Report severe abdominal pain, distension, rigidity, or rectal bleeding indicating bowel perforation.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client receiving a continuous heparin infusion suddenly develops hematuria, bruising, and a drop in blood pressure. After stopping the infusion, which medication does the nurse prepare to administer?
Answer: B. Active bleeding from heparin is reversed with protamine sulfate, which neutralizes heparin. The nurse stops the infusion first and prepares protamine. Vitamin K is for warfarin and would not reverse heparin.
Question 2 of 3
A client with cirrhosis develops abdominal pain, fever, and worsening ascites. Spontaneous bacterial peritonitis is suspected. Which diagnostic test should the nurse anticipate?
Answer: A. Spontaneous bacterial peritonitis is diagnosed by sampling the ascitic fluid, so the nurse anticipates a diagnostic paracentesis with cell count and culture of the fluid; a high neutrophil count in the ascitic fluid confirms infection. A barium swallow, colonoscopy, and skin biopsy do not evaluate ascitic fluid infection.
Question 3 of 3
A client with a peptic ulcer develops sudden severe abdominal pain and a rigid board-like abdomen. The nurse suspects:
Answer: B. Sudden severe pain with a rigid abdomen suggests a perforated ulcer with peritonitis — a surgical emergency. Keep NPO, notify the provider, and prepare for emergent intervention.
Keep the streak going with more questions like these, each with a full rationale.
What is colonoscopy prep?
A clean colon improves polyp detection and the accuracy of the exam. Memory aid: clear liquids and clear effluent; no red or purple dyes.
Key points to remember
- A clear liquid diet is started the day before, and the patient is NPO after midnight or as ordered before the procedure.
- Red, purple, and orange-colored liquids are avoided because they can mimic blood and obscure the view.
- The prep is complete when rectal output is clear, pale yellow, and free of solid stool.
- Conscious (moderate) sedation is used, so the patient needs a responsible adult to drive them home.
- Large-volume electrolyte solutions can cause fluid and electrolyte imbalances, especially in older adults.
- Anticoagulants and antiplatelet agents are often held before the procedure per provider orders.
Nursing priorities
- Confirm informed consent and review held medications including anticoagulants and antidiabetic drugs.
- Instruct on the clear liquid diet, the laxative regimen, and avoidance of red and purple fluids.
- Monitor hydration, electrolytes, and tolerance of the bowel prep, especially in older adults.
- Verify a responsible adult is available to drive the patient home after sedation.
- After the procedure, monitor vital signs, return of sensation, and for abdominal distension.
Labs & values
Patient teaching
- Drink only clear liquids the day before and avoid red, purple, or orange-colored drinks.
- Finish the entire bowel prep even if your stool is already running clear.
- Arrange for an adult to drive you home because you will be sedated.
- Some bloating, cramping, and gas after the test is normal as air is passed.
- Report severe belly pain or heavy rectal bleeding after you go home.
Red flags: report now
- Report severe abdominal pain, distension, rigidity, or rectal bleeding indicating bowel perforation.
- Report signs of dehydration or electrolyte imbalance such as dizziness, palpitations, or weakness during prep.
- Report fever or persistent bleeding after the procedure.
- Never allow the patient to drive or make important decisions for the rest of the day after sedation.
References
Clinical references for this topic
