Microsoft word - fleets_phosph-sada_bowel_preparation_for_colonoscopy.doc
Obtain two (2) I-In IL oz. Bottles Fled* Phospho-Soda (Ginger Lemon Flavor or Regular) at any pharmacy. Fleet Phospho-Soda is also available ln 2 larger sizes .3 fl. oz. and 8 fl. oz.; if larger size purchased, do not exceed recommended dosage, as serious side effects may occur. PMS06039 FLEET'S PHOSPHO SODA BOWEL PREPARATION FOR COLONOSCOPY
The purpose of the following Instructions is to provide good bowel preparation for colonoscopy to enhance the quality and safety of the examination. Failure to comply with these Instructions may result In having to repeat the bowel preparation and reattempt colonoscopy at a later date. If questions arise regarding the bowel preparation, please do not hesitate to contact the office.
1. Avoid aspirin for one week prior to the examination aspirin may contribute to bleeding problems following biopsy or polyp removal.
2. Avoid other arthritis medications for 24/72 hours prior to the examination these agents may also Increase the likelihood of bleeding, but the effect Is reversible with avoidance of the medication for several hours. No ibuprofen, Aleve, Motrin, Daypro, Advil, Vioxx, Celebrex, Arava. Tylenol Is okay.
3. If you are taking an iron preparation, please discontinue It two or three days prior to the scheduled examination.
4. Please continue all medications that you are taking with the exception of aspirin, Coumadin, and Arthritis medications as noted above. If you are taking Insulin or diabetes pills, please get special Instructions from Dr. Cook, Dr. Davis, or their nurse.
5. If you are taking Coumadin, discontinue dose on_______________ and get lab drawn on__________________
6. Since sedation Is used during the examination It will be necessary for you to have a friend or family member drive you home after the exam.
On ____________________only clear liquids may be taken for breakfast, lunch, and dinner (clear liquids Include water, coffee, ten, soda pop, clear fruit juices; apple, grape, bouillon, plain Jell o Gatorade, Nothing red. You must drink at least 6-8 ounce glasses of liquid. NO SOLID FOODS, MILK OR MILK PRODUCTS ALLOWED.
4 P.M. Add 1-1/2 counces* of Fleet's Phospho soda to 1/2 glass of water (4 fl. oz.) and take. This can be followed by one glass (8 fl. oz.) water or other clear liquid. Chew 2 Mylanta Gas tablets.
Drink at least three (3) 8 fl oz portions of a clear liquid before retiring more It desired.
On _______________@_____________ add1-1/2 counces* of Fleet's Phospho soda to 1/2 glass of water (4 fi oz) and take. Chew 2 Mylanta gas tablets. This can be followed by one glass of water or clear fruit juice.
Only drink clear liquids prior to the exam. IF YOU TAKE HEART, LUNG, OR BLOOD PRESSURE MEDICATION IN THE MORNING, PLEASE BE SURE TO TAKE YOUR MEDICATION BEFORE YOU COME TO THE HOSPITAL/ENDO CENTER.
Appear for examination at ______________________
NOTE: IF YOU CANCEL YOUR PROCEDURE WITHIN 24 HOURS OF SCHEDULED TIME YOU WILL BE CHARGED $100.00 CALL THE OFFICE IF UNABLE TO COMPLETE PREPARATION
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Obtain two (2) I-In IL oz. Bottles