Golytely

EYE ON DIAGNOSTICS

MANY PATIENTS dread the thought of having a colonoscopy. You can make their experience more comfortable by carefully explaining what to expect before, during, and after the exam.

A colonoscopy is a visual exam of the lining of the entire large intestine with a lighted, flexible fiber-optic or video endoscope. As a diagnostic tool, it helps the health care provider assess patients who've had a positive test for fecal occult blood, a history of persistent rectal bleeding, altered bowel habits, or other unexplained abdominal symptoms. It can also help the provider differentiate inflammatory bowel disease from neoplastic bowel disease.

A colonoscopy can detect cancer and precancerous polyps that a flexible sigmoidoscopy may miss. The American Cancer Society recommends colonoscopy for routine colorectal cancer screening in anyone over age 50 and in younger people with risk factors or suspicious symptoms.

Before the exam

Teach the patient how to prepare for the exam, and tell him what to expect during and after it.

Before the exam, he must clear his colon of stool. To accomplish this, the health care provider will order a bowel preparation regimen that consists of one or more of the following: liquid bowel stimulant solution (such as polyethylene glycol and electrolyte solution [GoLYTELY]), a stimulant laxative (such as bisacodyl), and an enema.

Although the preexam preparation regimen isn't pleasant, emphasize to the patient that he must complete it. Tell him to notify his health care provider immediately if he can't complete the preparation regimen.

Also tell him that he mustn't eat any solid food for 24 hours before the exam, although he may drink clear liquids. Provide a list of clear liquids he's allowed to drink and those he isn't. Instruct him not to eat or drink anything for as long as directed (usually 4 hours) before the exam.

Make sure he and his health care provider have discussed what medications he should (or shouldn't) take on the day of the procedure. If he takes aspirin, anticoagulants, or supplemental iron, for example, he'll discontinue these 4 to 7 days beforehand.

Because he'll be sedated during the exam, have him arrange for someone to drive him home afterward.

What the exam entails

Usually performed on an outpatient basis, the colonoscopy lasts 30 to 60 minutes. The health care provider will administer a sedative to help the patient stay relaxed during the procedure. The patient may drift in and out of consciousness during the procedure. Make sure the patient has given informed consent before he's sedated and the procedure begins.

Insert an IN. line for fluids and medications. While providing privacy, help him position himself on his left side. After the patient is sedated, the health care provider will perform a digital rectal exam and then insert the endoscope into the anus, moving it slowly through the colon. During the procedure, he may obtain biopsy specimens of suspicious tissue or remove polyps.

Evaluate and document vital signs, respiratory status, sedation level, medications administered, and patient responses. If the patient is conscious, provide reassurance and explain what is happening. If the patient experiences abdominal pressure and bowel spasms, be prepared to administer IN. anticholinergics and glucagon.

After the exam

Assess the patient's level of consciousness, vital signs, respiratory status, abdominal symptoms, and any other complaints. Tell him that mild cramping, abdominal pressure, and flatulence are normal and usually resolve in 24 hours. If the procedure was performed on an outpatient basis, the patient may leave after he's alert, drinking fluids, and passing flatus.

Complications from colonoscopy are uncommon. However, severe abdominal pain may indicate bowel perforation, which requires surgical repair.

If the provider removed a growth or polyp, the patient may experience minor bleeding that will stop without treatment. Tell the patient to report excessive bleeding, which is abnormal and requires further investigation. Instruct him to report nausea, vomiting, or fever, which may indicate perforation, hemorrhage, or infection. Also, if he had a growth or polyp removed, he should avoid eating foods high in fiber or fat for at least 24 hours after the procedure, as these foods can induce bleeding.

Tell the patient that his health care provider will have the biopsy results in 5 to 7 days.

BY DENISE M. McENROE AYERS, RN, MSN

Denise M. McEnroe Ayers is assistant professor of nursing at Kent State University-Tuscarawas in New Philadelphia, Ohio.

Copyright Springhouse Corporation Mar 2003
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