Question 1: A client undergoes a colonoscopy for colorectal cancer screening. During the procedure three small polyps were removed. Which nursing procedures are necessary when caring for the client immediately after the colonoscopy?
A. Monitor vital signs and inform her that there may be a small amount of blood in her stool.
B. Observe for signs and symptoms of bowel perforation, monitor vital signs, and inform her that there may be a small amount of blood in her stool and to report excessive blood loss.
C. Observe for signs and symptoms of bowel perforation, monitor vital signs, and inform her to follow a clear liquid diet.
D. Monitor vital signs and inform her that there may be a small amount of blood in her stool, and tell her not to drive for two days.
Question 2: A client is scheduled for a paracentesis. During the intake nursing assessment, he mentions that he forgot to tell the doctor about the four aspirin a day he has been taking for “at least three years” to treat his arthritis. He is scheduled for the paracentesis in twenty minutes. The nurse should
A. proceed as planned, the new information changes nothing.
B. provide patient education on the dangers of long-term aspirin use.
C. alert the physician to the aspirin use since it is can cause complications with this procedure.
D. document the new information in the chart; no additional action is necessary.
Answers:
1. B - Rationale: After a colonoscopy the nurse should observe the patient closely for signs of bowel perforation (rectal bleeding, abdominal pain and distention, malaise, fever, and mucopurulent drainage). Vital signs should be monitored until stable. Due to the polyp removal, there may be some blood, but excessive bleeding is not expected and must be reported. As well as monitoring vital signs and instructing the patient that a small amount of blood may be present, it is very important to educate and instruct to report excessive blood loss. The patient may resume a normal diet but is instructed to increase fluid intake due to fluids lost through laxatives and the NPO period. The patient should not drive for several hours after the procedure, until effects of any sedatives have worn off.
2. C - Rationale: Contraindications for this procedure include: pregnancy, a history of bleeding and clotting problems, and medications that can cause bleeding (such as aspirin, Coumadin, or non-steroidal anti-inflammatory drugs). The procedure needs to be cancelled because the patient is at increased risk for bleeding. The immediate risk at this time is potential bleeding during the procedure, not the other effects of his long-term aspirin use. The physician would be notified, the procedure cancelled, the patient informed, and then this information would be documented.
Source: The College Network