III. Patient’s Profile
a. Biographic Data
b. Chief Complain
c. History of Present Illness
d. Past History
❖ Birth and Maternal History
❖ Childhood Immunization
e. Personal and Social History
f. Family History
IV. Physical Assessment
V. Gordon’s Functional Health Pattern Assessment (Activities of Daily Living) VI. Developmental Task
VII. Laboratory Findings
VIII. Anatomy and Physiology
X. Course in the Ward
XI. Nursing Care Plan
XII. Drug Analysis
XIII. Discharge Planning
Hemorrhoids are dilated portions of veins in the anal canal. They are very common, about 50% of people have hemorrhoids. Shearing of the mucosa during defecation results in the sliding of the structures in the wall of the anal canal, including the hemorrhoidal and vascular tissues. Hemorrhoids are classified as one of the two types: those above the internal sphincter are called internal hemorrhoids, and those appearing outside the external sphincter are called internal hemorrhoids.
Hemorrhoids cause itching and pain and are the most common cause of bright-red bleeding with defecation. External hemorrhoids are associated with severe pain from the inflammation and edema caused by thrombosis (clotting of blood within the hemorrhoid). This may lead to ischemia of the area and eventual necrosis. It produces varying degrees of pain, feelings of pressure, itching, irritation, and a palpable mass. Bleeding occurs only if the external hemorrhoid is injured or ulcerated and begins to break down. Internal hemorrhoids are not usually painful until they bleed or prolapse when they become enlarged. Pain occurs rarely, unless there is an associated disorder such as an anal fissure, thrombosis, or strangulation of the affected vein.
Hemorrhoids are caused by increased pressure on the veins of the anus. Prolonged sitting, constipation, and hard, dry stools that are difficult to pass can lead to straining and sitting at stool for long periods of time, all of which add pressure on the anal veins. Failure to follow through on the urge to defecate can also lead to hemorrhoids.
Hemorrhoid symptoms and discomfort can be relieved by good personal hygiene and by avoiding excessive straining during defecation. A high-residue diet contains fruit and bran along with an increased fluid intake may be all the treatment that is necessary to promote the passage of soft, bulky stools to prevent straining. If this treatment is not successful, the addition of hydrophilic bulk-forming agents such as psyllium may help. Warm compresses, sitz baths, analgesic ointments and suppositories, astringent (e.g., witch hazel), and bed rest reduce engorgement.
There are several types of nonsurgical treatments for hemorrhoids. Infrared photocoagulation, bipolar diathermy, and laser therapy are used to affix the mucosa to the underlying muscle. Injection of sclerosing agents is also effective for small, bleeding hemorrhoids. These procedures help prevent prolapse. (Brenda G. Bare, et al (2010), Brunner & Suddhart’s Textbook of Medical – Surgical Nursing, 12th Edition, LWW)
This is a case of a 44 year old male with Internal Hemorrhoid and Anal Fistula. The signs and symptoms that are present are pain in the anal area related to anal fistula, and minor bleeding during defecation. His condition was most likely cause by excessive straining during defecation, constipation, and lifting heavy objects due to his work as a policeman and weight lifting during exercise.
At the end of this case study, we aim to impart information about Hemorrhoids, to our fellow nursing students and to other health care practitioners, for them to gain enough knowledge about this disease which affects many people...