WHAT IS COLONOSCOPY AND ITS PURPOSE

A colonoscopy (koe-lun-OS-kuh-pee) is an exam used to detect changes or abnormalities in the large

intestine (colon) and rectum. During a colonoscopy, a long, flexible tube (colonoscope) is inserted into
the rectum. A tiny video camera at the tip of the tube allows the doctor to view the inside of the
entire colon.

PRE OP PROCEDURE

Preparing for your colonoscopy

Learn what you need to do to prepare for your colonoscopy:

 Three days before your colonoscopy, eat only low-fiber foods.  Also, stop taking any
fiber supplements or anti-diarrheal medication.
 Two days before, continue eating only low-fiber foods.
 One day before, go on a clear-liquid diet.
 The evening before, drink half of a prescription laxative drink to clean out your colon for
the procedure. (You'll finish it the next morning.)

Important: Arrange for someone to drive you home after the colonoscopy. Your test will have
to be rescheduled if you don't have someone to accompany you home.

If you need to cancel your procedure, you must cancel 5 business days (1 week) in advance to
avoid a $100 late cancellation fee.

Three days before your procedure

Start preparing three days before your colonoscopy. For example, if your colonoscopy is
scheduled for Wednesday, you would start the low-fiber diet Sunday morning.

 Stop taking any fiber supplements and anti-diarrheal medication.

 If you are taking medication for diabetes and/or cardiac conditions, follow the
instructions you've received for managing those medications during the procedure
preparation.
 Eat only low-fiber foods, and avoid foods that contain red, blue or purple dyes that may
interfere with the test

Low-fiber food chart

Confirm that a family member or friend is available to drive you home after your procedure and
to stay with you for two hours afterward.

Two days before procedure

Continue eating only low-fiber foods. Avoid foods that contain red, blue or purple dyes that may
interfere with the test.

Low-fiber food chart

One day before procedure

 Drink only clear liquids or certain light-colored beverages. (See the clear liquid chart
below.)
 Do not eat solid foods.
 You will drink half of the laxative drink today, starting in the late afternoon.
 Mix your laxative drink and start drinking it, following the instructions below or a
handout from the medical center.  (Do not follow the instructions on the bottle itself.)
Start drinking the laxative between 4 p.m. and 7 p.m. (You will need up to 6 hours to
complete the laxative drink and finish bowel movements.)
 Do not use alcohol, marijuana, or other substances that could impair your thought
process.

Drink at least 8 glasses of liquid the day before your colonoscopy (in addition  to the laxative
drink)  to prevent dehydration. See examples of what liquids you may drink and what to avoid:

Clear liquid chart

Mixing the laxative drink

The laxative drink is a prescription and you may pick it up at a medical center or we can mail it
to you. Follow the instructions below or what you receive from the Kaiser Permanente
pharmacy. Don't follow the instructions on the bottle.

 Fill the laxative container to half full. Shake well, and then finish filling to the top line.

Drinking the laxative

 Drink 8 ounces every 10 to 15 minutes. Try to drink quickly rather than sipping.
 Drink half the laxative the evening before the procedure. This takes about 2 hours,
drinking a glass every 10 to 15 minutes. Store the rest in the refrigerator until the
morning of your procedure.
Day of the colonoscopy
If your procedure is in the morning, you may need to get up earlier than usual to finish drinking
the laxative.

 Drink the rest of the laxative 4 to 5 hours before you leave home for the procedure. 
Drink about an 8 ounce glass every 10 to 15 minutes, the same as the previous evening.
 You must finish drinking any other beverage at least 2 hours before your appointment
time.  This means that you need to calculate what time you need to get up so you have
time to finish the prep drink 4 to 5 hours before leaving home.

The other liquids you may drink are the same as you had the day before your procedure. See
the clear liquid chart.

Remember, you can't drink anything for at least 2 hours before your procedure.

You must have someone to take you home after your colonoscopy and stay with you for at least
two hours.

Do not use alcohol, marijuana, or other substances that could impair your thought process prior
to your appointment.

Do not drink alcohol, drive a car, or sign legal documents until the day after your procedure.

After your procedure

You will receive discharge instructions from your nurse after the procedure, including an after-
visit summary with the results.

If tissue was removed, you will get a letter or phone call within 10 days of your procedure with
those results.

There is a very small risk of bleeding after a colonoscopy for up to two weeks. You should be
within a two-hour drive of a medical center for two  weeks following your colonoscopy and
avoid traveling outside of the United States during this time period.

You'll need someone to take you home because it can take up to a day for the full effects of the
sedative to wear off. Don't drive or make important decisions or go back to work for the rest of
the day. If your doctor removed a polyp during your colonoscopy, you may be advised to eat a
special diet temporarily. You may feel bloated or pass gas for a few hours after the exam, as you
clear the air from your colon. Walking may help relieve any discomfort. You may also notice a
small amount of blood with your first bowel movement after the exam. Usually this isn't cause
for alarm. Consult your doctor if you continue to pass blood or blood clots or if you have
persistent abdominal pain or a fever. While unlikely, this may occur immediately or in the first
few days after the procedure, but may be delayed for up to one to two weeks.

Nursing Responsibilities

The following are the nursing interventions and nursing care considerations for the patient:

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Before the procedure

The following are the nursing interventions prior to colonoscopy:

 Secure an informed consent. Make sure that the patient or a significant other has signed an
informed consent form.
 Obtain a medical history of the patient. Check for allergies, bleeding histories, medications,
and information relevant to the current complaint.
 Provide information about the procedure. Tell the patient that colonoscopy permits
examination of the large intestine’s lining. Describe the procedure and tell the patient who
will perform it and where it will take place.
 Ensure that the patient has complied with the bowel preparation. Explain that the large
intestine must be thoroughly cleaned to be clearly visible. To do so, tell the patient that he
must maintain a clear-liquid diet for 24 to 48 hours before the test, take nothing by mouth
after midnight the before, and take a laxative, as ordered, or 1 gallon of GoLYTELY solution
in the evening (drinking the chilled solutions at 8 oz [236.6 ml] every 10 minutes until the
entire gallon is consumed).
 Establish an IV line. Inform the patient that an IV line will be started and a sedative will be
administered before the procedure. Because a sedative will be given, advise the patient to
arrange for someone to drive him home after the procedure.
 Provide reassurance. Assure the patient that the colonoscope is well lubricated to ease
it’s insertion, that it initially feels cool, and that he may feel an urge to defecate when it’s
inserted and advanced.
 Explain to the patient that air may be introduced through the colonoscope. This is done
to distend the intestinal wall and to facilitate viewing the lining and advancing the instrument.
 Tell him that flatus normally escapes around the instrument because of air insufflation and
that he shouldn’t attempt to control it.
 Instruct the patient to empty bladder prior to the procedure. It is more comfortable if the
patient voids immediately before the procedure and to change into the gown, robe, and foot
coverings provided.
 Instruct the patient to remove all metallic objects from the area to be examined. Metallic
objects such as jewelry within the examination area may alter organ visualization and cause
unclear images.
 Instruct the patient to cooperate and follow directions. Instruct patient to remain still
during the procedure because movement creates unreliable results.

During the procedure

The following are the nursing interventions during colonoscopy:

 Assist with patient positioning as necessary. Place the patient on the examination table in a

left lateral decubitus position with a sheet draped over the body.
 Administer medications as ordered. Pain medication and sedative will be given to reduce
discomfort and to promote relaxation.
 Instruct the patient to bear down. Bearing down as if having a bowel movement is advised
as the fiberoptic tube is inserted through the rectum.
 Change the position of the patient. When the scope is advanced through the sigmoid. The
patient’s position is changed to supine to allow passage into the transverse colon. Air is
insufflated through the tube during the passage to help in visualization.
 Encourage the patient to take slow, deep breaths. Instruct the patient to take deep breaths
to aid in the movement of the scope down through the ascending colon to the cecum and into
the terminal portion of the ileum.

After the procedure

The nurse should note of the following nursing interventions post-colonoscopy:

 Observe the patient closely for signs of bowel perforation. Signs of bowel perforations
such as severe abdominal pain, nausea, vomiting, fever, and chills must be reported
immediately.
 Obtain and record the patient’s vital signs. Monitor vital signs and neurological status
every 15 minutes for 1 hour, then every 2 hours for 4 hours, or as ordered. Assess temperature
every 4 hours for 24 hours.
 Instruct patient to resume a normal diet, fluids, and activity as advised by the health
care provider. After the patient has recovered from sedation, allow him to resume his usual
diet and activity unless the practitioner orders otherwise.
  Provide privacy while the patient rest after the procedure. Inform that the patient may
pass large amounts of flatus after insufflation.
 Monitor for any rectal bleeding. If a polyp has been removed, minimal rectal bleeding is
expected for 2 days but an increasing amount of bleeding should be reported immediately.
 Encourage increased fluid intake. Fluids must be given to replace fluid lost during the
preparation of the procedure.

REPORT