Anus, Rectum and Prostate Nursing 330 Governors State University Shirley Comer

Relevant History Usual bowel habits Change in habits Rectal bleeding Blood in stool Medication Hemorrhoids Pruritus Family hx Diet Hx colon disease Last rectal exam Last PSA (men)

Usual bowel habits Change in habits

Rectal bleeding Blood in stool

Medication Hemorrhoids

Pruritus Family hx

Diet Hx colon disease

Last rectal exam Last PSA (men)

Anus & Rectum Anatomy

Inspect Perianal Region Anus Normally moist and hairless (hair=pilonidal cyst?) Coarse folded highly pigmented skin Anal opening tightly closed Hemorrhoids are shiny blue sacs Fissure is a split in skin Fistula is an opening to skin Prolapsed is a red doughnut shaped tissue

Anus

Normally moist and hairless (hair=pilonidal cyst?)

Coarse folded highly pigmented skin

Anal opening tightly closed

Hemorrhoids are shiny blue sacs

Fissure is a split in skin

Fistula is an opening to skin

Prolapsed is a red doughnut shaped tissue

Palpate Anus and Rectum Use lubricant and glove Insert index finger into anus and rotate to palpate rectal wall Anal sphincter may resist- touch and let relax then insert finger Assess Decreased tone Lesions, masses, hemorrhoids

Use lubricant and glove

Insert index finger into anus and rotate to palpate rectal wall

Anal sphincter may resist- touch and let relax then insert finger

Assess

Decreased tone

Lesions, masses, hemorrhoids

Palpate Prostate Gland In men only Located anteriorly Assess Size- 2.5 cm to 4 cm Shape- heart shaped and smooth Consistency- elastic, rubbery Mobility- sl moveable Sensitivity- nontender

In men only

Located anteriorly

Assess

Size- 2.5 cm to 4 cm

Shape- heart shaped and smooth

Consistency- elastic, rubbery

Mobility- sl moveable

Sensitivity- nontender

Prostate exam

Benign Prostatic hypertrophy Occurs in older men – no specific age Gland enlarges and remains smooth Impairs urination Must stand Difficulty initiating a stream May impair sexual function Any hard irregular nodules may indicate cancer

Occurs in older men – no specific age

Gland enlarges and remains smooth

Impairs urination

Must stand

Difficulty initiating a stream

May impair sexual function

Any hard irregular nodules may indicate cancer

Pix enlargement

Fecal Exam Inspect and feces on glove for blood or other discharge Test feces for Occult blood using hemacult slide Occult blood may indicate colon cancer Bright red bleed in indicates rectal bleeding Black tarry stools indicate upper GI tract bleeding Gray, tan or clay stool indicates absent bile Yellow or greasy stool indicates malabsorption of fat Jelly like mucus indicates inflammation Iron tablets = green/black sticky stool

Inspect and feces on glove for blood or other discharge

Test feces for Occult blood using hemacult slide

Occult blood may indicate colon cancer

Bright red bleed in indicates rectal bleeding

Black tarry stools indicate upper GI tract bleeding

Gray, tan or clay stool indicates absent bile

Yellow or greasy stool indicates malabsorption of fat

Jelly like mucus indicates inflammation

Iron tablets = green/black sticky stool

Practice Exam Question 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? A. Colon cancer B. upper GI bleed C. Hemorrhoids D. iron tablets

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?

A. Colon cancer

B. upper GI bleed

C. Hemorrhoids

D. iron tablets

Rationale C is the correct answer. The hemorrhoids are the most likely source of the blood A is a possibility and occult blood specimens should be ordered by PHCP B is unlikely as Upper GI bleeds result in black tarry stool D. iron tablets generally cause the stool to turn green/black and sticky

C is the correct answer. The hemorrhoids are the most likely source of the blood

A is a possibility and occult blood specimens should be ordered by PHCP

B is unlikely as Upper GI bleeds result in black tarry stool

D. iron tablets generally cause the stool to turn green/black and sticky