Respond your fellow classmates per the Discussion Rubrics guidelines: Critic you

Respond your fellow classmates per the Discussion Rubrics guidelines:
Critic your fellow classmates in one response supported by a credible reference. Do you agree with their plan? What would you have said or done differently?
Original peer post provided below:
What exactly is a colonoscopy and how is it done?
A colonoscopy is a procedure that allows for direct visualization of the large bowel. The provider utilizes a colonoscope which is inserted through the rectum while the patient is under sedation or anesthesia, or in some cases alert, in order to view the entire length of the large bowel, from the distal rectum to the cecum (Fowler, 2020). A colonoscopy is the primary screening test in the United States for colorectal cancer (CRC) because it also allows biopsies to be taken simultaneously when indicated (Duobeni, 2023).
What is the guideline for average-risk screening for CRC?
According to the American College of Gastroenterology (ACG), a strong recommendation is given to screen average risk individuals between the ages of 50-75 years, with a conditional recommendation to begin at age 45 (Shaukat et al., 2021). The ACG suggests that either a colonoscopy every 10 years, or fecal immunochemical testing (FIT) yearly be utilized as primary CRC screening options (Shaukat et al., 2021). The guidelines from the United States Preventative Services Task Force (USPSTF) mirror the ACG guidelines with a grade A recommendation to screen ages 50-75, and grade B recommendation to start at age 45 in individuals at average risk for CRC (USPSTF, 2021).
What would you recommend for Tom? Argue against colonoscopy.
Despite Tom being at an increased risk for CRC since his mother died from the disease, he is also at an increased risk for complications from the colonoscopy due to his health history. Fecal immunochemical testing would be reasonable to recommend as an alternative screening method for Tom given his risks. FIT is strongly recommended by both the ACG and the USPSTF as a reasonable alternative to CRC screening when a colonoscopy is refused or risky for the patient (Shaukat et al., 2021; USPSTF, 2021). Although FIT is done annually, it only requires a stool sample, and does not include a bowel preparation, sedation, or any of the risks associated with a colonoscopy (USPSTF, 2021) making it a safe alternative to screen Tom for CRC.
After hearing your recommendation, Jack states “I do not think I want to proceed with the procedure. What else can we do?” Provide 5 monitoring of testing options
Fecal immunochemical testing (FIT): FIT is a stool based test that tests for the presence of blood in the stool. It requires one stool sample, no bowel prep or anesthesia. This test is recommended annually to screen for CRC, and if results are positive, a colonoscopy should be performed (Duobeni, 2023).
Multitarget stool DNA testing (MT-sDNA): A stool based test that occurs every three years, and detects DNA mutations from cancer cells in the stool. This test does not require a bowel prep or dietary restrictions, but the complete bowel movement must be collected and mailed to the lab (Duobeni, 2023).
Guaiac-based fecal occult blood test (gFOBT): A stool based test that detects the presence of blood in the stool. This test requires three consecutive stool samples that are collected and put on a test card, and then mailed in to the lab. Vitamin C and red meat should be restricted for three days prior to sample collections (Duobeni, 2023).
Computed tomography (CT) colonography: A CT scan is performed to visualize the entirety of the colon and is performed ever 5 years. This approach does involve a bowel prep, the potential for intravenous medications to aid in bowel relaxation, and the insertion of a small catheter in the rectum to inject air (Duobeni, 2023).
Septin 9 plasma assay: A blood test that has received FDA approval to help screen for CRC when individuals refuse other methods. This test is not typically supported as a primary screening approach due to lack of sensitivity (Duobeni, 2023).
Chart your treatment plan.
After fully counseling Tom, and guardian Jack, on risks of CRC and screening options, Jack has refused the colonoscopy and opted for FIT evaluation for Tom. Jack verbalized understanding of FIT procedure, including the potential outcomes such as false positives, and recommendation for follow-up colonoscopy if abnormal FIT results occur. Education on FIT procedure was provided, and information was also sent to the group home to ensure adherence. Plan on following up with Tom and Jack in 1-2 weeks when FIT results return to discuss outcome and further screening plan.
Provide 4 educational interventions for the CNA staff regarding Tom’s prep related to his health history and risk factors.
Diet: Make sure Tom is well hydrated the day prior to the preparation. The day before the colonoscopy, Tom should only have clear liquids administered, but avoid liquids with red coloring. When the bowel preparation begins, Tom should not receive other food or liquid through his G-tube and should remain NPO.
Medications: Continue to administer Tom’s medications as scheduled. If Tom is on any blood thinning medications, the risks/benefits will be reviewed, and the staff should be directed on whether or not to administer (A-Rahim & Falchuk, 2023).
Bowel Prep Administration: Reconstitute the solution with water as directed on the bottle. Begin administering Tom the preparation through his G-tube at 6:00pm the night before the colonoscopy. Give 240mL of solution about every 10 minutes until half of the solution (2L) has been administered, then stop. The remaining 2L of solution should be administered beginning 5 hours prior to the scheduled procedure, giving 240mL every 10 minutes until solution is gone. The preparation should be complete at least 2 hours prior to the start of the procedure (A-Rahim & Falchuk, 2023). Watery diarrhea is expected, this should begin within a few hours of the bowel preparation (A-Rahim & Falchuk, 2023). Document the appearance of each bowel movement to assist with adequate bowel preparation. Bowel movements should begin to appear clear yellow with complete preparation (A-Rahim & Falchuk, 2023).
Patient Safety: To minimize the risk of aspiration, make sure Tom is elevated at least 30 degrees, or sitting upright during administration of medication. If Tom develops nausea or bloating, the rate of administration can be slowed down allowing for more time in between doses (A-Rahim & Falchuk, 2023). Check Tom frequently for bowel incontinence, and ensure his stage-2 ulcer is remaining clean. Use a bedpan, incontinence pads, and barrier ointments to assist with skin care. Ensure complete incontinence care with each bowel movement and assess skin integrity throughout entirety of the bowel preparation.
References:
A-Rahim, Y.I. & Falchuk, M. (2023). Bowel preparation before colonoscopy in adults. UpToDate. Retrieved on March 1, 2023 from https://www.uptodate.com/contents/bowel-preparation-before-colonoscopy-in-adults?search=colorectal%20cancer%20risk&topicRef=7576&source=see_link#H3877864794
Doubeni, C. (2023). Tests for screening for colorectal cancer. UpToDate. Retrieved on February 28, 2023 from https://www.uptodate.com/contents/tests-for-screening-for-colorectal-cancer?sectionName=Fecal%20immunochemical%20test%20(FIT)%20for%20blood&search=colorectal%20cancer%20risk&topicRef=7565&anchor=H6&source=see_link#H6
Fowler, G.C. (2020). Pfenninger & Fowler’s procedures for primary care. (4th Ed.). Elsevier.
Shaukat, A., Kahi, C.J., Burke, C.A., Rabeneck, L., Sauer, B.G., & Rex, D.K. (2021). ACG clinical guidelines: colorectal cancer screening 2021. The American Journal of Gastroenterology, 116(3), doi: 10.14309/ajg.0000000000001122
U.S. Preventive Services Task Force (2021). Colorectal cancer: screening. https://uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening#bootstrap-panel–6