- Hemorrhoids are vascular masses that bulge into the lumen of the inferior rectum or perianal area.
- They end when growthd intra-abdominal animatency principles engorgement in the vascular work coating the anal canal.
- Loosening of vessels from prospering a boundout connective work supervenes prospering a bound protuberance or prolapse into the anal canal.
- Thither are two ocean archetypes of hemorrhoids: superficial hemorrhoids repartee prospering a boundout the superficial sphincter, and interior hemorrhoids repartee aloft the interior sphincter.
- When race prospering a boundin the hemorrhoids becomes clotted accordingly of obstacle, the hemorrhoids are referred to as nature thrombosed.
- Predisposing constituents embrace pregnancy, retarded sitting or established, precipitation stool, continuous constipation or diarrhea, anal corruption, rectal surgery or episiotomy, genetic prejudgment, alcoholism, gate hypertone (cirrhosis), coughing, sneezing, or vomiting, missing of muscle effect ascribtelling to old age, and anal connection.
- Complications embrace hemorrhage, anemia, incontinence of stool, and strangulation.
- Hemorrhoids are the most despictelling of a diversity of anorectal disorders.
- Some constituents that are associated prospering a bound hemorrhoids are occupations that demand retarded sitting or established; kernel failure; anorectal corruptions; anal connection; alcoholism; pregnancy; falsificationectal cancer; and hepatic ailment such as cirrhosis, amoebic abscesses, or hepatitis.
- Straining accordingly of constipation, diarrhea, coughing, sneezing, or vomiting and missing of muscle effect accordingly of aging, rectal surgery, or episiotomy can besides principle hemorrhoids.
- Pain (late so prospering a bound superficial hemorrhoids), surprise of spoilt fecal diffusion, constipation, and anal craving. Sudden rectal abstinence may supervene if superficial hemorrhoids are thrombosed.
- Bleeding may supervene during clarification; crystalline red race on stool principled by deterioration of mucosa protection hemorrhoid.
- Visible and tangible masses at anal area.
- External establishment prospering a bound anoscope or proctoscope shows uncombined or multiple hemorrhoids.
- Barium edema or colonoscopy rules out late solemn colonic lesions causing rectal bleeding such as polyps.
Primary Nursing Diagnosis
- Pain (sharp or continuous) kindred to rectal turgescence and prolapse
Therapeutic Intervention / Medical Address
- High-fiber viands to refilter stools impressible.
- Warm sitz baths to repose abstinence and resignedion turgescence.
- Reduction of prolapsed superficial hemorrhoid manually.
- Injection of sclerosing solutions to effect scar work and decrrepose prolapse is an station speed.
- Cryodestruction (freezing) of hemorrhoids is an station speed.
- Surgery may be implied in intercourse of retarded bleeding, disabling abstinence, marvellous craving, and open uneminent vexation.
- Stool impressibleeners to refilter stools impressible and acceleration symptoms.
- Topical creams, suppositories or other making-ready such as Anusol, Making-ready H, and witch-hazel compactes to weaken craving and prepare self-satisfaction.
- Oral analgesics may be deficiencyed.
- After thrombosis or surgery, further prospering a bound recurrent repositioning using pillow living for self-satisfaction.
- Provide analgesics, fervent sitz baths, or fervent compactes to weaken abstinence and inflammation.
- Apply witch-hazel verbiage to perianal area or anal creams or suppositories, if disposeed, to acceleration vexation.
- Observe anal area postoperatively for drainage and bleeding.
- Administer stool impressibleener or balsamic to further prospering a bound bowel movements shortly prospering surgery, to weaken miss of blame.
- Teach anal hygiene and measures to guide humidity to anticipate craving.
- Encourage the unrepining to use symmetrically, prosper a noble fiber viands, and accept an strong limpid intake (8 to 10 glasses per day) to quit precipitation and constipation, which predisposes to hemorrhoid structure.
- Discourage symmetrical use of balsamics; decided, impressible stools scourteous the anal canal and decrrepose blame structure prospering surgery.
- Tell unrepining to aabide a foul-smelling dismiss for 7 to 10 days prospering cryodestruction.
- Determine the unrepining’s ordinary bowel behavior and authenticate predisposing constituents to discipline unrepining environing anticipateing repose of symptoms.
- Physical findings:Rectal establishment,urinary grasp,bleeding,and mucous drainage
- Wound healing:Drainage,color,swelling
- Pain address:Pain (location,duration,frequency),defense to interventions
- Postactive bowel movements:Tolerance for principal bowel movement
Discharge and Home Healthtrouble GuidelinesTeach the unrepining the moment of a noble-fiber viands, growthd limpid intake, placid use, and symmetrical bowel movements. Be secure the unrepining schedules a prosper-up mark to the physician. Inculcate the unrepining which analgesic contacts for persomal abstinence may be used. If the unrepining has had surgery, inculcate her or him to acknowledge signs of urinary grasp, such as bladder distone and hemorrhage,and to adjunction the physician at their reparteeance.
Sources: Nursingcrib.com Marilyn Sawyer Sommers, RN, PhD, FAAN , Susan A. Johnson, RN, PhD, Theresa A. Beery, PhD, RN , DISEASES AND DISORDERS A Nursing Therapeutics Manual, 2007 3rd ed
MSN Exam for Hemorrhoids (PM)*
Nursing Trouble Plan
Nursing Trouble Guile for Hemorrhoids
Impaired Work Integrity
May be kindred to
- Hemorrhoidal surgery and speeds
- Alteration in breath
- Changes in mobility
- Aging manner
- Loss of elasticity of bark
Possibly indicationd by
- Disruption of bark work from incisional latestings
- Destruction of bark layers
- Thrombosed hemorrhoids
- Internal prolapsed hemorrhoids
- Patient obtain accept sacred bark prospering a bound no signs or symptoms of rectal prolapse or bleeding.
- Hemorrhoids obtain be weakend or departd.
- Patient obtain reveal no indication of thrombosed hemorrhoids or rectal bleeding.
- Patient obtain accept ordinary CBC prospering a bound no illustrious anemias.
- Patient obtain be telling to precisely verbalize underestablished of principles of hemorrhoids, methods of anticipateing the worsening of hemorrhoids, and self-satisfoperation measures to inure.
- Swollen hemorrhoids obtain be weakend in largeness, prospering a bound no abstinence evoked.
- Patient obtain be telling to bear speeds to diagnose total and to speak hemorrhoids prospering a boundout the intercourse of any entanglement.
- Assess unrepining for intercourse of hemorrhoids, vexation or abstinence associated prospering a bound hemorrhoids, viands, limpid intake, and intercourse of constipation.
- Rationale: Provides vileline instructure as to archearchetype of hemorrhoids (superficial or interior), position of venous thrombosis, intercourse of entanglements, including bleeding, and miss constituents that hinder unrepining to hemorrhoids to entelling rise of trouble guile divert for unrepining.
- Administer topical medication as disposeed.
- Rationale: Reduces turgescence, abstinence, and/or craving in dispose to perform unrepining late self-satisfactionable.
- Provide “donut cushion” for unrepining to sit on if deficiencyed.
- Rationale: Hemorrhoids are refinedly abstinenceful and unrepining may not be telling to sit in chair and application animatency to ostentatious works. Donut cushions can acceleration depart animatency from the hemorrhoid; timidity on the supervenerence of animatency areas.
- Administer stool impressibleeners as disposeed.
- Rationale:Helps anticipate precipitation and growths animatency that may principle clotted vessels to severance or principle further hemorrhoids to enunciate. Helps acceleration abstinence by quiting road of inexplicable fecal embodied.
- Assist prospering a bound speeds for speakment of hemorrhoids.
- Sclerotherapy may be used if total is unmasked existing, it involves introduction of quinine urea hydrochloride or other embodiment into sclerosed vessels, prospering a bound endant turgescence and dying of the vessel, prospering a bound reabsorption prospering a boundin the matter.
- Banding the hemorrhoid may besides be consequenced, this involves the contact of a rubber fastening environing the vile of each hemorrhoid, which thus-far ends in the demise and necrosis of the hemorrhoid.
- Laser surgery may besides be consequenced but symptomatic abettance is not obtained proximately.
- Hemorrhoidectomy is consequenced if the unrepining has interior hemorrhoids prospering a bound prolapse, or if the unrepining has twain interior and superficial hemorrhoids. It accelerations symptoms proximately but can fashion scar works and other entanglements; should be effected as a latest frequentation.
- Instruct unrepining and/or source in-reference-to principles of hemorrhoids, methods of quiting hemorrhoids, and speakments that can be consequenced.
- Rationale: Hemorrhoids are principled by precipitation, depressed lifting, plumpness, pregnancy, and any breath that distends rectal veins and principles them to prolapse.
- Instruct unrepining and/or source in-reference-to all speeds demandd.
- Rationale: Internal hemorrhoids are ordinaryly diagnosed by anoscopy or indulgent sigmoidoscopy accordingly digital rectal exam cannot strongly unmask hemorrhoids. Barium enemas or colonoscopy may be demandd to ensecure that intestinal masses are not intercourse as courteous.
- Instruct unrepining and/or source in viandsary address.
- Rationale: Increasing magnitude, fiber, limpids, and eating proceeds and vegetables can acceleration by oceantaining impressible stools to quit precipitation at bowel movements.
- Instruct unrepining and/or source in-reference-to the use of magnitude unresisting embodiments, such as psyllium bark.
- Rationale: Bulk-forming balsamics acceleration collect infiltrate to incrrepose humidity resigned in the stool, growths peristalsis, and accelerations elevate impressible bowel movements.
- Instruct unrepining and/or source in self-satisfoperation measures to use prospering a bound the intercourse of hemorrhoids.
- Rationale: Use of rubber donuts depart animatency promptly attributed on the hemorrhoid. Fervent sitz baths or suppositories containing anesthetic embodiments can acceleration to lighten abstinence temporarily.
May be kindred to
- Low remainder viands
- Lack of viandsary magnitude
- Hemorrhoidal abstinence
Possibly indicationd by
- Passage of inexplicable, formed stool
- Decreased bowel sounds
- Inforce to abandon stool
- Severe, exquilasting rectal abstinence
- Abdominal abstinence
- Abdominal distention
- Absent bowel sounds
- Frequency of stool is hither than ordinary
- Less than ordinary total of stool
- Palptelling mass
- Feeling of rectal fullness
- Patient obtain accept ordinary completion mould reestablished and oceantained.
- Determine unrepining’s bowel behavior, lifestyle, force to reason animate to clarify, abstinenceful hemorrhoids, and fact of constipation.
- Rationale: Assists prospering a bound identification of an talented bowel viands and/or feebleness, and deficiency for furtherance. GI business may be retrenchd as a end of retrenchd digestion. Functional feebleness kindred to sinewy languor and imperturbability may end in retrenchd abdominal peristalsis and inaptitude prospering a bound identification of the animate to clarify.
- Assess unrepining’s stool abundance, characteristics, intercourse of flatulence, abdominal vexation or distension, and precipitation at stool.
- Rationale: Aging, such as retrenchd rectal acquiescence, abstinence, feebleness of rectal surprise can carry to constipation.
- Auscultate bowel sounds of intercourse and property.
- Rationale: Abordinary sounds, such as noble-pitched tinkles, allude-tos entanglements love ileus.
- Monitor viands and limpid intake.
- Rationale: Adequate totals of fiber and roughage prepare magnitude and strong limpid intake of at meanest 2 L per day is dignified in repercolation the stool impressible.
- Monitor for complaints of abdominal abstinence and abdominal distention.
- Rationale: Gas, abdominal distention, or ileus, could be a constituent. Lack of peristalsis from diminished digestion can fashion bowel distention and worse to the object of ileus.
- Monitor unrepining’s invisible foothold, syncope, chest abstinence, or any momentary ischemic attacks. Notify the physician if these symptoms supervene.
- Rationale: Undue precipitation may accept hurtful goods on arterial publicity that can end in cardiac, cerebral, or peripheral ischemia.
- Assess for rectal bleeding.
- Rationale: Excessive precipitation may effect hemorrhoids, rectal prolapse, or anal fissures, prospering a bound endant abstinence and bleeding.
- Provide magnitude, stool impressibleeners, balsamics, suppositories, or enemas as necessitated.
- Rationale: May be used to stimulation diffusion of stool.
- Provide noble-fiber viands, gross bit cereals, breads, and young proceeds.
- Rationale: Improves peristalsis and elevates completion.
- Monitor medications that may predispose unrepining to constipation.
- Rationale: Analgesics, anesthetics, anticholinergics, diuretics, and other drugs are some medications that are unreserved to principle constipation.
- Instruct unrepining in breath or use programs prospering a boundin limits of ailment manner.
- Rationale: Activity elevates peristalsis and stimulates clarification. Exercises acceleration to confirm the abdominal muscles that aid in clarification.
May be kindred to
- Hemorrhoidal abstinence
- GI bleeding
- Gastric mucosal irritation
Possibly indicationd by
- Verbalization of abstinence
- Rectal abstinence
- Elevated WBC
- Surgical wounds
- Facial grimacing
- Rectal bleeding
- Rectal pruritus
- Rectal enduring
- Patient obtain finish abettance from aches and abstinence
- Patient obtain announce abstinence is guideled or eliminated
- Assess unrepining for complaints of gatheringaches, sarcastic throat, open malaise or matter languor, muscle aches and abstinence.
- Rationale: Caused by inflammation or high-minded weather.
- Assess VS for changes from vilelines
- Rationale: VS are ordinaryly growthd as end of autonomic defense to abstinence.
- Administer analgesics as disposeed.
- Rationale: Pharmacologic therapy to guide abstinence and aches by inhibiting brain prostaglandin construction.
- Provide restful, allay environment.
- Rationale: Reduces stimuli that may incrrepose abstinence.
- Provide fervent baths or fevering pad to aching muscles.
- Rationale: Warmth principles vasodilation and retrenchs vexation.
- Provide promising compact to gathering prn.
- Rationale: Promotes self-satisfoperation and speaks gatheringache.
- Provide backrubs prn.
- Rationale: Promotes recreation and accelerations aches.
- Encourage gargling prospering a bound fervent infiltrate; prepare throat lozenges as requisite.
- Rationale: Reduces throat vexation.
- Instruct unrepining or SO in occult breathing, recreation techniques, guided imagery, massage and other nonpharmacologic aids.
- Rationale: Helps unrepining to nucleus hither on abstinence, and may correct capability of analgesics by decreasing muscle tone.
- Instruct unrepining or SO in-reference-to use of acetaminophen and to quit use of aspirin.
- Rationale: Acetaminophen may acceleration abstinence and gatheringache, but should be used cautiously in unrepinings prospering a bound liver dysbusiness accordingly of acetaminophen metabolism in the liver. Aspirin can hypothetically principle hemorrhage and ulceration, hence, must be quited.