1. Mr. Shaggy comes in to see his health care provider for his yearly checkup. As...

1. Mr. Shaggy comes in to see his health care provider for his yearly checkup. As you are taking

his blood pressure, he says “I don’t need that rectal examination do I ? I had prostate surgery

last year.” How do you respond?

2. Mrs. Butterworth has just returned from an endoscopic examination. She says, “Something

went wrong, I just know it. Look at my belly. I look like I am 9 months pregnant”. How do you

respond?

Expert Solution

1. Explain the patient why it is important to examine the rectum to rule out abnormal prostate. The health care provider will insert a gloved finger into the rectum and feel the prostate for hard, lumpy, or abnormal areas. The test takes only a few minutes to complete. The patient may feel slight, momentary discomfort during the test. The procedure does not cause significant pain or any damage to the prostate. The patient may go on with his normal activities. Your doctor will discuss the test results with you. If he or she detects a suspicious lump or area during the exam, further testing will be the next step. If the patient asks for avoiding rectal examination, test PSA (Prostate Specific Antigen). PSA is such a sensitive marker of prostate cancer that if the PSA is undetectable, men don't need a digital rectal examination or further imaging studies at that time. The patient needs careful follow-up with a PSA test every year.

2. First of all reassure the patient.

Inform the patient that excess gas is one of the most common side-effects of upper endoscopy due to the introduction of air into the stomach during the exam.

Adopting dietary and lifestyle changes are two main ways to alleviate symptoms. Watching the foods you eat and how you eat certain foods can help manage gassiness after an endoscopy. Using over-the-counter gas relief medication is also a great solution to excess gas.

The nurse should also be aware of a condition called tension pneumoperitoneum which is a rare complication of endoscopy.

Tension pneumoperitoneum is defined as the massive accumulation of air in the peritoneal cavity, which results in a sudden increase in intraabdominal pressure.

TPP should be suspected when gastrointestinal endoscopy is followed by sudden distention of the abdomen, which becomes barrel-shaped, although this finding can be overlooked in obese patients. Percussion on all areas of the abdomen reveals tympanicity, and bowel sounds are usually present but distant. Abdominal tenderness can also be found when inflammation of peritoneal cavity is present.

Nightingale answered 2 years ago

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