3. Guide questions:
• What is hemorrhoids?
• Causes
• Signs & symptoms
• Pathophysiology
• Complications
• How to manage hemorrhoids?
4. C
O
A N E M I A
S T A
T H N
I R U
P R O L A P S E D
A M
T O B E S I T Y
I U
O S
N
Across
1. decrease in the number of red blood cells (RBCs) or
a decrease in the amount of hemoglobin in the
blood.
2. a condition in which an organ or structure slips out
of its normal position or location.
3. excessive accumulation of body fat to the extent
that it may have adverse effects on health.
Down
1. common digestive issue characterized by
infrequent bowel movements, difficulty passing
stools, or a sense of incomplete evacuation.
2. a blood clot that forms in a blood vessel or within
the heart.
3. opening at the end of the digestive tract through
which waste material (feces) is expelled from the
body
1
1
2 3
2
3
8. Types
1. external hemorrhoids
• like small hemorrhages (bleeds) under
the skin around the anus.
• feel like hard lumps
2. internal hemorrhoids
• found inside the rectum
• painless but tend to bleed
3. prolapsed
• both internal & external hemorrhoids can
prolapse
• meaning they stretch & bulge outside of
your anus.
4. thrombosed
• blood clot forms inside a hemorrhoid
9. Risk factors
• Inflammatory Bowel Disease
(IBD)
• Crohn’s disease & ulcerative
colitis
• persistent diarrhea
• family history
• severe constipation
• sedentary lifestyle
• anal intercourse
• colorectal cancer
11. Causes
• constriction
• during bowel motions
• sitting on the toilet
• for extended periods
• sedentary lifestyle
• severe or chronic diarrhea or
constipation
• being overweight
• pregnancy
• engaging in anal intercourse
• consuming a low-fiber diet
• persistent heavy lifting
12. Signs & symptoms
• rectal bleeding & itching
• discomfort or pain
• during bowel movements
• inflammation around the anus
• feces with bright red blood
• prolapse or protruded hemorrhoids
• with pain & discomfort
• a perception or urge to defecate
• even after going to the toilet
13. Causes
Straining during bowel movements
Chronic constipation/diarrhea
Pregnancy
Prolonged sitting on toilet
Hemorrhoids Increased intra-anal pressure
Increase influx of blood
Distention of venous wall in
the anal area
Hemorrhoids
Hemorrhage
Anemia
incontinence of stool
Strangulated hemorrhage
Blood clot
Perianal thrombosis
Rectal bleeding
Anal pain
Feces with bright red blood
Protruded hemorrhoids
Anal/rectal itching
Complications
S/S
Leading to
What
really
happen?
Swelling of the affected veins
Blockade if blood supply by
sphincter muscle
Rupture of distended vein
Protrusion in anal opening
Strangulated hemorrhage Thrombosed hemorrhage
Prolapsed hemorrhoid
16. Diagnostic Assessment
• Digital Rectal Examination (DRE)
• left lateral decubitus
• Physical examination
• External examination
• with anoscope or proctoscope
• shows single or multiple
hemorrhoids.
• Barium edema or colonoscopy
• to r/o more serious colonic lesions
causing rectal bleeding such as
polyps.
• Golytely is given
• Expect diarrhea
• The Hemorrhoid Grading System
18. Nursing Intervention
• Consume high-fiber foods
• vegetables, fruits, & whole grains.
• soften & bulk the stool
• to avoid straining
• aggravate discomfort from existing
hemorrhoids
• Avoid:
• Spicy food, citrus foods, caffeinated
drinks
• Soak in a warm bath or sitz bath
regularly
• 2x-3x each day for 10-15 min
• No ice packs
• l/t vasoconstriction & may worsen Sx
19. Nursing Intervention
• Administer stool softener or
laxative
• to assist with bowel movements soon
after surgery
• promoting regular bowel habit
• to ↓ risk of stricture
• discourage regular use of laxatives
• Teach anal hygiene & measures
to control moisture
• to prevent itching.
• Prevent constipation
• exercise regularly
• 8-10 glasses/day fluid intake
20. Nursing Intervention
• Expect a foul-smelling discharge
• for 7-10 days after cryodestruction
• Determine normal bowel habits
& identify predisposing factors
• to educate pt. about preventing
recurrence of Sx.
• No heavy lifting
• Elevate the legs when sitting
• ↓ pressure on the hemorrhoid
veins
• Promote circulation
21. Treatment
• Analgesics & NSAIDs
• relieve pain & inflammation
• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin IB)
• No aspirin
• can l/t bleeding
• Topical & suppositories
• to act as a numbing agent
• ↓ inflammation & relieving Sx
22. Treatment
• Minimally Invasive Procedures
• Rubber band ligation
• A little rubber band wrapped
around the base of the hemorrhoid
• cuts off the vein’s blood supply
• Sclerotherapy
• Hemorrhoid tissue is destroyed by a
chemical injected into the enlarged
vein
23. Treatment
• Minimally Invasive Procedures
• Infrared Coagulation
• For the removal of hemorrhoids, a tiny
probe is inserted into the rectum to
transfer heat.
• Electrocoagulation
• This is similar to infrared coagulation
• except instead of an infrared light,
your doctor uses heat from an electric
current to create scar tissue and cut
off the hemorrhoid’s blood supply.
24. Surgery
• Hemorrhoidectomy
• for severe hemorrhoids
• remove big external hemorrhoids
or internal hemorrhoids that have
prolapsed.
• Hemorrhoid stapling
• an internal hemorrhoid is
removed with a stapling device.
• pulls & retains a prolapsed internal
hemorrhoid inside the anus.
25. Post-op intervention
• After thrombosis or surgery
• assist with frequent repositioning using
pillow support for comfort
• Provide analgesics, warm sitz baths,
or warm compresses
• to ↓ pain & inflammation
• Apply witch-hazel dressing to
perianal area or anal creams or
suppositories per MD order
• to relieve discomfort
• Observe anal area postoperatively
• for drainage & bleeding
26.
27. • The nurse is trying to teach a
patient about treatment of
hemorrhoids. In trying to help
the client be more comfortable,
the nurse teaches nonsurgical
treatments for hemorrhoids,
which include:
a. fleet enema
b. hot packs
c. stool softeners
d. cold compress
Question:
28. • A patient tells the examiner that
passing stools is painful. What
term would the examiner use to
document painful bowel
movements?
a. Dyschezia
b. Occult
c. Flatulence
d. Encopresis
Question:
29. • Which of the following documentation
statements indicates a normal
assessment of the perianal area?
a. "Anus moist, color darker than
adjacent tissues. No lesions or
discharge. Opening tightly
closed.“
b. "Anal area dark pink, moist,
with 0.5-cm shiny blue skin sac
at 5 o'clock.“
c. "Anus with flabby skin sac at 7
o'clock.“
d. "Small round opening in the
anal area."
Question:
