LESSON PLAN ON

HEMORRHOIDS

SUBMITTED TO :- MR.JITHIN THOMAS PAREL (LECTURER)

SUBMITTED BY : MS. HIMANI SANGWAN (M.sc NURSING 1 YEAR)

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LESSON PLAN ON HEMORRHOIDS:
NAME OF STUDENT :- Himani Sangwan
SUBJECT :- Nursing Education
TOPIC :- Hemorrhoids
DATE AND TIME OF TEACHING :- 16 September 2023
DURATION :- 10 min
GROUP OF STUDENTS:- M.sc nursing 1st year
SIZE OF GROUP:- 10 students
VENUE:- M.sc nursing 1st year classroom , ILBS
METHOD OF TEACHING :- Lecture cum Discussion
AV AIDS:- Power point presentation , charts, ladder
PREVIOUS KNOWLEDGE:- The students have some previous knowledge regarding hemorrhoids as they have studied this topic in their B.sc Nursing
course.

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GENERAL OBJECTIVES :-
At the end of the microteaching class, the students will be able to gain knowledge regarding the topic hemorrhoids and will be able to apply this
knowledge in clinical setting.

SPECIFIC OBJECTIVES:-
 At the end of the class, the students will be able to :
 Define the topic hemorrhoids
 Enlist the types of hemorrhoids
 Explain the pathophysiology of hemorrhoids
 Describe the clinical manifestation of hemorrhoids
 Explain the medical management of hemorrhoids
 Describe the nursing management of hemorrhoids

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 Objective learning aids n
activity
1. 30 Introduce the Introduction Lecture
sec topic to the class Hemorrhoids are a common disorder , affecting both men and women of cum
any age, but the incidence is higher in people between 45 and 65 years of discussion
age. About 80% of people in India develop hemorrhoids. They affect
millions of people around the world, and represent a major medical and
socioeconomic problem

2. 30 Define Definition Lecture What do

sec hemorrhoids Hemorrhoids are a very common anorectal condition defined as the cum you mean
symptomatic enlargement and distal displacement of the normal anal discussion by
cushions. (They are painful , swollen veins in the lower portion of the hemorrhoid
rectum or anus ).They can develop inside the rectum or under the skin s?
around the anus . Hemorrhoids are also called as piles .
3. 30 Enlist Etiology Etiology and risk factors Lecture Pow What are
sec and risk factors Hemorrhoids can occur due to : cum er risk factors
 Constipation discussion poin of
 Straining during bowel movements s t hemorrhoid
 Pregnancy pres s?
 Certain diseases such as liver cirrhosis , heart failure enta
 Obesity tion
 Anal infections
 Sitting or standing for long periods of time
 Weakening of the connective tissue that supports the
hemorrhoidal veins
 Any condition that increases intra - abdominal pressure or
hemorrhoidal venous pressure(tenesmus)
 Loss of rectal muscle tone (aging)
 Rectal surgery
 Internal sphincter abnormalities

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S Time Specific Content Teaching A V Evaluation
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4. 30 sec Discuss the Etiopathogenesis :- Lecture Ladder What is
etiopathogenesis Straining and constipation cum etiopathogenesis?
Low fibre diet discussion
↓
Less bulky stools
↓
Straining at defecation
↓
Increased intra anal pressure
↓
Decreased venous return
↓
Enlarged hemorrhoidal venous cushions

5. 1.5min Explain types of Types of hemorrhoids :- Lecture Power What are

hemorrhoids Internal hemorrhoids :- They are varicosities of the superior cum point types of
hemorrhoidal plexus occurring above the mucocutaneous border discussion Prese hemorrhoids?
(dentate line) , they are covered by columnar epithelium of anal ntatio
canal. Occur inside the anus at the beginning of the rectum. They n
are classified on the basis of appearance and degree of prolapse .
Goligher’s Classification :-
 Grade 1:- The anal cushions have painless bleeding, no
prolapse .
 Grade 2: - The anal cushions prolapse on defecation that
reduces spontaneously
 Grade 3:- The anal cushions prolapse through anus on
straining or exertion and require manual replacement into
anal canal .
 Grade 4:- Permanent prolapse of anal cushions occurs.
External hemorrhoids :- They occur at the anal opening, lie below
dentate line and covered by squamous epithelium.
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6. 1 min Describe clinical Clinical manifestation :- Lecture Black What are clinical
manifestation Internal hemorrhoids are characterized by:- cum board manifestations of
 Painless bleeding during bowel movements (Blood is bright discussion hemorrhoids?
red and may be seen in stool or on toilet tissue)
 Prolapse(protrusion outside anus) can occur
 Anal pruritis
 Rectal itching and constipation
 Pain may be present if there is associated thrombosis
External hemorrhoids are characterized by enlarged mass at the
anus. They are reddish blue and seldom bleed. There is pain,
itching , burning and edema . Thrombosed hemorrhoids are a
bluish purple tinge and palpable at anal orifice .
7. 30 sec Describe Diagnostic tests :- Lecture Present What are the
diagnostic tests External hemorrhoids are diagnosed by :- cum - various diagnostic
Visual inspection (prolapsed hemorrhoids can be seen) discussion ation tests done in
Digital examination hemorrhoids?
Internal hemorrhoids are diagnosed by history, digital
examination, anoscopy, proctoscopy (note number, degree, size,
surface and appearance of hemorrhoids as well as features of
chronicity of prolapse), sigmoidoscopy (malignancy) and complete
blood count test ( hematocrit and platelet count).
8. 30 sec Enlist the Complications of hemorrhoids:- Lecture What are
complications of  Bleeding :- Blood oozes or may even spurt out following a cum complications of
hemorrhoids bowel movement. discussion hemorrhoids ?
 Thrombosis :- It can occur at any time within the
hemorrhoids.
 Extreme edema and inflammation .
 Occult bleeding resulting in anemia.

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9. 1.5 Discuss the Medical management Lecture M What is
min medical It is divided in three:- cum O medical
management 1.Conservative 2. Non surgical 3. Surgical discussion management
D
of Conservative :- It is used in case of grade 1 internal and non thrombosed of
hemorrhoids? external hemorrhoids. E hemorrhoids
 Dietry changes to treat constipation include high fibers diet and oral L
fluid intake .
 Constipation unrelieved by diet may require use of a stool softener
(docusate sodium) or a hydrophilic psyllium preparation (Metamucil).
 For pain , an initial application of cold packs, followed by warm sitz
baths for 15 min ,three or four times a day.
 A topical anesthetic or steroid preparation , such as lidocaine
( xylocaine) or steroid cream , also reduces pain and itching .
Non – surgical approaches:- It is used for internal hemorrhoids
 Rubber band ligation :- It is most widely used technique. The surgeon
inserts an anoscope to identify the hemorrhoid and then ligates it with
rubber band around the hemorrhoid constricts circulation and the
tissue becomes necrotic, separates and sloughs off .
 Infrared coagulation - The infrared coagulator produces infrared
radiation which coagulates tissue and evaporizes water in the cell,
causing shrinkage of the hemorrhoid mass.
 Sclerotherapy - With the help of the proctoscope, a liquid containing drugs
such as quinine, polidocanol or zinc chloride is injected into the area around
the enlarged hemorrhoids. This procedure is done to shrink the hemorrhoids
by damaging blood vessels and reducing the blood supply to the
hemorrhoids.
 Laser treatment
Surgical approach :- Surgery is indicated when there is marked prolapse,
excessive pain or bleeding, or large or multiple thrombosed hemorrhoids.

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  Hemorrhoidectomy :- Surgical removal is done by cautery, clamp, or
excision. After removing the hemorrhoids, the tissue is either sutured
and the wound heals by primary intention or the area is left open and
the wound heals by primary intention or the area is left open and
healing takes place by secondary intention. Complications include
infection, stricture formation and hemorrhage.

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10. 1 min Discuss the Nursing management :- Lecture Power What is
nursing The first step is nursing assessment where physical, psychosocial, cum Point nursing
management emotional and diagnostic data is collected. discussion Present management?
Nursing diagnosis :- ation
1. Constipation related to ignorance of urge to defecate due to pain
during defecation.
Interventions:-
 To advice patient to take high fiber diet .
 To encourage patient to increase fluid intake.
 To advice patient to do physical exercise .
 To administer laxatives as adviced .
2. Pain related to rectal swelling .
Interventions:-
 To administer analgesics .
 To provide warm sitz baths to reduce local pain and swelling.
3. Risk for infection related to inadequate primary defenses.
 To check sign and symptoms of anal infection such as increase pain
and foul smelling anal drainage.
 To emphasize the need for good anal hygiene .
 To encourage the use of toilet paper without dyes and perfumes.

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SUMMARY :-
Today we learnt about hemorrhoids, causes and risk factors of hemorrhoids, types of hemorrhoids and sign and symptoms of hemorrhoids. We
also discussed about diagnostic tests and complication of hemorrhoids. Medical and surgical treatment of hemorrhoids was also discussed. We
also learnt about various nursing interventions which can be applied for patient suffering with hemorrhoids.

Conclusion :-
Hemorrhoids are swollen and inflamed veins in the rectum and anus that cause discomfort and bleeding. High fiber diet and increase fluid intake
can help to reduce the constipation, thus decreasing the chances of occurrence of hemorrhoids.

Bibliography :-
1. Mariann M. Harding, Lewis’s Medical – surgical Nursing Assessment and Management of Clinical Problems , Fourth South Asian edition ,
Volume -2 , Page no – 987-988.ssss
2. Black, j m. Black’s Medical – Surgical Nursing Clinical Management for Positive Outcomes , First South Asian edition , Volume – 1,
Page no – 720-722.