Procedure HEMORRHOIDECTOMY

According to Black and Hawks (2009), hemorrhoidectomy is a procedure wherein the vein is excised, and the area is either left open to heal by granulation or is closed with sutures. The open method is very painful but has a high rate of success. The suture method, although far less painful, is more likely to cause infection and result in poor healing. (p.722).

Preoperative
Explain procedure and secure informed consent for legality. Stop any anticoagulant medication like aspirin &NSAIDS 1 or 2 weeks before procedure to prevent severe bleeding. Check baseline vital signs, weight, urine test, and bleeding profile to determine abnormalities. Those patients over the age of 45 will likely have to receive a colonoscopy or x-ray of their colon. This is to make sure that the bleeding of patient may be experiencing is not due to some other factor. Ensure that the patient NPO 6-8 hrs before procedure to prevent aspiration. Assess the pre operative educations received by the patient and ensure that it is complete and understood for effective postoperative recovery. Two enemas will be needed prior to the surgery to cleanse the lower intestinal tract. Laxatives and antibiotics, however, will not likely be administered prior to the operation. Prepare patient physically, must have full bath to improve circulation prior and prevent complications. Complete the pre operative check list by asking the patient and checking records and notes before giving any pre medication as done routinely. Check whether the patient has urinated before pre medication to prevent bladder distention and injury due to premeds effect. Carry out pre -op medication as ordered by the surgeon.

Intraoperative
SCRUB NURSE: Set up sterile supplies and instruments. Assists the surgeons as needed throughout the surgery. Assists in gowning and gloving the surgical team. Assists in draping the patient and the fields. Hands instruments and, sutures, sponges etc. as needed in an efficient manner. Keeps operative tidy during the case. Wipes blood from instruments. Keeps close watch on needles, instruments, and sponges so that none will be misplaced or lost during the surgery. Keeps an accurate account of needles and instruments. Supplies sterile dressing materials. Discards soiled linen into hamper after checking it for any instruments. Cares for all instruments and supplies. CIRCULATING NURSE: Functions as the overseer of the room during the procedure to maintain sterility. Assists the entire team and the patient. Sends for the patient at appropriate time. Receives, greets and identifies the patient. Checks chart for completeness. Assists patient in moving safely to operating room table. Assist anesthesiologist when requested stays with the patient during induction. Ties scrubbed members’ gown. Checks operating room lights in advance for good working order turns lights on at appropriate time and adjust when needed. Prepares operative site: shave the perineum, skin preparation at perianal area & clean with antiseptic detergent. Connects catheter to drainage bottle, or catheterize if desired by the surgeon. Does the sponge count with the scrub nurse. Assist patient in lithotomy or prone position for anal exposure. Supplies foot stools if needed by the surgeon team. Watches forehead for perspirations. Fills out required operative records completely and legible. Remains in the room as much as possible to be constantly available. Watches progress of surgery, anticipates needs, reacts quickly to emergency. Uses equipment and supplies economically and conservatively. Gathers supplies for case and opens sterile supplies for the scrub nurse. Connects/ reminds those who breaks any technique. Directs cleaning of the room and preparations for the next operation.

Post Operative
During the first hour following surgery, patients lie flat on their back to decrease the risk for an anesthesia-induced headache, which can be painful and prolonged. Administer analgesic to reduce post operative pain. An ice pack can help reduce swelling. Encourage 15 minute warm sitz baths three or four times per day to help ease the discomfort. Use a donut ring (cushion with a hole in the middle) to make sitting upright more comfortable. Monitor for prolonged rectal bleeding and urinary retention. To prevent hemorrhage and establish catheterization. Avoided heavy lifting for 2 to 3weeks to facilitate wound healing. As soon as the patient can resume oral feelings; administer a bulk medication, such as psyllium, about 1 hour after the evening meal, to ensure a daily stool. Warn against using stool-softening medications soon after hemorrhoidectomy because a firm stool acts as a natural dilator to prevent stricture from the scar tissue. Keep the wound site clean to prevent infection and irritation. Warn against too-vigorous wiping with washcloths and using harsh soaps. Encourage the use of medicated astringent pads and white toilet paper (the fixative in colored paper can irritate the skin). Eat fiber-containing foods and drink ample fluids to prevent straining. Remind the client not to sit on the toilet longer than necessary. This position impairs blood flow and puts added pressure on anal vessels. Regular ambulation, prevent standing or sitting for prolonged period of time. This increases anal perfusion and prevent undue tension on anal site.

Indication •Hemorrhoids with
persistent itching, anal bleeding, pain, and blood clots (thrombosis) not relieved by non-surgical treatment (fiber rich diet, laxatives, stool softener, suppositories, medications, warm baths) •Very large internal hemorrhoids • Internal hemorrhoids that still cause symptoms after nonsurgical treatment •Large external hemorrhoids that cause significant discomfort and make it difficult to keep the anal area clean •Both internal and external hemorrhoids •Patients who have had other treatments for hemorrhoids (such as rubber band ligation) that have failed • Patients with severe bleeding, intolerable pain and pruritus, and large prolapsed hemorrhoids. Contraindication •Blood dyscrasias ( acute Leukemia) •Aplastic anemia or hemophilia •GI carcinoma •During the first trimester of pregnancy

Submitted by: GINA D. ALBALADEJO BSN IV

Sign up to vote on this title
UsefulNot useful