Name: GINA D.

ALBALADEJO BSN CONFIDENCE

DIAGNOSTIC EXAMS >Digital Rectal Exam >Stool Guaiac >Sigmoidoscopy >Anoscopy >Virtual Colonoscopy

GRADING
1 degree-hemorrhoids w/c bleed but don’t prolapsed 2nd degree-hemorrhoids w/c retract on their own (w/out bleeding) 3rd degree-hemorrhoids w/c prolapsed but must be pushed back in a finger 4th degree- hemorrhoids w/c prolapsed and can’t be pushed back in
st

2 TYPES 1. External Hemorrhoids-swell outside anus/at anal opening and may hang outside anus 2. Internal-swell veins inside anal canal/rectum

SIGNS & SYMPTOMS >anal itching, irritation, pain >bright red blood on toilet tissue/stool/toilet bowl >grapelike lump on anus >painful defecation (external hemorr.) >painless bleeding w/ defecation (internal hemorr.) >constipation

RISK FACTORS
Precipitating Fx: >Age: 20-50 y/o >Gender: Female >Family History >Pregnancy Predisposing Fx: >Obesity >Sedentary Lifestyle >Constipation >Chronic Diarrhea >Poor Bathroom Habits >Postponing BM >Low Fiber Diet >Diseases:  Cirrhosis of liver  Portal Hypertension  Heart Failure >Prolonged sitting/standing >Straining during defecation

HEMORRHOIDS Swollen or inflamed veins in or around anus.

ETIOLOGY Increased intra-abdominal pressure resulting in enlargement of hemorrhoids

NURSING DIAGNOSIS
>Acute pain r/t pressure on defecation >Risk for constipation r/t fear of pain on defecation >Risk for ineffective therapeutic regimen mng’t r/t insufficient knowledge of condition, bowel routine, diet instructions, exercise program and perianal care

NURSING MNG’T
>Increase fluids intake and fiber in diet >Avoid postponing defecation. >Avoid straining during defecation. >Exercise regularly. >Use moist wipes and avoid aggressive wiping. >Wear cotton undergarments. Avoid prolonged standing, sitting/heavy lifting.

MEDICAL MNG’T
>Administer stool softener (docusate sodium) or psyllium preparation (Metamucil) >Warm sitz bath 3-4x a day >Administer topical anesthetic or steroids e.g. lidocaine (Xylocaine), steroid cream

SURGICAL MNG’T
>Hemorrhoidectomy  Stapled/Open/Closed >Rubber Band Ligation >Anal Dilation

COMPLICATIONS
>Bleeding >Thrombosis >Hemorrhoidal Strangulation >Anemia

PREVENTION
>Increase fiber on diet