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Nursing 172 > Week 12: Chp 58: Hemorrhoids > Flashcards

Week 12: Chp 58: Hemorrhoids Flashcards

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1
Q

What is a hemorrhoid?

A

swollen or dilated veins in the anorectal area

-they are varicose veins of the rectum

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2
Q

What are hemorrhoids caused by?

A

caused or precipitated by straining during defecation, prolonged constipation, heavy lifting, prolonged standing and sitting, portal hypertension (as in cirrhosis), increased intra-abdominal pressure, pregnancy, obesity, and heart failure
-most frequently reported by women

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3
Q

Internal Hemorrhoid

A

lying above the dentate line

-cannot be seen on visual inspection

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4
Q

External Hemorrhoid

A

lying below the dentate line

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5
Q

What can happen to a hemorrhoid?

A

can become prolapsed or protrude through the anal canal

-may become thrombosed or clotted

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6
Q

Strangulated hemorrhoid

A

is trapped by the anal sphincter, compromising blood flow to the vein in the hemorrhoid

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7
Q

Grading System for Internal Hemorrhoids

A

used according to severity of prolapse and serves as a guide for treatment

  • Grade I: the hemorrhoids do not prolapse
  • Grade II: the hemorrhoids prolapse on defecation but reduce spontaneously
  • Grade III: the hemorrhoids prolapse on defecation and must be reduced manually
  • Grade IV: the hemorrhoids are prolapsed and cannot be reduced manually
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8
Q

Clinical Manifestations of Internal hemorrhoids

A

bleeding is almost always painless and is observed as bleeding during bowel movement

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9
Q

Clinical Manifestations of External Hemorrhoids

A

itching, irritation, and pain of the rectal area

  • pain and pruritus of the rectal area
  • bleeding may occur and is usually seen on toilet paper but may also be streaked in the stool
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10
Q

How are external hemorrhoids diagnosed?

A

visual inspection

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11
Q

How are internal hemorrhoids diagnosed?

A

digital examination, anoscopy (procedure involving a small, tubular instrument inserted into the anal canal for inspection), and sigmoidoscopy

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12
Q

Treatment of hemorrhoids

A

usually conservative and involves relief of symptoms and associated pain
-cold packs and sitz baths (warm water baths covering the hips and buttocks) three or four times a day to reduce some swelling and decrease pain

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13
Q

What happens if conservative therapy does not alleviate symptoms within 3 to 5 days?

A

patient needs to be referred to a primary care provider

  • patient is encouraged to consume adequate fluid and fiber intake to decrease constipation associated with hemorrhoids
  • stool softeners also recommended
  • topical nitroglycerin (0.4%) may be used to decrease pain caused by thrombosed hemorrhoids as well as topical nifedipine
  • over-the-counter preparations available in creams and suppositories
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14
Q

Medications used for Treatment of Hemorrhoids

A
  • Local Anesthetics
  • Protectants/ Emollients
  • Astringents
  • Corticosteroids
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15
Q

Local Anesthetics

A

provide temporary relief from burning, itching, and pain

-Benzocaine, dibucaine, lidocaine

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16
Q

Protectants/ Emollients

A

form physical barrier on the skin to prevent irritation of the perianal region
-cocoa butter, lanolin, white petroleum, zinc oxide, mineral oil, cod liver oil, or shark liver oil

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17
Q

Astringents

A

promote skin dryness, which helps relieve itching, irritation, and inflammation
-calamine, zinc oxide, witch hazel

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18
Q

Corticosteroids

A

reduce inflammation

-hydrocortisone

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19
Q

Surgical Management

A

not required unless the hemorrhoid is thrombosed
-patients with grade III or IV may require definitive treatment with surgery
>rubber-band ligation
>bipolar, infrared, and laser coagulation
>sclerotherapy
>cryosurgery
>hemorrhoidectomy

20
Q

Rubber-band Ligation

A

most widely used technique

  • hemorrhoid is identified using an anoscope
  • a rubber band is placed around the base of the hemorrhoid, which constricts circulation, causing the hemorrhoid to slough off in 2 to 4 days
21
Q

Bipolar, infrared, and laser coagulation

A

uses bipolar current or infrared or laser light, which causes coagulation and necrosis of the hemorrhoid, leaving fibrosis in the submucosal layer

22
Q

Sclerotherapy

A

involves injecting a sclerosing agent (an agent that causes formation of scar tissue) directly into the hemorrhoid, which causes an inflammatory reaction leading to the vessel drying up and disintegrating

23
Q

Cryosurgery

A

used liquid nitrogen to freeze the hemorrhoid

-procedure usually associated with intense pain and is not first method of choice

24
Q

Hemorrhoidectomy

A

excision of the vein

  • the area may be left open to heal by secondary intention, or may be closed with sutures
  • closing the area with sutures is less painful for the patient but has a higher risk of infection
25
Q

Complications following surgery for hemorrhoids

A

infection, pain, urinary retention, fecal impaction, damage to the sphincter, bleeding, and abscess formation, which involves a localized collection of pus

26
Q

Complications: Fecal impaction and why does it occur?

A

as a result of inadequate pain management, with the person being afraid to have a bowel movement or as a result of opiate usage

27
Q

Complications: urinary retention

A

occurs because of rectal spasms and pain

28
Q

Nursing Management: Assessment and Analysis

A

clinical manifestations of hemorrhoids include rectal pain, and itching that may be accompanied by bleeding
-the management is based on severity of clinical manifestations, location, and response to conservative therapy

29
Q

Nursing Diagnoses

A
  • acute pain r/t inflammation in the rectal area
  • knowledge deficit r/t the care of hemorrhoids and/or postoperative care
  • risk for altered bowel elimination: constipation r/t fear of pain with bowel movements
30
Q

Nursing Assessments

A
  • vital signs
  • visual inspection of rectal area
  • frequency and character of bowel movements
  • bowel habits postoperatively compared with preoperative pattern
  • pain
  • intake and output
31
Q

Assessments: Vital Signs

A

a fever may be indicative of an infection and should be reported to the healthcare provider
-an increased heart rate and/ or respirations may be indicative of pain

32
Q

Assessment: Visual inspection of rectal area

A

the rectal area may appear reddened secondary to itching

  • postoperatively, it may appear swollen from manipulation during surgery
  • there should not be significant drainage or bleeding
33
Q

Assessment: Frequency and character of bowel movements

A

the patient often tries to avoid having a bowel movement due to painful defecation, particularly after surgery because of the increased pain associated with bowel movements
-this can lead to constipation and should be avoided because this will further increase pain and perhaps bleeding of the surgical site

34
Q

Assessment: bowel habits postoperatively compared with preoperative pattern

A

if the patient becomes constipated after surgery, this can lead to increased pain with each subsequent bowel movement

35
Q

Assessment: Pain

A

pain results secondary to the surgical procedure, and associated inflammation
-adequate pain management allows the patient to resume normal activities sooner

36
Q

Assessment: Intake and Output

A

urinary retention may occur because of rectal spasms and pain

37
Q

Nursing Actions

A
  • administer pain medications
  • provide cold packs and sitz baths
  • administer laxatives
  • apply local moist heat
38
Q

Nursing Actions: Administer Pain Medications

A

the first bowel movement after surgery may be painful, and the patient needs to take an analgesic prior; fainting has occurred during bowel movements early after surgery because of the intensity of the pain along with vagal stimulation
>Local anesthetics: provide temporary relief from burning, itching, and pain
>Astringents: promote skin dryness, which helps relieve itching, irritation, and inflammation
>Corticosteroids: reduce inflammation
>Protectants/ Emollients: form a physical barrier on the skin to prevent irritation of the perianal region

39
Q

Nursing Actions: Provide cold packs and sitz baths

A

these interventions are used to reduce swelling and pain

40
Q

Nursing Actions: administer laxatives

A 
bulk laxatives (hydrophilic psyllium) require the use of increased fluids, or they can result in constipation
-if the patient has not had a bowel movement within 3 days after surgery, a mild laxative may be ordered
41
Q

Nursing Actions: apply local moist heat

A

local moist heat can be used to provide comfort but should be avoided in the immediate postoperative period because of an increased risk of bleeding

42
Q

Teaching

A
  • care of surgical site
  • measures to prevent constipation
  • avoid straining to have a bowel movement and avoid sitting for long periods of time
  • avoid stimulant laxatives
  • nonpharmacological methods of reducing pain
  • contact healthcare provider if unable to urinate
43
Q

Teaching: Care of surgical site

A

area should be washed gently and patted dry to keep the surgical area free from contaminants that may cause infection

44
Q

Teaching: measures to prevent constipation

A

include good sources of fiber; include whole grain and raw vegetables and fruits

  • regular bowel habits are important for the patient in the postoperative period for avoiding constipation
  • increasing fluids and fiber in their diet helps prevent constipation
  • over-the-counter stool softeners such as docusate sodium may also be used
  • the use of narcotic analgesics may increase the chances of developing constipation
45
Q

Teaching: Avoid stimulant laxatives

A

they are irritating and habit-forming

46
Q

Teaching: non-pharmacological methods of reducing pain

A

cold packs and sitz baths alleviate some pain associated with hemorrhoids
-the use of sitz baths can be used for cleansing as well as having a soothing effect, and they can be used three of four times a day

Nursing 172 (120 decks)

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