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Colonoscopy

Category: Gastrointestinal

🔍 Indications

  • Screen for colon and rectal cancer
  • Detect and evaluate inflammatory and ulcerative bowel disease
  • Locate source of lower GI bleeding and perform hemostasis
  • Determine cause of lower GI disorders
  • Assist diagnose colonic strictures and lesions
  • Evaluate colon postoperatively for recurrence
  • Investigate iron-deficiency anemia of unknown origin
  • Remove colon polyps
  • Remove foreign objects

⚠️ Contraindications

  • Pregnant women near term
  • Patients with bleeding disorders
  • Recent acute MI or abdominal surgery
  • Ischemic bowel disease, acute diverticulitis, peritonitis
  • Fulminant granulomatous or ulcerative colitis
  • Perforated viscus

⚕️ Procedure

  1. Patient placed on left side with knees flexed and draped.
  2. Baseline vital signs obtained; monitored throughout.
  3. Patient instructed to breathe deeply through mouth.
  4. Lubricated colonoscope inserted through anus into sigmoid colon.
  5. Small amount of air insufflated to locate bowel lumen.
  6. Scope advanced through rectum, colon to cecum.
  7. Abdominal palpation or fluoroscopy may guide advancement.
  8. Suction used to remove blood and secretions.
  9. Biopsy forceps or cytology brush may obtain specimens.

📋 Nursing Care

Before:

  • Secure informed consent
  • Obtain medical history (allergies, bleeding, medications)
  • Ensure bowel preparation completed
  • Maintain clear-liquid diet 24-48 hours
  • NPO after midnight
  • Administer laxatives or GoLYTELY as ordered
  • Establish IV line for sedation
  • Arrange for driver after procedure
  • Instruct patient to empty bladder before procedure
  • Remove metallic objects

During:

  • Assist with patient positioning (left lateral decubitus)
  • Administer pain medication and sedative as ordered
  • Instruct patient to bear down during insertion
  • Change patient position as scope advances
  • Encourage slow, deep breaths

After:

  • Observe for signs of bowel perforation (severe pain, nausea, fever)
  • Monitor vital signs every 15 min for 1 hr, then every 2 hrs
  • Resume normal diet and activity as advised
  • Provide privacy for rest
  • Monitor for rectal bleeding (minimal expected for 2 days)
  • Encourage increased fluid intake

✅ Normal Results

Light-pink-orange mucosa, visible blood vessels beneath intestinal mucosa

⚠️ Abnormal Results

  • Benign or malignant lesions
  • Bowel inflammation and ulceration
  • Granulomatous or ulcerative colitis
  • Colonic polyps
  • Crohn's disease
  • Diverticular disease
  • Hemorrhoids
  • Proctitis
  • Tumors
  • Vascular abnormalities