Prep(s)aring For A Colonoscopy

The previous articles, To Colonoscopy or Not to Colonoscopy and Diseases of the Colon: A
Case for Getting a Colonoscopy explained the importance of getting a colonoscopy and diseases
of the colon. This article will complete the thread, tying it up by talking about how important it is
to follow the doctors instructions in colon cleansing and how nurses can be patient advocates to
ensure their success.

Preparing a patient for a test involves instructing them with specific teaching points plus not just
listening, but hearing the patients questions in order to ensure the best results. There are many
steps leading up to a colonoscopy that can prevent a repeat test due to an inadequate prep. These
steps can get confusing, so this is where nurses can guide patients in navigating the dos and
don'ts.

Because its not a simple, stay NPO after midnight instructions, we will go over tips for the
days preceding the colonoscopy, the different preps, special indications for diabetics and renal
patients, and some important things to remember post colonoscopy.

Having a clean colon can literally save a persons life because if there is stool left, it can adhere
to the wall of the colon or pool in a puddle, covering a sessile polyp, or other disease process.
Sessile polyps are flat and are more likely to become cancerous than polyps on a stalk. Usually
the doctor will repeat the colonoscopy soon enough to catch it, but some patients put it off not
realizing the dangers.

Dr. Robert Bresalier is quoted in the article, Ensure success with colonoscopy prep, If the
prep isnt done right, and your colon isnt completely clean, the danger is we wont see
important, potentially cancer-causing polyps.

It seems like everyone has advice about how best to get ready for a colonoscopy, but there are
some diet suggestions that are proven to help. According to the article, Preparing for a
colonoscopy by The Family Health Guide, begin several days before the test date to eat low
fiber foods. Stay away from whole grains, seeds, dried fruit, nuts, and vegetables. Good things to
eat are; soup, chicken, fish, white rice, pasta, eggs, with plenty of fluids.

More specifically, one week prior have patients stop fiber supplements like Citrucel or
Metamucil. If they take iron pills, they need to be stopped as well as NSAIDs such as Aleve,
naprosyn, and ibuprofen. Most doctors will allow continued use of aspirin, especially if patients
have a history of a stroke or heart attack, but anticoagulants such as plavix and coumadin and
over the counter herbs and vitamins like vitamin E, should be discontinued. Patients need to
check with their cardiologists regarding their anticoagulant therapy before scheduling a
colonoscopy.

Depending on the doctors request, some patients are told to be on clear liquids the day before
the prep, which is two days before the actual test, or just the day of the prep. It is important to
reinforce what clear liquids are, such as broth, sprite, coffee (no milk), jello, and frozen
popsicles.

Instruct patients to read over all instructions several days before their colonoscopy, and again the
day before the prep to make sure nothing is forgotten. A must for patients comfort is wet wipes
and butt balm. Their bottom will be sore, so using these items from the beginning will decrease
irritation.

Common Colon Preps

According to The Gourmet Colon Prep by Carol Rees Parish, R.D., M.S., the following colon
preps are the most common.

NuLytely (GoLytely) - powder miralax (PEG-3350) in 3-4 liters with flavors available.
This prep requires clear liquid diet the day before the procedure.
Half-Lytely - Miralax (in 2 liters) along with bisacodyl delayed release (4 tablets) with
clear liquids the day of the prep.
Colyte - Miralax in 3-4 liters with flavors available. No solid food allowed after light
lunch then prep begins between 4 and 6 pm.
Moviprep - Miralax in 2 liters with 1 liter of additional clear liquid. A small dinner of
yogurt or clear soup one hour before the prep begins the night before the test.
Fleet Phospho-soda - Monobasic sodium phosphate monohydrate, comes in a 45ml bottle
or 75ml prep kit. A total of 72 oz prep after a low residue lunch followed by prep and
clear liquids starting at 2pm the day before procedure. Extra fluids strongly encouraged.
Lo-So Prep - Magnesium carbonate, citric acid, potassium citrate, and bisacodyl tablets.
The powder is mixed in 8 oz of water along with 4 tablets, and one suppository. Not
much is available about further recommendations such as diet and fluids.
OsmoPrep - Sodium Phosphate monobasic - 32 (thirty-two) tablets with 64 oz. clear
liquids minimum.
Suprep - Sodium sulfate, potassium sulfate, and magnesium sulfate. Some doctors will
have patients on a clear liquid diet two days before, then depending on the doctor's order,
one dose of 6 oz mixed with water to make 16oz. The second dose is the same day or the
next morning both doses followed by 2 16 oz. water.

Tips to Make the Prep More Palatable

No red or purple colored drinks or frozen items! The reason for this is that the red/purple dye
will look like blood because the dye remains in the colonic fluids. Chilling the prep is
recommended along with drinking it quickly through a straw. Rinsing the mouth helps to remove
the taste of the prep and/or suck on hard candy. Remember nothing after midnight, even gum or
hard candy will generate bile production and increase the chance of aspiration or cancellation of
the procedure.
Special Considerations

Diabetic patients should check their sugar levels frequently, and choose sugar free clear liquids.

Kidney patients must take special precautions, avoiding preps with sodium phosphate. Sodium
phosphate crystals can deposit in the kidneys, causing damage, impairing tissue along with
electrolyte imbalances. NuLytely or GoLytely are safe alternatives for renal impaired patients.

Post Colonoscopy

Most patients go back to normal diet and medications post procedure. If there were biopsies
taken, the doctor will call the results to them, or discuss the pathology on the follow up visit in
the office. Patients usually receive written discharge instructions and pictures along with a verbal
result from the doctor immediately post procedure. The patient should not drive, operate any
machinery, or make any legal decisions for about 24 hours, and it is recommended to have
someone stay with them during this recovery period.

Conclusion

It has been established that a screening colonoscopy can save a persons life. Making up your
mind to go ahead and schedule one is the first hurdle. We as nurses should be an example and get
ours when appropriate, plus it gives us insight into what the patient goes through.

Educating the patient on the benefits of a colonoscopy and the importance of following the prep
instructions can make a huge difference in their success.

**If you are a floor nurse and the patient is not taking the prep as prescribed or they are not
having the expected results - call the doctor. There are steps that can be taken to move things
along or delay the procedure until the patient is compliant in finishing the prep. This saves
everyone a lot of phone calls and an incomplete colonoscopy due to inadequate prep.

Helping one patient at a time get through the rough days of colon cleansing is how to make the
largest impact. You will learn from them and they will learn from you, taking that knowledge to
the next patient and friend or family member.

This concludes the articles regarding colonoscopies, thank you for reading all three of them and
happy prepping!

Johnson, Brenda F. 2015.

Artikel sebelumnya, "Untuk Colonoscopy atau Tidak Kolonoskopi" dan "Penyakit
Colon: Sebuah Kasus untuk Memperoleh Colonoscopy" menjelaskan pentingnya
mendapatkan kolonoskopi dan penyakit usus. Artikel ini akan menyelesaikan
benang, mengikat itu dengan berbicara tentang betapa pentingnya untuk mengikuti
petunjuk dokter di pembersihan usus dan bagaimana perawat dapat menjadi
advokat pasien untuk memastikan keberhasilan mereka.

Mempersiapkan pasien untuk tes melibatkan memerintahkan mereka dengan poin pengajaran
khusus ditambah tidak hanya mendengarkan, tapi mendengar pertanyaan pasien untuk
memastikan hasil yang terbaik. Ada banyak langkah yang mengarah ke kolonoskopi yang dapat
mencegah tes ulang karena sebuah persiapan yang tidak memadai. Langkah-langkah ini bisa
membingungkan, jadi ini adalah di mana perawat dapat membimbing pasien dalam menjelajahi
dan tidak boleh dilakukan.

Karena itu tidak sederhana, "tinggal NPO setelah tengah malam" petunjuk, kita akan pergi ke
tips untuk hari-hari sebelum kolonoskopi, yang preps berbeda, indikasi khusus untuk penderita
diabetes dan pasien ginjal, dan beberapa hal penting untuk diingat pasca kolonoskopi.
Memiliki usus bersih benar-benar dapat menyelamatkan hidup seseorang karena jika ada bangku
kiri, dapat mematuhi dinding usus atau kolam renang di genangan air, meliputi polip sessile, atau
proses penyakit lainnya. Polip sessile datar dan lebih cenderung menjadi kanker daripada polip
pada tangkai. Biasanya dokter akan mengulangi kolonoskopi segera menangkapnya, tetapi
beberapa pasien menundanya tidak menyadari bahaya.

Dr Robert Bresalier dikutip dalam artikel, "Pastikan sukses dengan persiapan kolonoskopi," "Jika
persiapan tidak dilakukan dengan benar, dan usus Anda tidak benar-benar bersih, bahayanya
adalah kita tidak akan melihat penting, berpotensi cancer- menyebabkan polip. "

Sepertinya semua orang memiliki saran tentang cara terbaik untuk bersiap-siap untuk
kolonoskopi, tetapi ada beberapa saran diet yang terbukti untuk membantu. Menurut artikel,
"Mempersiapkan kolonoskopi" oleh The Panduan Kesehatan Keluarga, mulai beberapa hari
sebelum tanggal tes untuk makan makanan rendah serat. Tinggal jauh dari biji-bijian, biji, buah
kering, kacang-kacangan, dan sayuran. Hal yang baik untuk makan adalah; sup, ayam, ikan, nasi
putih, pasta, telur, dengan banyak cairan.

Lebih khusus, satu minggu sebelum memiliki pasien berhenti suplemen serat seperti Citrucel
atau Metamucil. Jika mereka mengambil pil zat besi, mereka perlu dihentikan serta NSAID
seperti Aleve, naprosyn, dan ibuprofen. Kebanyakan dokter akan memungkinkan terus
menggunakan aspirin, terutama jika pasien memiliki riwayat stroke atau serangan jantung, tapi
antikoagulan seperti Plavix dan coumadin dan selama herbal counter dan vitamin seperti vitamin
E, harus dihentikan. Pasien perlu memeriksa dengan ahli jantung mereka mengenai terapi
antikoagulan sebelum penjadwalan kolonoskopi.

Tergantung pada permintaan dokter, beberapa pasien diberitahu untuk berada di cairan bening
sehari sebelum persiapan, yaitu dua hari sebelum tes yang sebenarnya, atau hanya hari persiapan
itu. Hal ini penting untuk memperkuat apa cairan bening yang, seperti kaldu, sprite, kopi (tidak
ada susu), jello, dan es loli beku.

Menginstruksikan pasien untuk membaca seluruh petunjuk beberapa hari sebelum kolonoskopi
mereka, dan lagi hari sebelum persiapan untuk memastikan tidak ada yang terlupakan. Suatu
keharusan untuk kenyamanan pasien adalah tisu basah dan pantat balm. Bawah mereka akan
terasa sakit, sehingga dengan barang-barang tersebut dari awal akan menurun iritasi.

Common Colon Preps

According to The Gourmet Colon Prep by Carol Rees Parish, R.D., M.S., the
following colon preps are the most common.

NuLytely (GoLytely) - powder miralax (PEG-3350) in 3-4 liters with flavors available.
This prep requires clear liquid diet the day before the procedure.
Half-Lytely - Miralax (in 2 liters) along with bisacodyl delayed release (4 tablets) with
clear liquids the day of the prep.

Colyte - Miralax in 3-4 liters with flavors available. No solid food allowed after light
lunch then prep begins between 4 and 6 pm.

Moviprep - Miralax in 2 liters with 1 liter of additional clear liquid. A small dinner of
yogurt or clear soup one hour before the prep begins the night before the test.

Fleet Phospho-soda - Monobasic sodium phosphate monohydrate, comes in a 45ml

bottle or 75ml prep kit. A total of 72 oz prep after a low residue lunch followed by
prep and clear liquids starting at 2pm the day before procedure. Extra fluids
strongly encouraged.

Lo-So Prep - Magnesium carbonate, citric acid, potassium citrate, and bisacodyl
tablets. The powder is mixed in 8 oz of water along with 4 tablets, and one
suppository. Not much is available about further recommendations such as diet and
fluids.

OsmoPrep - Sodium Phosphate monobasic - 32 (thirty-two) tablets with 64 oz. clear

liquids minimum.

Suprep - Sodium sulfate, potassium sulfate, and magnesium sulfate. Some doctors
will have patients on a clear liquid diet two days before, then depending on the
doctor's order, one dose of 6 oz mixed with water to make 16oz. The second dose is
the same day or the next morning both doses followed by 2 16 oz. water.

Tips Membuat Prep lebih enak

Tidak ada minuman berwarna merah atau ungu atau item beku! Alasan untuk ini
adalah bahwa merah / ungu pewarna akan terlihat seperti darah karena dye tetap
dalam cairan kolon. Chilling persiapan yang dianjurkan bersama dengan minum
dengan cepat melalui sedotan. Membilas mulut membantu untuk menghilangkan
rasa persiapan dan / atau menghisap permen keras. Ingat apa-apa setelah tengah
malam, bahkan permen karet atau permen keras akan menghasilkan produksi
empedu dan meningkatkan kemungkinan aspirasi atau pembatalan prosedur.

Pertimbangan khusus

Pasien diabetes harus memeriksa kadar gula mereka sering, dan memilih gula
cairan bening gratis.

Pasien ginjal harus mengambil tindakan pencegahan khusus, menghindari preps

dengan natrium fosfat. Kristal natrium fosfat dapat deposit pada ginjal,
menyebabkan kerusakan, merusak jaringan bersama dengan ketidakseimbangan
elektrolit. NuLytely atau GoLytely aman alternatif untuk pasien gangguan ginjal.