Anus, Rectum and Prostate Nursing 330 Governors State University Shirley Comer
Relevant History <ul><li>Usual bowel habits Change in habits </li></ul><ul><li>Rectal bleeding Blood in stool </li></ul><u...
Anus & Rectum Anatomy
Inspect Perianal Region <ul><li>Anus </li></ul><ul><ul><li>Normally moist and hairless (hair=pilonidal cyst?) </li></ul></...
Palpate Anus and Rectum <ul><li>Use lubricant and glove </li></ul><ul><li>Insert index finger into anus and rotate to palp...
Palpate Prostate Gland <ul><li>In men only </li></ul><ul><li>Located anteriorly </li></ul><ul><li>Assess </li></ul><ul><ul...
Prostate exam
Benign Prostatic hypertrophy <ul><li>Occurs in older men – no specific age </li></ul><ul><li>Gland enlarges and remains sm...
Pix enlargement
Fecal Exam <ul><li>Inspect and feces on glove for blood or other discharge </li></ul><ul><li>Test feces for Occult blood u...
Practice Exam Question   <ul><li>You 65 yo female pt just had a bowel movement with a few drops of bright red blood. You a...
Rationale <ul><li>C is the correct answer.  The hemorrhoids are the most likely source of the blood </li></ul><ul><li>A is...
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Anus, Rectum And Prostate.330.Gsu

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Anus, Rectum And Prostate.330.Gsu

  1. 1. Anus, Rectum and Prostate Nursing 330 Governors State University Shirley Comer
  2. 2. Relevant History <ul><li>Usual bowel habits Change in habits </li></ul><ul><li>Rectal bleeding Blood in stool </li></ul><ul><li>Medication Hemorrhoids </li></ul><ul><li>Pruritus Family hx </li></ul><ul><li>Diet Hx colon disease </li></ul><ul><li>Last rectal exam Last PSA (men) </li></ul>
  3. 3. Anus & Rectum Anatomy
  4. 4. Inspect Perianal Region <ul><li>Anus </li></ul><ul><ul><li>Normally moist and hairless (hair=pilonidal cyst?) </li></ul></ul><ul><ul><li>Coarse folded highly pigmented skin </li></ul></ul><ul><ul><li>Anal opening tightly closed </li></ul></ul><ul><ul><li>Hemorrhoids are shiny blue sacs </li></ul></ul><ul><ul><li>Fissure is a split in skin </li></ul></ul><ul><ul><li>Fistula is an opening to skin </li></ul></ul><ul><ul><li>Prolapsed is a red doughnut shaped tissue </li></ul></ul>
  5. 5. Palpate Anus and Rectum <ul><li>Use lubricant and glove </li></ul><ul><li>Insert index finger into anus and rotate to palpate rectal wall </li></ul><ul><li>Anal sphincter may resist- touch and let relax then insert finger </li></ul><ul><li>Assess </li></ul><ul><ul><li>Decreased tone </li></ul></ul><ul><ul><li>Lesions, masses, hemorrhoids </li></ul></ul>
  6. 6. Palpate Prostate Gland <ul><li>In men only </li></ul><ul><li>Located anteriorly </li></ul><ul><li>Assess </li></ul><ul><ul><li>Size- 2.5 cm to 4 cm </li></ul></ul><ul><ul><li>Shape- heart shaped and smooth </li></ul></ul><ul><ul><li>Consistency- elastic, rubbery </li></ul></ul><ul><ul><li>Mobility- sl moveable </li></ul></ul><ul><ul><li>Sensitivity- nontender </li></ul></ul>
  7. 7. Prostate exam
  8. 8. Benign Prostatic hypertrophy <ul><li>Occurs in older men – no specific age </li></ul><ul><li>Gland enlarges and remains smooth </li></ul><ul><li>Impairs urination </li></ul><ul><ul><li>Must stand </li></ul></ul><ul><ul><li>Difficulty initiating a stream </li></ul></ul><ul><li>May impair sexual function </li></ul><ul><li>Any hard irregular nodules may indicate cancer </li></ul>
  9. 9. Pix enlargement
  10. 10. Fecal Exam <ul><li>Inspect and feces on glove for blood or other discharge </li></ul><ul><li>Test feces for Occult blood using hemacult slide </li></ul><ul><li>Occult blood may indicate colon cancer </li></ul><ul><li>Bright red bleed in indicates rectal bleeding </li></ul><ul><li>Black tarry stools indicate upper GI tract bleeding </li></ul><ul><li>Gray, tan or clay stool indicates absent bile </li></ul><ul><li>Yellow or greasy stool indicates malabsorption of fat </li></ul><ul><li>Jelly like mucus indicates inflammation </li></ul><ul><li>Iron tablets = green/black sticky stool </li></ul>
  11. 11. Practice Exam Question <ul><li>You 65 yo female pt just had a bowel movement with a few drops of bright red blood. You assess her rectum and find moderately large hemorrhoids but no masses or lesions. You notify the Primary HCP but what do you suspect causes the blood? </li></ul><ul><li>A. Colon cancer </li></ul><ul><li>B. upper GI bleed </li></ul><ul><li>C. Hemorrhoids </li></ul><ul><li>D. iron tablets </li></ul>
  12. 12. Rationale <ul><li>C is the correct answer. The hemorrhoids are the most likely source of the blood </li></ul><ul><li>A is a possibility and occult blood specimens should be ordered by PHCP </li></ul><ul><li>B is unlikely as Upper GI bleeds result in black tarry stool </li></ul><ul><li>D. iron tablets generally cause the stool to turn green/black and sticky </li></ul>
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