Lower Endoscopy Procedures Flashcards

A CGRN is reviewing a procedure report that describes the patient's colonoscopy preparation using the Boston Bowel Preparation Scale (BBPS). The scores are: Right colon=2, Transverse colon=1, Left colon=2. How should the nurse interpret this finding?

Answer: The total score of 5 indicates an inadequate preparation, requiring a shorter interval for repeat examination.

The Boston Bowel Preparation Scale (BBPS) scores each of three colon segments from 0 (unprepared) to 3 (excellent). A score of 1 in any segment indicates that portions of the mucosa could not be seen, rendering the overall preparation inadequate. A total score of 5 or less is considered poor, which is associated with a lower polyp detection rate and necessitates a repeat colonoscopy at a shorter interval than standard guidelines would otherwise suggest.

A patient calls the gastroenterology unit 10 hours after a colonoscopy with polypectomy. The patient reports a sudden onset of severe, constant abdominal pain, a fever of 101.2°F (38.4°C), and states their abdomen feels "hard as a rock." The CGRN should recognize these signs as most indicative of which complication?

Answer: Bowel perforation

The combination of severe, constant abdominal pain, fever, and a rigid, board-like abdomen are classic signs of peritonitis, which is most commonly caused by a bowel perforation in this context. This is a medical emergency requiring immediate evaluation. Post-polypectomy syndrome can present with similar pain and fever but is a transmural burn without a frank perforation and typically does not cause profound abdominal rigidity. Delayed hemorrhage would present with rectal bleeding.

During a colonoscopy, the endoscopist works to advance the scope to the beginning of the large intestine. Which of the following is considered the most definitive photographic evidence that cecal intubation has been achieved?

Answer: Identification of the appendiceal orifice

The appendiceal orifice and the ileocecal valve are the two definitive landmarks proving the cecum has been reached. Photographing the appendiceal orifice confirms that the entire colon has been examined. While entering the terminal ileum also confirms cecal intubation, the appendiceal orifice is a landmark within the cecum itself. The hepatic flexure is a landmark passed earlier in the procedure, and haustral folds are present throughout the colon.

A CGRN is preparing a 70-year-old patient with a history of Stage 4 chronic kidney disease and congestive heart failure for a colonoscopy. Which type of bowel preparation regimen is absolutely contraindicated for this patient due to the risk of acute phosphate nephropathy and severe electrolyte shifts?

Answer: An oral sodium phosphate (OSP) based solution.

Oral sodium phosphate (OSP) preparations are absolutely contraindicated in patients with moderate to severe chronic kidney disease (Stage 3-5), heart failure, or liver disease. They can cause significant fluid shifts and electrolyte disturbances, including hyperphosphatemia, which can lead to acute phosphate nephropathy and worsening renal failure. Polyethylene glycol (PEG) based solutions are the safest alternative as they are iso-osmotic and not absorbed systemically.

What is the primary advantage of using carbon dioxide (CO2) for insufflation during a colonoscopy as compared to using ambient room air?

Answer: It reduces post-procedure abdominal pain and bloating.

Carbon dioxide is absorbed from the colon into the bloodstream approximately 150 times faster than the nitrogen in room air. This rapid absorption and subsequent exhalation via the lungs leads to less residual gas in the bowel, which significantly reduces post-procedure abdominal pain, cramping, bloating, and discomfort for the patient. Visualization is comparable, and CO2 requires additional equipment, making it more expensive than room air.

A 52-year-old patient undergoes an average-risk screening colonoscopy. The findings are limited to two tubular adenomas, both less than 10 mm, which are completely removed. Based on the 2020 U.S. Multi-Society Task Force (USMSTF) guidelines, what is the appropriate recommendation for the next surveillance colonoscopy?

Answer: 7-10 years

The 2020 USMSTF guidelines updated the surveillance interval for patients with 1 or 2 small (<10 mm) low-risk adenomas. The recommended interval was extended to 7-10 years, reflecting data that shows this group has a low risk of developing advanced neoplasia, similar to patients with a normal baseline colonoscopy. The 3-5 year interval is reserved for patients with higher-risk findings, such as 3 or more adenomas or a single larger adenoma.