The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [439]
Postprocedural considerations
Immediate care
Many organisms responsible for infection of the lower respiratory tract do not survive well outside the host, so specimens should be dispatched to the laboratory immediately and processed within 2 hours (Gould and Brooker 2008). If there is an anticipated delay in despatching the sample to the laboratory, it should be refrigerated at 4–8°C and sent as soon as possible (HPA 2008a).
Documentation
The date and time of when a sputum sample is sent to the laboratory should be documented clearly and promptly in the patient’s notes and care plan (NMC 2009). This should be done alongside documentation in relation to significant findings that have prompted the collection of the sample such as a description of the type and colour of sputum/secretions and method used to obtain the sample.
Endoscopic investigations
Definition
Occasionally patients will be required to undergo further invasive diagnostic procedures such as an endoscopy. An endoscopy is the direct visual examination of the gastrointestinal tract which may include gastroscopy or colonoscopy. Endoscopy allows the practitioner to evaluate the appearance of the visualized mucosa for the purpose of diagnosis and therapeutic procedures (Smith and Watson 2005).
Gastroscopy
Definition
A gastroscopy or oesophagogastroduodenoscopy (OGD) is a procedure in which a long flexible endoscope is passed through the mouth, allowing the doctor or nurse endoscopist to look directly at the lining of the oesophagus, stomach and proximal duodenum. The endoscope is generally less than 10 mm in diameter but a larger scope may be required for therapeutic procedures where suction channels are required (Smith and Watson 2005) (Figure 11.3).
Figure 11.3 Endoscopy.
© Cancer Help UK, the patient information website of Cancer Research UK: www.cancerhelp.org.uk.com Used with permission.
Anatomy and physiology
Oesophagus
The oesophagus is a muscular thin-walled tube approximately 25 cm long and about 2 cm in diameter. It is located behind the trachea and in front of the vertebral column. There are two sphincters within the oesophagus: the upper or hypopharyngeal sphincter and the lower gastro-oesophageal sphincter. Food passing into the stomach is controlled by the lower sphincter. The oesophagus has three layers, the mucosa, submucosa and the muscularis, with the innermost layer consisting of stratified squamous epithelium (Smith and Watson 2005, Waugh et al. 2006). See Figure 11.4.
Figure 11.4 Anatomy of the lower gastrointestinal tract.
Stomach
The stomach is located between the oesophagus and the small intestine. It is a J-shaped dilated portion of the alimentary tract. It is also located between the epigastric, umbilical and left hypochondriac regions of the abdomen. It is divided into three regions: the fundus, body and antrum. Distally, the pyloric sphincter is located between the stomach and the duodenum. The stomach has three muscle layers to allow for gastric motility to move the contents adequately whereas other parts of the alimentary tract only have two muscle layers (Smith and Watson 2005, Waugh et al. 2006). See Figure 11.4.
Duodenum
The duodenum is part of the small intestine. It is approximately 25 cm long and 3.5 cm in diameter. It is generally C-shaped and muscular, beginning at the pyloric sphincter of the stomach and joining the jejunum. Both the pancreas and the gall bladder release secretions into the duodenum (Smith and Watson 2005, Waugh et al. 2006). See Figure 11.4.
Evidence-based approaches
Rationale
A gastroscopy is undertaken to investigate symptoms originating from the upper GI tract such as reflux and dysphagia. The doctor or nurse endoscopist is able to use direct vision to diagnose, sample and document changes in the upper GI tract.
Indications
Dysphagia.
Odynophagia.
Achalasia.
Unresponsive reflux disease.
Gastric and peptic ulcers.
Haematemesis and melaena.
Suspected carcinoma.
Oesophageal or gastric varices.
Monitoring Barrett’s oesophagus disease.
Contraindications