There are several medical tests recommended for both men and women on a regular basis to maintain optimum health. Starting as toddlers, we should get our teeth examined and cleaned annually, and as we grow, so does the list of check ups. Mammograms, pap smears, skin cancer checks, prostate exams, and a colonoscopy are among the exams considered to be routine, yet life saving.
Most people cringe when a colonoscopy is mentioned. As societal misconceptions are corrected and more data is available about the advantages of having a screening colonoscopy, more lives will be saved. First, we will discuss the anatomy of the large intestine, then what the recommendations are for getting a colonoscopy, and last, the importance of nurses being educated so they can help their patients through the process.
Anatomy of the Colon
Knowing what the colon does for us, and the five different anatomical sections will help us nurses in educating ourselves and our patients. Beginning at the ileocecal valve to the orifice, the colon is divided into areas: Ascending, Transverse, Descending, Sigmoid, and Rectum (Carpenter p163). The ileocecal valve resides in the distal end of the colon and prevents the passage of intestinal contents from the small bowel into the colon (163). This amazing flap also keeps bacteria from refluxing the other way, keeping the small bowel sterile (163).
The colon is made with complicated layers of muscle innervated with nerves and a blood supply that keep it doing its job and keep us regular and healthy. The main function of the colon is storage and movement of intestinal contents (164). Once the intestinal contents make it into the large intestine the small bowel has absorbed most of the nutritional contents, what's left is water and waste. Most of the water left is absorbed, along with some electrolytes and bile salts in the colon, leaving feces (164). Feces contains intestinal bacteria that break down the the body wastes (164)
Recommendations
A colonoscopy is a test performed by a Gastroenterology doctor, using a colon scope that is inserted into the orifice and can be pushed all the way to the ileocecal valve. The advantage of this test is the direct visualization of the colon mucosa, and the ability to diagnose and treat colon disease. Screening colonoscopies are crucial in order to prevent colon cancer.
According to SGNA, the Society of Gastroenterology Nurses and Associates, Inc., "Colorectal cancer is the most commonly diagnosed cancer and the third leading cause of cancer death in both men and women in the United States." They break patients down into two groups, Average risk - Asymptomatic people age 50 or older with no other previous family or personal history of colon cancer. High risk - people with a history of polyps, colorectal cancer or inflammatory bowel disease, and/or a family history of colorectal cancer.
Average risk patients should get their first colonoscopy at the age of 50. If no polyps are found, then the next colonoscopy needs to be in 10 years (Lieberman). If the doctor finds a small hyperplastic (an abnormal increase in the number of cells - benign) polyp, they also are recommended to have a follow up colonoscopy in 10 years. If adenomas (polyps that can turn into cancer) are found, depending on the amount and size, that will buy you a ticket to repeat a colonoscopy in 3 - 5 years.
According to the American Cancer Society, patients with a family history of colorectal cancer in any first degree relative before the age of 60 it is recommended that their first colonoscopy be at age 40 or 10 years before the youngest case of immediate family. If the first degree relative is older than 60, then age 40 for the first screening colonoscopy is advised.
Education
Nurses play a huge role in educating patients before, during and after their colonoscopy. You can make the difference between a poor prep and repeat the test next year, and a good prep where the doctor is able to see the entire mucosa and possibly save a life or prevent surgery for that patient. Most offices give written instructions regarding the prep, NPO status and a clear liquid diet the day before the prep, but these can become confusing and complicated.
Nurses can help confusion by clearly explaining why the colonoscopy is needed, and that early intervention can save their lives. Have the patient repeat their version of the prep instructions and listen for errors. Reinforce the important things, like what medicine to take the night before, and when to be NPO. Ask the patient what they are most concerned about and answer any question they have. This will help to decrease their anxiety and increase compliance.
Reviewing things every once in awhile is beneficial for nurses, it keeps us up to date and helps us remember details we may have forgotten. We can't remember everything, making books, pamphlets, and the internet our friend while educating our patients. Knowing how the large intestine works and what a colonoscopy entails, will help you the next time you have a patient going for one.
If you have any questions on anything discussed, please ask. The next two articles will first cover different disease processes of the colon and some therapeutic interventions that can be done while doing a colonoscopy, then a detailed discussion on the preps prescribed that clean out the colon for a colonoscopy. I recently had my 50 year colonoscopy and I will share my experience. After having worked in the GI lab for over 20 years, I learned a lot about what the patient goes through.
References
"American Cancer Society recommendations for Colorectal Cancer Early Detection". Revised 02/05/2015. American Cancer Society Recommendations for Colorectal Cancer Early Detection. 23 June, 2015. Web.
Carpenter Aquino, Amy, MS, Ed. Gastroenterology Nursing, A Core Curriculum. 4th Edition, 2008. USA. Print.
Guidelines for Performance of Flexible Sigmoidoscopy by Registered Nurses for the Purpose of Colorectal Cancer Screening". 2009. SGNA Society of Gastrointestinal Nurses and Associates, Inc. June 18, 2015. Web.
Lieberman, David A., Rex, Douglas K. et. al. "Guidelines for Colonoscopy Surveillance Polypectomy: A Consensus Update by the US Multi Society Task Force on Colorectal Cancer." 9/2012. American College of Gastroenterology. 23 June, 2015. Web.
