• Evaluate postsurgical status of colon

COLONOSCOPY Resection
· Evaluate stools that show a positive
SYNONYMS/ACRONYM: Full colonoscopy, occult blood test, lower-GI bleeding,or
lower endoscopy, lower panendoscopy. change in bowel habits
• Assess GI function in a patient with a
AREA OF APPLICATION: Colon. personal or family history of colon
cancer, polyps, or ulcerative colitis
CONTRAST: Air.
RESULT
DESCRIPTION: Colonoscopy allows
inspection of the mucosa of the entire Normal Findings:
colon, ileocecal valve, and terminal • Normal intestinal mucosa with no
ileum using a flexible fiberoptic abnormalities of structure, function, or
colonoscope inserted through the mucosal surface in the colon or terminal
anus and advanced to the terminal ileum
ileum. The colonoscope is a multichannel Abnormal Findings:
instrument that allows viewing • Bleeding sites
of the gastrointestinal (GI) tract • Benign lesions
lining, insufflation of air, aspiration of • Bowel distention
fluid, obtaining of tissue biopsy • Bowel infection or inflammation
samples, and passage of a laser beam • Colon cancer
for obliteration of tissue and control • Crohn’s disease
of bleeding. Mucosal surfaces of the • Colitis
lower GI tract are examined for ulcerations, • Diverticula
polyps, chronic diarrhea, • Foreign bodies
hemorrhagic sites, neoplasms, and • Hemorrhoids
strictures. During the procedure, • Polyps
tissue samples may be obtained for • Proctitis
cytology, and some therapeutic procedures • Tumors
may be performed, such as excision • Vascular abnormalities
of small tumors or polyps,
coagulation of bleeding sites, and CRITICAL VALUES: N/A
removal of foreign bodies. ■
INTERFERING FACTORS:
INDICATIONS:
This procedure is contraindicated
• Determine cause of lower GI disorders, for:
especially when barium enema and • Patients with bleeding disorders or
proctosigmoidoscopy are inconclusive cardiac conditions
• Determine source of rectal bleeding • Patients with bowel perforation, acute
and perform hemostasis by coagulation peritonitis, acute colitis, ischemic
• Remove foreign bodies and sclerosing bowel necrosis, toxic colitis, recent
strictures by laser bowel surgery, advanced pregnancy,
• Confirm diagnosis of colon cancer and severe cardiac or pulmonary disease,
inflammatory bowel disease recent myocardial infarction, known or
• Follow up on previously diagnosed and suspected pulmonary embolus, and
treated colon cancer large abdominal aortic or iliac
• Detect Hirschsprung’s disease and aneurysm
determine the areas affected by the • Patients who have had a colon
disease anastomosis
• Reduce volvulus and intussusception within the past 14 to 21 days,
in children because an anastomosis may break
• Remove colon polyps down with gas insufflation
• Investigate iron-deficiency anemia of
unknown origin
Factors that may impair clear
imaging:
• Inability of the patient to cooperate or
remain still during the procedure
because of age, significant pain, or
mental status
• Patients who are very obese, who may
exceed the weight limit for the equipment
• Incorrect positioning of the patient,
which may produce poor visualization
of the area to be examined
• Strictures or other abnormalities
preventing passage of the scope
• Barium swallow or upper GI series
within the preceding 48 hours, which
can hinder adequate visualization
• Severe lower GI bleeding or the presence
of feces, barium, blood, or blood
clots, which can interfere with visualization
Other considerations:
• Failure to follow dietary restrictions
before the procedure may cause
the procedure to be canceled or
repeated.
• Bowel preparations that include
laxatives or enemas should be avoided
in pregnant patients or patients
with inflammatory bowel disease,
unless specifically directed by a physician
Nursing Implications and
Procedure
➤ Explain to the patient the purpose of
the study and how the procedure is
performed.
➤ Obtain a written, informed consent
for the procedure from the patient.
➤ Obtain a history of GI disorders,
noting any information relating to
lower bowel, anal, rectal, or coagulation
disorders.
➤ Note use of drugs that affect bleeding,
such as aspirin and other salicylates.
➤ Note intake of oral iron preparations
1 week before the procedure
because these cause black, sticky
feces that are difficult to remove
with bowel preparation.
➤ Obtain the results of other tests
(particularly hematologic or coagulation
tests), treatments, surgeries,
medication usage, and procedures
done to diagnose or treat disorders
of the intestinal system. For related
tests, refer to the gastrointestinal
system table.
➤ Determine date of last menstrual
period and possibility of pregnancy
in perimenopausal women.
➤ Explain that the procedure usually
takes 30 to 60 minutes to complete
and is generally performed in an
endoscopy suite by a physician and
support staff.
➤ Restrict the diet to clear liquids for
48 hours before beginning oral
bowel preparation.
➤ Ensure that ordered laxatives have
been administered late in the afternoon
of the day before the procedure.
➤ Inform the patient that it is important
that the bowel be cleaned thoroughly
so that the physician can
visualize the colon and that the
patient will have to receive enemas
before the test.
➤ Note recent administration of
barium because it can obscure the
area to be examined.
➤ Resuscitation equipment should be
readily available.
Intratest:
➤ Two hours before the procedure,
administer a warm tap water or
saline enema until the returns are
clear or as ordered.
➤ Have the patient put on a hospital
gown and void.
➤ An intravenous (IV) line may be
started to allow infusion of a sedative
or IV fluids.
➤ Obtain baseline vital signs.
➤ Administer ordered sedation.
➤ The patient is placed on an examination
table in the left lateral decubitus
position and draped with the
buttocks exposed.
➤ The physician performs a visual
inspection of the perianal area and a
digital rectal examination.
➤ The patient is requested to bear
down as if having a bowel movement
as the fiberoptic tube is
inserted through the rectum.
➤ The scope is advanced through the
sigmoid. The patient’s position is
changed to supine to facilitate
passage into the transverse colon.
Air is insufflated through the tube
during passage to aid in visualization.
➤ The patient is instructed to take
deep breaths to aid in movement of for the test.
the scope downward through the ➤ A physician specializing in this
ascending colon to the cecum and branch of medicine sends a written
into the terminal portion of the report to the ordering provider, who
ileum. discusses the results with the
➤ Air is insufflated to distend the GI patient.
tract, as needed. Biopsies, cultures, ➤ Inform the patient that an abnormal
or any endoscopic surgery is examination may indicate the need
performed. for further studies.
➤ Foreign bodies or polyps are ➤ Evaluate test results in relation to
removed and placed in appropriate the patient’s symptoms and other
specimen containers, labeled properly, tests performed. Related diagnostic
and sent to the laboratory. tests include barium enema and
➤ Photographs are obtained for future proctosigmoidoscopy.
reference.
➤ At the end of the procedure, excess
air and secretions are aspirated
through the scope, and the colonoscope
is removed.
➤ Gloves and gowns are worn by the
examiner throughout the procedure.
➤ Monitor the patient for signs of
respiratory depression. Resuscitation
equipment should be available.
Post-test:
➤ Monitor for any rectal bleeding.
Instruct the patient to expect slight
rectal bleeding for 2 days after
removal of polyps or biopsy specimens,
but that an increasing amount
of bleeding or sustained bleeding
should be reported to the physician
immediately.
➤ Observe the patient until the effects
of the sedation have worn off.
➤ Observe the patient for indications
of chest pain, abdominal pain or
tenderness, or breathing problems.
If these symptoms are present or
increase in frequency or severity, the
change should be reported to a
physician immediately.
➤ Inform the patient that belching,
bloating, or flatulence is the result of
air insufflation.
➤ Emphasize that any severe pain,
fever, difficulty breathing, or GI
bleeding must be reported to the
physician immediately.
➤ Resume normal activity, medication,
and diet 2 hours after the procedure
or as tolerated, unless otherwise
indicated.
➤ Encourage the patient to drink
several glasses of water to help
replace fluids lost during the preparation