Question

Clients with an EGD and Colonoscopy

Simon Sazes, a 62-year-old male client, is seen at an outpatient clinic for the recent development of pain with eating and bloody loose bowel movements. He has generalized abdominal colicky pain that radiates to his right shoulder. At times, he vomits bile; before the bloody stools began, he had episodes of clay-colored stools and tea-colored urine. Currently, his urine is dark amber-colored. The renal profile is within the normal range. The vital signs are T, 100° F; BP, 150/80 mm Hg; HR, 100 beats/minute; RR, 22 breaths/minute. The client will need to have an EGD and colonoscopy.

a. Explain why these tests would be appropriate for this client.

b. Explain instructions the nurse should provide the client for the diagnostic tests. Also include the nurse's role in these tests. For both consider the preop, intraop. and postop periods.

Answer 1

(A) colonoscopy:- A colonoscopy is an outpatient procedure that is done to examine the inside of the large intestine (colon and rectum). The examination uses an instrument called a colonoscope (sometimes called a scope). This flexible instrument, is very long and includes a camera and the ability to remove tissue (you do not feel tissue being removed).

A colonoscopy is commonly used to evaluate gastrointestinal symptoms, such as bleeding, abdominal pain or changes in bowel habits (how often you poop, how easily you poop, and the color and consistency of your poop).Colonoscopy can be used to detect ulcerative colitits, polyps, cancer, diverticulosis and Crohn's disease.

EDG:- An esophagogastroduodenoscopy (EGD) to examine the lining of your esophagus, stomach, and duodenum. The esophagus is the muscular tube that connects throat to stomach and the duodenum, which is the upper part of small intestine.

An endoscope is a small camera on a tube. An EGD test involves passing an endoscope down your throat and along the length of esophagus.

Why an EDG and colonoscopy test is performed/why appropriate for clientWhy:- doctor may recommend an EGD test if you have certain symptoms, including:

• severe, chronic heartburn
• vomiting blood
• black or tarry stools
• regurgitating food
• pain in your upper abdomen
• unexplained anemia
• persistent nausea or vomiting
• unexplained weight loss
• Having a genetic condition associated with colon cancer.
• Having inflammatory bowel disease, such as Crohn’s disease and ulcerative colitis.
• Having first-degree relatives with colon cancer (that is, your mother or father, brother or sister, or child).
• Having multiple relatives with colon cancer

(B) Instruments:-   

• Gastroscope:- Used to perform esophagogastroduodenoscopy (EGD/OGD)
• Duodenoscope:- Used to perform ERCP
• Enteroscope:- Used to perform push enteroscopy
• Colonoscope:- Used to perform colonoscopy
• Flexible sigmoidoscope:- Used to perform flexible sigmoidoscopy
• Rigid sigmoidoscope:- Used to perform rigid sigmoidoscopy
• Ultrasound endoscope:- Used to perform endoscopic ultrasound (EUS)
• Video capsule:- Used to perform video capsule enteroscopy
• Endoscopy snare:- Used to perform polypectomy and endoscopic foreign body removal
• Band ligator:- Used to perform variceal band ligation
• Sengstaken-Blakemore tube:- Used in the management of bleeding esophageal varices
• Balloon dilator:- Used to perform esophageal balloon dilatation, pyloric dilatation or ileocolonic dilatation
• Savary-Gilliard dilator:- Used to perform esophageal bougie dilatation
• Heater probe:- Used to perform endoscopic heater probe thermocoagulation of bleeding blood vessels
• APC unit:- Used to perform endoscopic Argon plasma coagulation
• PEG tube:- Used to perform percutaneous endoscopic gastrostomy
• Menghini needle or Tru-Cut needle:- Used to perform percutaneous liver biopsy

Role of nurse in EGD and colonoscopy

Before colonoscopy:-

• Nurse performs an assessment of the patient.
• The nurse takes vital signs and records important information including the patient's current medications, prior procedures, allergies, medical history and drug history. Additionally.
• the nurse documents the patient's skin color, pain tolerance levels, airway assessment, concerns, admitting time and identification information.

During colonoscopy:-

• Nurse is expected to record a patient's vital signs, record analgesia information.
• monitorthe patient's level of consciousness, record the patient's skin color.
• document fluids administered and procedures performed and record equipment used.
• Registered nurses may also assist physicians in the procedures, providing them with necessary equipment and supplies.

After Care:-

• Once a colonoscopy is performed, the endoscopy nurse performs an after care routine.
• the nurse will assess and record a patient's vital signs, perform a pain assessment.
• Recordunusual events or outcomes, record the patient's disposition and explain discharge instructions to the patient or designated caregiver,