Bowel Preparation

 Taken from HUSM Endoscopy Unit
1 day prior to appointment
(Breakfast only)
Allow 2 piece of plain bread or plain mee and plain water. Do not take any meat, vegetables, fruits or any dairy product (produk tenusu). Please drink at least 2 litre of plain water until midnight. (If needed, take glucose drink dibenarkan sahaja jika perlu).

3pm and 7pm
Add 45ml of FLEET into a glass of plain water. Finish the dilution. This preparation(cirit-birit) works within 30 mins but may take as long as 3 hours.

12 midnight
Start fasting until colonoscopy done.

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Taken from H K.L Nurse's blog

Colclean or Fleet solution.(for patients with no renal impairment)

• ·         Avoid eating any dietary fibers at least 3 days before the scheduled procedure. E.g.: veggies, fruits, oats, etc. (for outpatients)
• ·         Can eat Breakfast and lunch.
• ·         Preparation must be done the day before the Colonoscopy procedure
• ·         45mls Colclean / Fleet + a minimum of 3 glasses of water to be given to the patient at 3.00pm. (No more meals are to be taken after the first dose.)
• ·         Your patient will start to have Diarrhea soon afterwards.
• ·         Another 45mls + a minimum of 3 glasses of water to be given at 6.00pm
• ·         Patient should be encouraged to drink lots of clear fluids afterwards to avoid dehydration and given IV Drips if necessary. Your patient is going to lose a lot of fluids.
• ·         Patient is allowed to drink clear fluids. No need NBM. (consult your Gastro M.O first)
• ·         On the day (8.00am) of the planned procedure, call Scope room to inform the case.
• ·         Call scope room if you are not sure about the bowel prep.

Fortrans - Poly Ethelyne Glycol (most Gastroenterologist likes to use this)

• ·         Avoid eating any dietary fibers at least 3 days before the scheduled procedure. E.g.: veggies, fruits, oats, etc. (for outpatients)
• ·         Can eat Breakfast and lunch.
• ·         One sachet of Fortrans is to be diluted with one liter of clear fluid.
• ·         3 sachet = 3liters
• ·         One liter of diluted Fortrans is to be taken at 6.00pm
• ·         Another liter of fortrans at 7.00pm
• ·         And another one at 8.00pm
• ·         All Diluted fortrans should be finished by the patient.
• ·         Patient should be encouraged to drink lots of clear fluids afterwards to avoid dehydration and given IV Drips if necessary. Your patient is going to lose a lot of fluids.
• ·         Patient is allowed to drink clear fluids. No need NBM. (consult your Gastro M.O first)
• ·         On the day (8.00am) of the planned procedure, call Scope room at to inform the case.
• ·         Call scope room if you are not sure about the bowel prep.
• this solution is safe for patients with fluid restrictions because it does not absorb the fluid in the system.

Now, please make sure that your patient has a FUNCTIONING I.V access (branula) before you send them to the scope room.

*FLEET can't be used for renal impairment or cardiac failure patient because the sodium will cause fluid overload.

Fever: Taking temperature in a child

Frequently asked questions about fever in children

What is a fever?

The definition of fever depends upon the site where it is measured:

Rectal temperature above 100.4°F (38°C)

Oral temperature above 100°F (37.8°C)

Axillary (armpit) temperature above 99°F (37.2°C)

Ear temperature above 100.4°F (38°C) in rectal mode or 99.5°F (37.5°C) in oral mode

Forehead temperature above 100.4°F (38°C)

How do I measure my child's temperature?

The best method to measure temperature depends upon several factors. In all cases, rectal temperatures are the most accurate. However, measurements of temperature in the mouth (for children older than 4 or 5 years) is accurate when done properly. Temperatures measured in the armpit, in the ear, and on the forehead are least accurate, but may be useful as a first test.

Glass thermometers are not recommended due to the potential risks of exposure to mercury, which is toxic. If another (digital) thermometer is not available, be sure to carefully "shake down" the glass thermometer before use. Instructions for disposing of glass thermometers are available online (www.epa.gov/mercury/spills/index.htm).

Measuring a rectal temperature

The child or infant should lie down on his or her stomach across an adult's lap.

Apply a small amount of petroleum jelly (sample brand name: Vaseline®) to the end of the thermometer.

Gently insert the thermometer into the child's anus. The silver tip of the thermometer should be 1/4 to 1/2 inch inside the rectum.

Hold the thermometer in place. A glass thermometer requires 2 minutes, while most digital thermometers need less than 1 minute.

Measuring an oral temperature

Clean the thermometer with cool water and soap. Rinse with water.

Do not measure the temperature in a child's mouth if he or she has consumed a hot or cold food or drink in the last 30 minutes.

Place the tip of the thermometer under the child's tongue toward the back. Ask the child to hold the thermometer with his or her lips.

Keep the lips sealed around the thermometer. A glass thermometer requires about 3 minutes, while most digital thermometers need less than 1 minute.

Measuring an armpit temperature

Place the tip of the thermometer in the child's dry armpit.

Hold the thermometer in place by holding the child's elbow against the chest for 4 to 5 minutes.

Measuring an ear temperature

To measure temperature in the ear, the parent must pull the child's outer ear backward before inserting the thermometer.

The ear probe is held in the child's ear for about 2 seconds.

If the child has been outside on a cold day, wait 15 minutes before measuring the ear temperature.

Ear tubes and ear infections do NOT affect the accuracy of an ear temperature.