Endoscopy, Nursing Intervention and Care Plan



What is an endoscopy?:
Definition ;
An endoscopy is a medical procedure used to view the digestive tract,and other internal organs, non surgically. Through the use of an endoscope (a flexible tube with a lighted camera attached, the internal body structures are seen on a color monitor by the physician.
Or A procedure looking at the inside of body cavities, such as the esophagus or stomach.
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Endoscopy can consist of ;
* a rigid or flexible tube .
* A light delivery system to illuminate the organ or object under inspection . the light source is normally outside the body and light is typically directed via an atopical fiber system.
* a lens system transmitting the image to the viewer from the fiberscope.
* an additional channel to allow entry of medical instruments or manipulators.
Where is the endoscope inserted?:
the endoscope is either passed through the mouth to view the esophagus, stomach and most of the small intestine, or through the anus to view the anus, rectum and lower large intestine. The images provided by an endoscopy may not be available using other techniques, and endoscopic images are often superior to those of a standard x-ray.

Types and differences of endoscopy

Gastrointestinal (GI) endoscopies are performed using one of two techniques: inserting the endoscope through the mouth to examine the upper GI tract, or inserting the endoscope through the anus to examine the lower GI tract.
When the endoscope is inserted through the mouth, it is known as an upper endoscopy. This approach enables the physician to view the esophagus, stomach and duodenum. Also known as an esophagogastroduodenoscopy, this procedure is used to diagnose swallowing difficulties, nausea and vomiting, reflux, bleeding, indigestion, abdominal pain, and chest pain. These procedures normally take between 15 to 20 minutes. Examples of upper endoscopies include:

  • Esophagoscopy. Examines the esophagus.
  • Gastroscopy. Examines the stomach.
  • Upper GI endoscopy. Examines the esophagus, stomach and duodenum (the first part of the small intestine).

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  • Enteroscopy. The small intestine beyond the duodenum is examined using a long endoscope, or enteroscope.
  • Endoscopic retrograde cholangiopancreatography (ERCP). An examination of gallbladder, pancreas, and the ducts that drain into the liver. After the endoscope is inserted, a dye is passed through a thin flexible tube (catheter) inside the endoscope before x-rays are taken.

In other cases, the endoscope is inserted through the anus(lower endoscopy ). This allows the physician to see the anus, rectum and large intestine. It may take from a few minutes to an hour to perform these procedures. There are three major types of these endoscopies:

  • Anoscopy. Examines the anus.
  • Sigmoidoscopy. Examines the lower part of the large intestine (sigmoid colon), the rectum and the anus.
  • Colonoscopy. Examines the entire large intestine, the rectum and the anus.

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In some cases, patients may undergo an endoscopic ultrasound. This procedure combines endoscopy with ultrasound, in which sound waves are used to create images of organs deep within the body. It is often used to evaluate fistulas, abnormal openings or passages that may be associated with inflammatory bowel disease.

Uses ;
Endoscopy can be used to diagnose or treat many disorders of the digestive system. Some examples of such disorders include
1-gastrointestinal tract (gi tract );

  • Inflammatory bowel disease
  • Peptic ulcers clip_image009
  • Diverticulosis
  • Appendicitis
  • Gallbladder stones
  • Colon polyps
  • Colon cancer

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Uses of endoscopy
* The endoscope itself is a long flexible tube with several channels that can project light on the area being examined. A camera attached to the tip of the tube allows images to be captured. Air also can be pumped through the tube to expand tissue folds, making it easier to see the stomach. Surgical instruments can be passed through the endoscope to perform surgery, and a small clipper attached to the endoscope can be used to collect a sample for biopsy.
* endoscopes are used to examine various parts of the digestive tract.
* Endoscopes can reveal the presence of irritation and inflammation, as well as features such as tissue growth, hiatal hernia or ulcers.
* endoscope can be used to obtain a tissue sample that is then analyzed in a laboratory. This analysis can help determine the cause of the abnormality (e.g., inflammation, infection, cancer)..
* Endoscopes can also be used to treat some disorders, such as opening a duct or removing a gallstone or polyp. To perform such treatments, the physician clip_image012passes instruments through a channel in the endoscope. An electric probe located at the tip of the endoscope can be used to destroy abnormal tissue, remove small growths or seal a blood vessel. The endoscope also has a needle that is used to treat swelled (dilated) vessels in the esophagus with drugs that can halt bleeding.
equipment ;
1- endoscopy tray , which contain
– fiber – optic endoscopy
-Camera
-Solution for biopsy
-Biopsy specimens
2- local anesthesia spray , lidocaine
3- suction equipment
4- maouth gag
5- drugs as order : sedative , atropine and anti spasmodic .
6- sterile gloves
7- sterile water – soluble jelly
8- kidney basin
9- normal saline bottle
10- syringe , needle , alcohol swap and tape
11- antiseptic solution for hand washing
12- plastic pag
13- histology specimen container
14- jelly for lubricant .
Solution
For clean ; 1- savlone 2- sedex 3-normal saline or water.
Medication
1-lidocaine (local anesthesia )
2- sedation ( midazolam ) iv.
Indication for upper gastrointestinal endoscopy

1- bleeding
2- abdominal pain,
3- chest pain.
4- difficulty swallowing
5- change in bowel habits.
6- nausea and vomiting,
7- reflux bleeding.
8- indigestion, abdominal pain, and chest pain.
. Indications for Endoscopy in GERD

  • Dysphagia to solids
  • Weight loss and anorexia
  • Iron deficiency anemia and occult G.I. blood loss
  • Elderly patients with GERD symptoms
  • White males 40 years or older with heartburn (increased risk of Barrett’s esophagus)
  • Surveillance of Barrett’s patients to look for dysplasia and cancer
  • Patients with extra-esophageal manifestations of GERD (to possibly confirm GERD diagnosis by finding erosive esophagitis)
  • Patients with severe heartburn not responding to appropriate medical management.

Endoscopy contra-indication
1-patient who are physically unfill(e.g who are sever cardiorespiratory disease or similar).
2- patient who are at risk sub-acute bacterial endocarditis (e.g who have a prosthetic heart valve or previous history ).
3- patient who are talking anticoagulants .
4-diabetics(on sulphonylurea or insulin ).
Potential risks with endoscopy
Endoscopies are safe procedures that rarely cause complications for the patient, although in rare cases a patient may have an;
1-allergic reaction to anesthesia..
2-puncture the digestive tract, causing a hole (perforation) to form..
3-Pain, bleeding and infection also sometimes occur as the result of an endoscopy.
However, it is more likely that patients who experience complications will have only minor irritation or bleeding of the digestive tract.
Rare complications associated with upper endoscopies include:

  • Severe irregular heartbeat
  • Pulmonary aspiration (in which foreign matter enters the trachea [windpipe])
  • Fever
  • Breathing problems

Rare complications associated with endoscopies of the lower gastrointestinal tract include:

  • Dehydration as a result of using too many laxatives or enemas
  • Cardiac arrhythmias (abnormal heart rhythms)
  • Bursting of combustible gases in the colon when polyps are removed
  • Breathing problems

In addition, patients should contact their physician if they experience any of the following symptoms:

  • Unexplained or chronic abdominal or chest pain, including heartburn
  • Swallowing difficulties or pain when swallowing
  • Nausea and vomiting or reflux
  • Indigestion
  • Weight loss (unexplained)
  • Unexplained and persistent changes in bowel habits
  • Abdominal pain
  • Diarrhea
  • Black or tarry stools or bleeding from the rectum

Before the endoscopy
Patients should closely follow their physician’s advice about all the preparatory measures necessary before an endoscopy. Patients usually are asked to stop eating for several hours prior to or the night before the procedure, because food that is present may obstruct the physician’s view of the digestive tract and potentially cause the patient to vomit during the procedure. Patients may also be advised to change their medication routine. For example, taking aspirin just prior to an upper endoscopy could cause false readings on some tests.
Patients scheduled to have an endoscopy of the lower gastrointestinal tract usually have to take laxatives and may be asked to undergo an enema prior to the procedure to ensure that the colon is empty of stool. They also are asked to avoid solid food for several days prior to the procedure.
Patients should also inform their physician about any drugs or supplements (e.g., vitamins) they are taking and any allergies they may have to drugs or other substances. In addition, it is important to inform the physician of any health conditions the patient may have, such as heart or lung problems.
Upper endoscopy
Position
The pt in comfortable position on your side . put pillow under the head of patient and put kidney basin under the face
See the picture
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The physician insert the endoscopy to treat bleeding abnormalities or to take sample(biopsy ) from soft tissue or to diagnosis or further tests .
Lower endoscopy
There are three major types of these endoscopies:

  • Anoscopy. Examines the anus.
  • Sigmoidoscopy. Examines the lower part of the large intestine (sigmoid colon), the rectum and the anus.
  • Colonoscopy. Examines the entire large intestine, the rectum and the anus.

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Indication of lower endoscopy
1- fresh bleeding
2- diagnosis of cancer
3- change in bowel habit
4- pain, blood diarrhea , weight loss
Rare complications associated with endoscopies of the lower gastrointestinal tract include:

  • Dehydration as a result of using too many laxatives or enemas
  • Cardiac arrhythmias (abnormal heart rhythms)
  • Bursting of combustible gases in the colon when polyps are removed
  • Breathing problems

During the endoscopy
The procedure may be performed in either a hospital or a clinic setting. A sedative or anesthetic may be administered intravenously prior to an esophagoscopy, gastroscopy, upper gastrointestinal endoscopy, or colonoscopy. The air that is pumped into the digestive tract during endoscopy sometimes causes discomfort, and sedation can reduce the unpleasant feeling. Some patients also may react to any anesthesia that is given. The patient’s breathing, blood pressure, heart rate and oxygen level will be closely monitored to ensure safety.
Patients who undergo an upper endoscopy may receive a spray or gargle solution with an agent that numbs the throat. This can help prevent the patient from gagging when the endoscope is inserted.
The procedure will unfold differently depending on the type of endoscopy being performed. During an upper endoscopy, patients are placed on their left side and a plastic mouthpiece is positioned between the teeth. This props the mouth open, making it easier to insert the tube. The endoscope is lubricated, and the patient is asked to swallow it. Any saliva that builds up is suctioned away with a suction tube. The physician inspects the lining of the esophagus, stomach and small intestine using high-quality images captured by the endoscope that are projected onto a monitor or viewed directly through an eyepiece. If necessary, tissue samples are removed for biopsy or foreign bodies and polyps are cut away. The procedure usually takes 10 to 15 minutes.
During an endoscopy of the lower GI tract, patients are also placed on their left side. The physician then lubricates the endoscope and inserts it into the anus. The physician studies images of the colon and rectum walls that are transmitted to a monitor and performs any necessary surgery. Patients may be asked to change position to assist the physician in moving the endoscope. The procedure usually takes 15 to 60 minutes to complete.
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Most patients do not experience significant discomfort during an upper endoscopy. However, patients who have an endoscopy administered through the rectum may feel the urge to have a bowel movement. Although this may be uncomfortable, it usually does not cause any pain


After the endoscopy
Following the procedure, patients who have been sedated may be asked to wait for an hour or two while their sedative wears off. These patients also should not drive themselves home.
Some patients may experience a mild sore throat following an upper endoscopy. Bloating and cramping are sometimes reported after a lower endoscopy. The physician will inform the patient about when it will be safe to eat and drink again, as well as provide a time frame for resuming normal activity. In most cases, patients are urged to rest and eat lightly for the remainder of the day following the endoscopy.
Notes ;
after finish the procedure of endoscopy the nurse act the clean of endoscopy with ;
1-start with savlone to remove blood and any secreation for2-4
2- then wash with water 3-5
3-then wash withsedex to kill any bacteria 2-3
4- then put endoscopy in the water
5- then handle the endoscopy and wash with spirte then leave endoscopy dry and can you used endoscopy for another patient .
sterilaization ;
sterilization of endoscopy require put the endoscopy in the sedex solution from 15-30 minutes .

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