NCM 116

• Fecal analysis is a noninvasive laboratory test useful in identifying disorders of the digestive tract
• Disorders that may be identified through fecal analysis include malabsorption, inflammation, infection (bacteria, viruses, or fungi), or cancer
• Fecal analysis is performed in combination with blood work, physical examination, x-ray imaging, and endoscopy to confirm these conditions
• The most common test done on a stool can detect traces of blood in the feces
• A fecal sample is a solid body waste discharged from the large intestine through the anus by the process of defecation, made of cellulose, other indigestible food matter, water, and bacteria
• About 100 to 300 grams of fecal material is excreted by an average adult daily, the residue of approximately 10 liters of liquid material that enters the GI tract each day
• Laboratory analysis of feces includes macroscopic examination (volume, odor, shape, color, consistency, presence of mucus), microscopic examination (leukocytes, epithelial cells, meat fibers), and chemical tests for specific substances (occult blood, trypsin, estimation of carbohydrates)
• Proper specimen collection and handling, accurate sample identification, ensuring all supplies are appropriate for collection, and timely transport of specimens to the laboratory are essential
• Fecal analysis aids in diagnosing disorders related to gastrointestinal (GI) bleeding or medication therapy that results in bleeding, determining intestinal parasitic infestation, diagnosing suspected inflammatory bowel syndrome (IBS), identifying the cause of diarrhea, investigating disorders of protein digestion, screening for colorectal cancer, and screening for cystic fibrosis
• Medications that irritate the gastric mucosa such as non-steroidal anti-inflammatory medicines (NSAIDs), anticoagulants, colchicine, corticosteroids, phenylbutazone, and iron preparations can cause positive results for occult blood
• High doses of vitamin C (more than 250 mg per day) can cause false negative occult blood, while dietary intake high in red meat, certain vegetables (radish, turnips, cauliflower, broccoli), and fruits (bananas, apples, cantaloupe) can cause false-positive results for occult blood
• Colonoscopy is a common diagnostic test that utilizes a flexible fiberoptic colonoscope inserted into the rectum to visually examine the large intestine (colon) lining
• Indications for colonoscopy include screening for colon and rectal cancer, detecting and evaluating inflammatory and ulcerative bowel disease, locating the source of lower GI bleeding, determining the cause of lower GI disorders, assisting in diagnosing colonic strictures and benign or malignant lesions, evaluating the colon postoperatively for recurrence of polyps and malignant lesions, investigating iron-deficiency anemia of unknown origin, and removing colon polyps
• Contraindications for colonoscopy include patients with bleeding disorders, patients who had a recent acute myocardial infarction or abdominal surgery, insufficient bowel preparation, retained barium in the intestine from a previous diagnostic procedure, inability of the patient to tolerate the introduction or retention of barium, air, or both in the bowel, and sigmoid colon fixation due to inflammatory bowel disease, surgery, or radiation therapy
• 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 the patient to remain still during the procedure because movement creates unreliable results
• 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 sedatives 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
• 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 the 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 rests 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