Leaving the emergency room for endoscopy - page 2

by cadency

7,531 Views | 17 Comments

Hey all! Just wanting to introduce myself and talk about endoscopy. I'm going to be starting a new position in the field in the next two or three weeks. I'm pretty excited - I shadowed for a little while and the area is... Read More


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    As someone who has had more EGDs than I can even count, how about if I give you a patient's perspective? I've been getting EGDs regularly since the mid 90s, and I've also had an unmedicated colonoscopy within the last couple years.

    In the pre-procedural area, your typical patient is going to be scared and uncomfortable, particularly if they've never had a 'scope before. If they're having a colonoscopy, they're likely going to be fatigued from having been up all night pooping their brains out. If they didn't get the advance warning to purchase wet-wipes during their cleanse, they also have a ring of fire where their anal sphincter used to be. If they haven't been actively rehydrating, they may be a difficult stick for the IV start. If they're having an EGD, they're probably going to be starving and thirsty and dehydrated. Regardless of which procedure, they're probably at least a little scared about what is going to happen, unless they've been through it before.

    If you haven't observed each type of procedure, I highly recommend it. That way you can explain the nitty-gritty details to the patient (yes, the MD is supposed to do the actual informed consent, but as the nurse, you are going to be the one spending face-time with the patient before the procedure). You can explain to the patient that you'll have them change into a gown, get vital signs, start an IV, take a short EKG strip on them, have them sign papers, etc., then they'll be wheeled to the procedure room where the lights will be dimmed, they will be placed on their left side, and if having an EGD they will be given an anti-bubbles liquid to swallow, they will be strapped down so they won't move during the scope, a hard plastic thing will be placed in their mouth so they don't bite the tube, and medicine will be inserted into their IV for the procedure itself. Then after the procedure, they'll wake up in the recovery area and be there until the sedation wears off enough for them to go home. Also, tell them now, when fully aware, that it's normal for them to forget things that happen later in the day.

    A few things for post-procedure -- don't tell your colonoscopy patient that it's okay to pass gas freely because it's just the air that was pumped into them. Unless you know for a fact that they had a completely clean bowel, you could end up having to wipe up some residue if you have them fart at will. (Fortunately I was unmedicated for my own colonoscopy because I wanted to watch it myself, and I had seen the little bits and pieces that were still inside me. Had I not been fully conscious, I would have followed the nurse's advice and left skid-marks all over the bed!) Don't panic if the O2 sats are low for a sedated patient -- just remind them to breathe (some of us kind of forget that until the sedation wears off). Make sure that the responsible adult escorting your patient home knows that it's normal for the patient to forget stuff for several hours.

    I hope that helps with the patient's perspective a little bit.
    CP1983 and noyesno like this.
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    Brillo, Thanks, I really appreciated being reminded of your, the patient's, point of view.

    But (of course there has to be a butt, ha ha) about passing gas. I would rather have the patient pass some stool in the bed than keep it in and get cramps? I can easily clean the bed. Not so easy to relieve abdominal cramping.

    How about if I tell the patient to let the gas out and if some stool or liquid, comes with it don't worry, the bed is padded and we can clean the bed easier than relieve their cramping.

    Also I have no problem letting a patient get up to use the toilet soon after the procedure, if I judge they are not too sedated.
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    I think the biggest thing is to let them know what *could* happen (and remind them more than once, for a sedated patient ... it really does take quite a while for your short-term memory to return!). Nobody wants to poop the bed unexpectedly, particularly when they have to explain it to a stranger (and then depend upon that stranger to clean up after them)!

    In my case, my "recovery room" nurse (using quote marks b/c I wasn't sedated, so I technically wasn't recovering) told me that it was "just air in there" and it was okay to let it fly. Like I said, I knew better, and the first time I tooted was on a toilet... and it looked like a Jackson Pollock original!

    So if they're steady enough to get up to the toilet, or if they want a washcloth or towel to put between their cheeks to catch any skidmarks, or if they're comfortable just letting it all fly and pick up the pieces later, I think the biggest thing is to let them be a participant in the process.

    That's one thing that my two decades of dealing with my own medical issues has taught me.... the patient's perspective. Hopefully it makes me a better nurse in the end.
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    I worked for 4 years in a busy out/inpatient endo unit in a hospital, and I loved it. Endoscopy is truly an interesting field, and I think you will get out what you put in. There is a lot to learn, and the field changes a lot. I was also able to become a float in the department, after I learned pre-op, post-op and PACU, and gained more valuable skills that way. I do think that if you haven't already, you should definitely research the unit and figure out what they're really all about (i.e.: hours, holidays, etc.). I ended up leaving endo recently for all the reasons you seem to think you'll be leaving behind in the ER: non-stop politics, horrible hours, crappy management, incompetent physicians, etc. The endo unit was supposed to be 4 10-hour shifts, but we were chronically understaffed and had to take call, so I was frequently putting in 14-16 hour days. Also, since the schedule was solely census based, we were staffed daily -- meaning I didn't know what time I was coming to work the next day until the previous afternoon/evening. I could be staffed at 0530, or not until 1200. That kind of work environment was not conducive to a happy life, so I got out. The 3 12-hour shifts without call that I work now are such a welcome change!

    As for being "clique-y," you have to learn to work really closely with your co-workers and be part of a team. If one member of the team fails, literally you all fail. You depend on one another to make the unit flow smoothly. I also think endo nursing is very unique, and a type of nursing that you can only understand after you enter the field, so that may also contribute to what people perceive as "clique-y."

    I know that not all endo units are as dysfunctional as mine was -- I would just encourage you ask as many questions as possible before you commit! Definitely shadow there also. Good luck to you!
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    Nurses nurturing nurses....I love that! Thank you all so much for your pearls of wisdom !!!
    I especially appreciated knowing more of what the patient experiences per Brillohead....muchas gracias. I LOVE your nursing intervention of "cloth-in-crack"...lol! (So simple yet so effective. I wonder why I haven't seen this offered yet.)

    Having never undergone these types of procedures myself, it's INVALUABLE to hear a "nurse-as-patient" perception. I also agree with you that I would be best served by observing each procedure now that I am a little more comfortable in the unit. My unit manager has agreed to allow me the time to do exactly that.
    brillohead likes this.
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    I work in a small out patient clinic where the GI lab is also located, we do GI 3 - 4 days a week, we see aprox 25- 30 patients a week in our small GI lab. I am and LPN soon to sit for my NCLEX RN, I have done preop, assisted with the scopes, and assisted an RN in the recovery area. the flow of our pts are:
    1 patient arrives
    2 pt signs all consents and discharge instructions, review all home medications, time out is started
    3 pt changes into a gown and placed on a stretcher, IV is started and LR is up
    4 procedure with sedation by a CRNA we use diprovan to sedate
    The nurse assisting also fills out all relevant paper work to the procedure, label specimens, and at end of day deliver all specimens to Lab.
    5 recovery

    we have one nurse in preop, one nurse in the procedure room, one nurse and a CNA in recovery room, one nurse in the clean room cleaning scopes with evotech, and one nurse to float to assist where needed between the four.

    We do any where from 5 to 20 procedures in a day. We are very busy, we are a team. If one doesnt pull their weight then everyone else feels it. Cliques --- I dont know we are a close bunch if one is hurting we all hurt for them, we pull together and act like a family.

    I also work in our ER part time when there are staffing issues I find that both are very stimulating.

    Medications we use in the GI lab -- we might give a little glucogon, zofran for the occasional nausea

    It can be just as stressful as ER at times - GI bleed.....

    in short I love Gi nursing
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    Quote from yrmajesty3
    Nurses nurturing nurses....I love that! Thank you all so much for your pearls of wisdom !!!
    I especially appreciated knowing more of what the patient experiences per Brillohead....muchas gracias. I LOVE your nursing intervention of "cloth-in-crack"...lol! (So simple yet so effective. I wonder why I haven't seen this offered yet.)

    Having never undergone these types of procedures myself, it's INVALUABLE to hear a "nurse-as-patient" perception. I also agree with you that I would be best served by observing each procedure now that I am a little more comfortable in the unit. My unit manager has agreed to allow me the time to do exactly that.
    I'm so glad that my perspective was helpful to you!

    As I said, I'm an old pro at EGDs now, plus I've gone the other end as well. If there's anything I can help you with from the patient's perspective, please feel free to ask -- I'm subscribed to this thread, so I'll know when there's a new post here.
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    cadency-

    Your story sounds identical to mine!!! I have been in the ER for 3+ years and desperately wanted a change. I will be starting in an outpatient endoscopy lab in a few weeks!! I am so excited. I have two great friends that work there, and they love it!! One was a prior med-surg nurse and the other worked at a long term acute-care hospital. I hope everything is going well for you!! How do you like it? Any tips for me? Thanks!!


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