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REFLECTION ON ESCORTING AND CARING FOR A PATIENT UNDERGOING AN INVESTIGATION I escorted a patient, I will call Mary Smith to maintain confidentiality (Nursing and Midwifery Council [NMC] 2002), from a rehabilitation hospital to a city centre teaching hospital for an investigation. Mary knew she was going for the procedure and had been fasted from the previous evening.
When we arrived at the endoscopy unit Mary was quite nervous about the procedure. I explained briefly what was going to happen and how she might feel. I said that a camera would be put in her mouth and she would have to swallow it. I told her that it would probably be uncomfortable although anaesthetic would be sprayed in the back of her throat. I asked Mary if she thought she would like to have some sedation so she wouldn't remember much about the procedure. I remember how distressed a patient I had looked after previously had been throughout an endoscopy having never been offered sedation. According to the British Society of Gastroenterology (BSG 1999) the patient should be offered the choice of whether or not to have sedation. From this experience I knew it could be a very unpleasant procedure for the patient to go through. I was also acutely aware that Mary was a very anxious lady and wanted the investigation to be as stress free for her as possible. When I asked her if she would like to be sedated she said yes. I asked the nurse if it would be ok for her to have some sedation and she said it should be discussed with the doctor.
Mary had not yet signed a consent form so the doctor then went over the procedure and advised Mary of possible adverse effect than can happen as a result of the investigation. Consent must be obtained for any treatment that patients need to undergo (BSG 1999 and NMC 2001). Mary agreed to sign the consent form and I requested some sedation from the doctor on her behalf.
Mary was placed in position on her left side and guard was placed in her mouth and fastened around her head. This did not look very comfortable for her. The back of her throat was sprayed with the local anaesthetic before introducing the endoscope. She was also given some sedation intravenously via a venflon on her hand. She was producing a lot of saliva and this had to be removed by a suction machine. I stayed close to Mary and held her hand to reassure her. On my previous visit to endoscopy I was not allowed to hold the patient's hand but told to stand at the end of the bed to see the procedure on the video screen. I however felt that my patient was much more in need of reassurance from me than from me observing the procedure. I felt happier this time as I was allowed to hold her hand and see the procedure as well.
Before the endoscope was introduced Mary had oxygen via nasal cannula and was connected to a pulse oximetre to monitor her pulse and oxygen saturations throughout the investigation.
The endoscope was introduced slowly but caused Mary to gag as she tried to swallow it. Once it had passed into her oesophagus it went down more smoothly although there continued to be a lot of saliva produced. As water and air was introduced into her stomach and duodenum she was retching and vomiting it up. Mary was making quite a lot of noises because of the discomfort. Although she had been sedated she was not unconscious so everything she was experiencing was very real to her at the time.
The doctor carrying out the procedure then noted a very large duodenal ulcer. I asked her if this is what was causing Mary's anaemia and she said that this was most likely even though it didn't appear to be a bleeding ulcer at present. There was a large polyp like growth beside the ulcer so she decided to take 2 biopsies to rule out any malignant growth. She felt it was most likely to be over granulised tissue from healing taking place beside the ulcer. e the biopsies were taken and put in labelled specimen containers the endoscope was with drawn from Mary's oesophagus. Mary wriggled into a more comfortable position and was transferred to the recovery area.
Mary had her observations of pulse, blood pressure and oxygen saturations monitored every 10 minutes for about half an hour. She was also roused to see if she was coming round from the sedation. After an hour she seemed more awake but a bit disorientated. I reassured her and orientated her to time and place. I told her that her procedure was over and she said she was relieved but that she could not remember anything about it. I felt relieved when she told me this because I was sure she wouldn't have liked to remember such an experience.
The doctor says that she should be started on an ulcer-healing drug as soon as possible and Mary said she thought that was fine. After a cup of tea and a biscuit Mary was ready to go back to the rehabilitation hospital.
I felt relieved that the procedure had gone so well. I also felt very proud of Mary because as an anxious lady she coped remarkably. I enjoyed the experience too and it was good to actually see what was causing Mary so much discomfort so clearly. I was pleased that I was able to tell Mary what the procedure was likely to be like and that I could act as her advocate and ask for the sedation she wanted.
page last updated 11/06/05
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