboratory that may be collected. | |
| 15. | Record the procedure in the nurse’s record. |
Postprocedural care
- Monitor and document vital signs every 15 minutes for first hour and then every 30 minutes for 2 hours.
- Observe signs of complications, such as rectal bleeding, vomiting, severe and persistent abdominal pain, distention, rigidity, malaise, tenesmus, etc., which are indications of perforation.
- Document the time of the procedure and the patient’s response.
- Provide a calm environment and make the patient comfortable.
Special consideration
- Confirm the patient has followed pre-procedure instructions, such as bowel preparation and dietary restrictions.
- Address any anxiety by explaining the procedure clearly and reassuring the patient.
- Observe the patient for signs of discomfort or complications, such as bleeding or adverse reactions to sedation.
- Ensure the patient’s vital signs are monitored throughout.
- Maintain strict sterile conditions to minimize the risk of infection.
- Ensure the colonoscope and accessories are properly prepared and functioning.
- Monitor the patient for delayed complications, such as bloating or bleeding.
- Provide clear instructions for recovery, including dietary recommendations and follow-up care.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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