Hemorrhoid

A Case Analysis presented to the Nurse Educators of the

Nursing Training and Development
Asian Hospital and Medical Center

In partial fulfilment of the requirements

In Preceptorship Program
for the Basic Competency Program

Catherine Uy Diaz, RN

September 06, 2022

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 TABLE OF CONTENTS

Page
I. Title Page......................................................................................................1

II. Overview of Anatomy and Physiology ……………………………………. 3

III. Database

a. Patient Profile....................................................................................5

b. Chief Complaint.................................................................................5

c. Admitting Diagnosis...........................................................................5

d. History of the Present Illness.............................................................6

e. Past Medical History..........................................................................6

f. Family History....................................................................................6

g. Review of System..............................................................................7

h. Personal and Social History...............................................................7

i. Course in the Ward/Area…………………………….………………….8

j. Physical Assessment Findings………………………………………….9

Gordon’s Functional Health Pattern……………………………………9

IV. Laboratory and Diagnostic Procedures…..............................................….11

V. Medications.................................................................................................…...16

V. Theoretical Framework.............................................................................….17

VI. Concept Map..............................................................................................…18

VII. References....................................................................................................19

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II. Overview of Anatomy and Physiology

To understand hemorrhoids, we need to review the anatomy of the

digestive system (start backward- from the anus)

The anus is the endpoint of the digestive system. It contains sweat and oil
glands, hair follicles, as well as many nerve endings, which make it very
sensitive to pain and erotic stimulation. The anal opening is an oval
opening located about an inching front of the spine. When closed, the anus
is about an inch in circumference-however, the external sphincter muscle
that circles it can stretch to about five times the size.

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WHAT ARE HEMORRHOIDS The term hemorrhoids refer to a condition in which the veins
around the anus or lower rectum are swollen and inflamed.

4
Overview
Inflammation of the blood vessels in the walls of the anus and rectum is known as piles or
hemorrhoids. These blood vessels act as shock absorbers for defecation throughout the
body. This causes hemorrhoids, which are one of the leading causes of rectal bleeding.

What Are Piles?

The word hemorrhoid is derived from the Greek word “hemorrhoids,” meaning veins liable
to discharge blood. It is commonly seen in the age group of 45-65 years.

Piles are hemorrhoids swollen inside and around the lining of your buttocks or anal lining.
They usually get better on their own after a few days. There are several ways for the
prevention and treatment of hemorrhoids.

The question remains, what causes piles? There are many reasons for hemorrhoids, which
increase the pressure on the blood vessels that supply the anus and rectum, causing them
to swell.

The cause of hemorrhoids is unknown. A few factors that cause hemorrhoids are
constipation, the increased pressure on the blood vessels during pregnancy and sustained
weight gain, persistent diarrhea and prolonged sitting on the toilet, straining to lift heavy
objects. They may reduce within 1-2 weeks, but if persistent symptoms like rectal bleeding
occur, a physician must be consulted immediately.

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Itching and discomfort can also be seen in a few patients. Typically, it is not always
associated with symptoms like pain and rectal bleeding.

What Causes Piles or Hemorrhoids?

Piles are caused due to several reasons. These causes increase the pressure within the
blood vessels supplying the anus and rectum and cause the vessels to swell.

 Watery or hard bowel movements (stools)

 Diet low in fiber
 Diseases of the liver that cause increased blood pressure in the vessels that
supply the anus and rectum (portal hypertension), Ascites (accumulation of fluid
in the abdomen)
 Family history
 Prolonged diarrhea
 Physical straining to lift heavy objects
 Rectal cancers
 Excessive weight gain
 A persistent cough, sneezing and vomiting (prolonged)
 Prolonged Squatting while defecating
 Anal Intercourse

Piles Symptoms
Symptoms can occur due to the enlargement of the vessels, bleeding or due to the
slippage of the blood vessels outside the anus. Any of the following symptoms may be
experienced if you have piles

 Pain which increases on straining or sitting

 Bleeding from the anus
 Protrusion of soft, bulging vessels through the anus
 Itching around the anal opening
 Sometimes a clot may form within the protruding blood vessels and cause
extreme pain. This is known as thrombosed piles
 If any of the above symptoms are present, you need to seek the advice of a
doctor. Severe bleeding from a ruptured (torn) pile can cause extreme blood loss
and lightheadedness.
 Most commonly we can identify them when we observe blood on a toilet paper or
purple/pink bumps are seen around the edge or bulging out from the anus.
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Risk Factors of Hemorrhoids
The risk factors for developing piles are

 Prolonged constipation
 Sitting for a long duration
 Vigorous straining
 Chronic diarrhea
 Colon cancer
 Alcoholic Liver diseases (causing portal hypertension and  ascites)
 Lifting of heavy objects
 Poor posture (lack of erect posture)
 Family history of piles
 Elevated anal resting pressure
 Loss of the tone of rectus muscle (muscle in rectum)
 Episiotomy (It is a surgical incision done during delivery by an obstetrician for the
baby to pass without any complications through the birth canal)
 Anal Intercourse
 Inflammatory bowel diseases like Ulcerative colitis and Crohn’s diseases.
 Surgeries related to the anal canal and rectum.

Diagnosis of Piles

 Doctors diagnose piles by enquiring about the patient’s symptoms and clinical
history and by conducting a physical examination.
 During the physical examination, the anal region is inspected for any bulging piles
through the anal orifice. Rectal examination is also done. For the examination of
the rectum, the patient is made to lie on his left side with knees folded on to the
chest. The doctor inserts a gloved finger through the anal orifice and examines
the walls of the anus and rectum for swellings and other abnormalities. Usually,
piles can also be diagnosed with a visual examination of the anal region
and digital rectal examination.
 Endoscopy or proctosigmoidoscopy is done to further visualize the rectum and
anus and rule out causes of rectal bleeding other than piles. In this procedure,
the surgeon inserts a tube into the rectum through the anus and visually inspects
the region using a light.
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  Blood tests like hemoglobin, complete blood counts, blood coagulation studies
and liver function tests are also done as additional tests.

 Barium enema (injection of a radio contrast fluid, barium sulfate, into the rectum
from the anus) is taken by the patient and then the Barium X- RAY is done to
observe the entire colon.

Piles Treatment
The best treatment for piles is strictly following the dos and don’ts that your doctor says at
home, before and after the surgical procedure. Follow these: 

DOs:

 Drink plenty of water

 Eat more fiber to keep your stool soft
 Mildly soak your toilet paper to wipe after passing stool
 If your piles are painful, take acetaminophen
 To relieve itching and pain, you can also take a warm shower
 If the piles are coming out of your anus, use your finger to put it back in gently
 Wrap an ice pack with a towel to relieve discomfort
 Maintain personal hygiene in the toilet and keep your parts dry and clean
 Regular exercise can help
 Alcohol and caffeine drinks can cause constipation, making it worse.

DONTs:

 Practice wiping gently after you have finished passing stool

 If you feel like using the toilet, go ahead and do not stop it
 Try not to force your gut out while forcing the stool out
 Codeine-containing medications can cause constipation. Avoid them.
 Ibuprofen is a strict no if you have suffered from bleeding piles
 Do not extend your toilet duration

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You have tried all the remedies and tricks to treat piles at home, and you still have a
problem that has not been resolved. At this stage, you need to consult a physician and get
an expert medical opinion.

Some of the best piles treatment. There are various options of piles treatment grossly the
surgical and non-surgical methods.

Non-Surgical Methods

Most patients are initially advised to increase the fiber content of their diet, drink plenty of
water, and avoid straining, sitting for long durations and lifting heavy objects. In mild cases,
the symptoms can resolve with changes in the lifestyle of the patient. Patients who have
hard stools may be prescribed medications to soften the stools. These medications are
called laxatives.

Some patients are also advised to perform a “sitz” bath. In this procedure, a large tub is
filled with warm water and a pinch of salt is added to it. Then the patient sits in the tub, with
the water reaching up to the hip level for 10-15 minutes (3 times a day).  This procedure
can relieve inflammation, constipation, and pain.

If the pile symptoms are not relieved by lifestyle changes, then patients may have to
undergo procedures for treatment. Patients on blood thinners are advised to stop these
medications before any surgical procedure to avoid chances of bleeding. Non-surgical
procedures are those that can be performed without anesthesia.

After passing stools, the anal area may be cleaned with wet toilet paper. Avoid using dry
toilet paper.

Cold compresses and ice packs can be used to reduce the swelling in the anal region.

Topical treatments are often used such as hydrocortisone suppository and pads containing
numbing agents.

Piles treatment methods available include:

 The most common procedure done is rubber band ligation for internal piles. In
this procedure, the surgeon looks at the piles through an anoscope and rubber
bands are placed at the base of the blood vessels. This shuts off the blood supply
to the pile mass and causes them to shrink and fall off.

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  Sclerotherapy involves injecting a chemical into the tissue surrounding the
enlarged piles. These chemical damages the tissue and shuts off the blood
supply to the piles leading to its shrinkage. This treatment may have to be
repeated to prevent recurrence of the hemorrhoids.
 Infrared coagulation is also practiced but less often. In this procedure, infrared
light is used to destroy the blood vessels and reduce the size of the hemorrhoids

Surgical Procedures

Patients who are distressed due to a large, swollen and prolapsed pile may have to be
treated with surgery. Surgery for piles may be performed under local, spinal, or general
anesthesia. Cleaning of the lower gut (rectum and anus) is performed before the surgery
by an enema.

Surgical hemorrhoidectomy is the most effective treatment in India for all types of
hemorrhoids. It is preferred in patients who have piles for a long period with repeated
bleeding, severe pain and swelling. The surgeon performs this procedure by removing the
enlarged vessels using a surgical scalpel or laser. Once the blood vessels are removed,
the resulting gap in the anal region is either left open or sutured using stitches. When left
open, the wound takes a longer duration to heal but is associated with lesser stitch related
complications.

Stapling for piles is a procedure in which the enlarged piles are first removed.  A circular
stapler is then inserted into the anus and a ring of tissue around the anus is removed. This
procedure may have to be repeated to prevent reoccurrence of piles.

Doppler-guided trans-anal “hemorrhoidal dearterialization” is a modern technique which

uses Doppler to locate the blood vessels causing piles and remove them.

Piles Prevention
The practices that can prevent the occurrence of piles and reduces the intensity of the
disease are:

 Consuming high-fiber diet which contains fruits (pears, bananas, apples,

raspberries), legumes(lentils, black beans, lima beans) vegetables (green peas,
broccoli, brussels sprouts) and whole grains(oatmeal, barley, brown rice).

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 Recommended total daily fiber consumption is 20-38 grams in both men and
women.
 Drinking adequate water (6-8 glasses of water) and fluids.
 Practicing good bowel habits such as going to the toilet as soon as the urge for
defecation appears.
 Regular exercise and weight loss (hemorrhoids causing Constipation can be
prevented by staying active and maintaining proper BMI).
 Avoid straining while passing stools.
 Avoid prolonged hours of sitting especially on a toilet, prolonged posture of
squatting (the knees and hips are bent while the weight of the body falls on the
feet).


 Supplemental fibers (Methylcellulose, Calcium polycarbophil and psyllium) can be

used to increase the fiber intake in the body.
 Occasionally Stool softeners can be used for easy passing of stools without
straining.

FAQs

Will changing my lifestyle reduce my risk of developing piles?

Yes. The risk for piles can be reduced by following regular exercise and consuming food
with high-fiber content.

Can I get piles again after treatment?

Yes. It is possible for the piles to recur after treatment. This can be avoided by eating foods
rich in fiber and drinking plenty of water.

Do piles during pregnancy require treatment?

Yes. Treatment of piles during pregnancy is required if they become bothersome.

Can piles be treated without surgery?

Yes. Piles can be treated with lifestyle modifications and non-surgical methods.

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lII. Database

a. Patient Profile

Patient’s Name: C.M.D.F

Birthdate: 06- December- 1987
Race: Asian
Age: 34
Gender: Male
Weight: 70.2 kg.
Height: 165.5 cm
BMI: 42.4
Civil Status: Single
Religion: Protestant
Nationality: Filipino
Occupation: Unknown
Address: Bacoor, Cavite City
Physician(s): Dr. A. C. C
Admitting Diagnosis: Lower Gastrointestinal Bleeding
Name of the Informant: Patient himself
Admission Date: August 24, 2021

b. Chief Complaint: Constipation, Blood on stool

c. Admitting Diagnosis: Lower Gastrointestinal Bleeding

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d. History of Present Illness: According to the patient one day prior to admission,he
experienced constipation and noted blood in his stool for 10 weeks ago. He felt painful
sensation at anal region after passing out hard stool, and a soft mass over the perianal
region which was painful to touch. Patient started to experienced painful sensation on the
anal region which was aggravated when assuming sitting position. He sought consultation
with Dr. A. C. C. and was advised for Colonoscopy last August 29, 2021.

e. Past Medical History: Unremarkable. No known cause of DM and HPN. No history of

major surgery. No medications taken and treatment history, no known allergy. Has sound
sleep, appetite reduced, bowel movement 2/3 times per day with blood, urine is
clear/normal frequency, 6 times per day. He is not addicted to alcohol, nicotine, and any
other addictive substances. Physical examination: Blood Pressure: 130/83 mmHg, CR: 78,
RR: 18, Temperature: 36.4, Weight: 70.2 kg. Mental state, Heart and Lungs, and any other
pertinent physical findings are normal.

f. Family History: No specific diseases.

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g. Review of System:

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h. Personal and Social History: Patient was born in Manila and lives with his mother, he is
Single, and a Protestant, occupation and education level did not specify/unknown. Has
sound sleep but reduced appetite. Drinking alcohol occasionally, Non-smoker. Phil health
(SSS member), 2014 Intellicare.

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 i. Course in the Ward/ Area
Nursing Related Work
Date and Time Significant Events Intervention Instruction/ Policy
August 24, 2021/ Arrival of patient  PL-ADS-012
0600H  Registration PATIENT
 Identify the IDENTIFICATION
patient
 Placing of ID
band
 Patient
Identifiers
(Stating the
FULL NAME
and
BIRTHDATE)
Patients are
identified
BEFORE
providing
treatment and
any diagnostic
procedures.

August 24, 2021 Before interviewing PL-IPC-001

/0630H and touching the  Hand Hygiene HAND HYGIENE
patient.  Height and HAND HYGIENE
Weight COMPLIANCE
 Vital signs MONITORING
FORM

August 24, 2021 Assessing ALL  PL-QMD-014

/0645H Inpatients and  Reduce the FALL
some Outpatients Risk of PREVENTION
whose conditions, Patient Harm AND
diagnosis, situation, Resulting MANAGEME
or location identifies from Falls. NT
them as at high risk  QF-QMD-040
for falls. VULNERABILITY
SCREENING
TOOL
August 24, 2021 Witness in signing of  Ensuring QF-POS-045
/0700H the consents. Correct-Site, CONSENT FOR
Correct- SURGERY
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 Procedure,
Correct-
Patient
Surgery
August 24, 2021  SIGN-IN,  The full  QF-POS-036
/0715H TIME OUT, Surgical team PERI-
SIGN OUT conducts and OPERATIVE
documents a SAFETY
Time-out CHECKLIST
procedure in
the area in
which the  QF-POS-013
surgery/ PRE-
invasive OPERATIVE
procedure will NURSING
be performed CHECKLIST
just before
starting a
surgical/
invasive
procedure.
August 24, 2021 Anesthesiologist  A pre PL- MAF- 011
/0725H performed pre - anesthesia SEDATION AND
sedation assessment assessment is ANALGESIA OF
performed for PATIENTS
each patient. QF-POS-073
PRIMARY PRE-
OPERATIVE
EVALUATION


AUGUST 24, 2021
/0735H
August 24, 2021  Inform them
/0740H that the
turnaround
time is 5 to 7
days
July 22, 2021 /1140H Discharge  Assist patient  PL-BIL-003
to the cashier
 Instruct them
that they will
be notify when
will be the 1st
day of their
treatment
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 a. Physical Assessment Findings Assessment done last July 22, 2021 at LG Asian
Cancer Institute
Technique Findings
General Appearance
Alert, oriented to person, place, time,
situation

Well groomed
SKIN Intact skin integrity, Afebrile

(-) Jaundice

Head No signs of physical deformities or

asymmetry
Eyes And Vision Pupil Reactive to Light and
Accommodation
Ears And Hearing No significant findings

Nose and Sinuses No significant findings

Mouth No significant findings

Neck No significant findings
Thorax and Lungs Clear breath sounds, No distress
Heart No edema Strong pulses, regular rhythm
HR 82; BP 131/84;
Peripheral Circulation Warm, natural skin Normal (1-2 seconds)
capillary refill
Abdomen With surgical incision
Musculoskeletal System Normal Range Of Motion

Neurologic System Conscious.

Six components She is oriented to person, place, and time
situation. She shows good judgment and
intact memory. She always verbalizes her
full name and date of birth correctly when
asked.

GORDON’S FUNCTIONAL HEALTH PATTERN

Health Patterns Before During Analysis and

Hospitalization Hospitalization Interpretation
1. Health Ang kalusugan para sakin Ang kalusugan para sakin She values her health
ay ang malusog ako at ngayon ay kayamanan na dapat now. Not just for her but

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 Perception and ang aking pamilya” as kong alagaan para sa also for her family
verbalized by the patient. magandang kinabukasan ko
Management atang aking pamilya” as
verbalized by the patient. She
managed her health right now by
following the doctor’s order to
her
2. Nutritional Patient usually eats 3 Before the operation patient eats She had to adjust her
times a day every meal her meals 3x a day 1 cup of rice meal to prepare her to her
Metabolic she eat 1 cup of rice more in every meal but she was on surgery. But once
on meat and fish and often NPO 12 hours before the surgery. recovered her diet will be
on vegetables. she drinks “Sobrang gutom ako” back as tolerated
6-8 glasses of water a
day.
She has allergies reaction
to any food and
medication.
3. Elimination According to patient she According to patient she voids 9- Once you increase your
voids 8-10 times a day 10 times and difficult to fluid intake urine output
with yellowish in color of defecates. Her urine color is light will be good as well as
urine. She also defecate yellow. Her stool is watery helping to defecate.
everyday. Stool is brown because she take laxative as
in color and semi formed. prescribe by her doctor Dulcolax
She does not take any
laxatives. Patient does not
have painful sensation
during urination and
defecation

4. Activity Exercise According to patient she
does household chores
she was able to bathe
herself and have her
exercise sometimes
by walking. she does not
take energy vitamins. She
feels uneasy when she
does not take a bath.
Patient can ambulate and
perform activities of daily
living without assistance.
5. Sleep rest According to patient she
sleeps for 8 hours in
a day. She usually takes
up at night to urinate.
She does not take
medication for inducing
sleep. Her usual routine
before sleeping is taking a
bath to feel
more comfortable when
sleeping.
6. Cognitive- She rated pain as 9, from
a pain scale of 1-10, 10 as
Perceptual the highest. She claimed
pain to be intermittent
7. Self -perception/ Practice to have a healthy She still manages to be calm
lifestyle as to seek medical and relaxed. Agreed to have a
self -concept assistance surgery and the radiation
She was able to ambulate, lay
down herself in bed, bathe
herself, and have her meal
without assisting before her
operation. After the operation
the patient cannot
easily ambulate because of her
surgical incision but we told
her that she must move
her body so that she can easily
to recover to the surgery.
There is a change in sleeping
pattern. She usually sleeps 4
hours.
As verbalized “ang tahi ko
nasakit pa” Felt pain in the
surgical area. Believe that pain
is felt due to post-operative
experience
Once you had something
done to your body it will be
very difficult for you to do
the activities of you daily
living.
Complete sleep helps to
have a good state of mind
and healthy body
Feeling the Pain is very
subjective. When the
patient says it hurts
believe her and have a
management for that pain
so that she could continue
to her Activity of Daily
Living
Acceptance. She accepted
that she has an
Endometrial
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 treatment. Adenocarcinoma. And
know the procedure and
treatment that she will go
through
8. Role Married with 2 children. Well supported by her family. Support system is very
Her husband is a seafarer Still plays the role of a mother important especially if
relationship who returns home every 9 despite the condition by means you’re not in good health
month. She loves her of reminding important matters
family so much to her children
9. Sexuality Married with 2 children; After the operation, she had For now it is not applicable
Menarche starts in 1984 never had contact with her since her husband is on
reproductive when she was 11 years husband. board for almost 7 months
old. No history of Sexually
transmitted disease
10. Coping-stress Copes up with the stress Verbalized the desires to Since she had accepted
of house chores. No recover. Able to accept situation her condition, she is
tolerance traumatic events by cooperating with the medical capable to move around
experienced. team her house and have a
normal life and more
eager to overcome her
condition through
treatment
11. Value-belief A Christian with strong With this point in her life her faith Letting God as the center
faith with the Lord. She in the Lord made stronger as of everything makes things
pattern always pray and goes to days go by. lighter and easy
church every Sunday.

IV. Laboratory and Diagnostic Procedures

Fecal occult blood test

Overview

The fecal occult blood test (FOBT) is a lab test used to check stool samples for hidden
(occult) blood.

Occult blood in the stool may indicate colon cancer or polyps in the colon or rectum —
though not all cancers or polyps’ bleed.

Typically, occult blood is passed in such small amounts that it can be detected only through
the chemicals used in a fecal occult blood test.

If blood is detected through a fecal occult blood test, additional tests may be needed to
determine the source of the bleeding. The fecal occult blood test can only detect the
presence or absence of blood — it can't determine what's causing the bleeding.
20
A fecal occult blood test isn't recommended if you have colon cancer symptoms. If you
notice blood in your stool or in the toilet or if you experience abdominal pain or a change in
your bowel habits, make an appointment with your doctor.

Why it's done

The fecal occult blood test is one option for colon cancer screening. It may be an option if
you have an average risk of colon cancer and don't have any symptoms. The fecal occult
blood test is typically repeated yearly.

Risks

Risks and limitations of the fecal occult blood test include:

 The test isn't always accurate. Your fecal occult blood test could show a
negative test result when cancer is present (false-negative result) if your cancer
or polyps don't bleed.

Your test could show a positive result when you have no cancer (false-positive
result) if you have bleeding from other sources, such as a stomach ulcer,
hemorrhoid, or even blood swallowed from your mouth or your nose.

 Having a fecal occult blood test may lead to additional testing. If your fecal
occult blood test result is positive, your doctor may recommend a test to
examine the inside of your colon, such as a colonoscopy.
How you prepare

Various foods, dietary supplements and medications can affect the results of some fecal
occult blood tests — either indicating that blood is present when it isn't (false-positive) or
missing the presence of blood that's there (false-negative). Your doctor may ask you to
avoid certain foods or medicines. To ensure accurate test results, follow your doctor's
instructions carefully.

For about three days before the test, your doctor may ask you to avoid:

 Certain fruits and vegetables, including broccoli and turnips

 Red meat
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  Vitamin C supplements

 Pain relievers, such as aspirin and ibuprofen (Advil, Motrin IB, others)
What you can expect

Fecal occult blood test kit Open

pop-up dialog box
There are several types of fecal occult blood tests, each with a different approach to
collecting and testing stool. They include:

 Immunochemical fecal occult blood test (iFOBT, or FIT). The collection

method for this test may depend on the manufacturer, but typically, you use a
special spoon or other device to collect a sample of stool and store it in a
collection container that comes with the test kit.

The collection container is then returned to your doctor or a designated lab, by

mail or in person.

Immunochemical testing is preferred over the guaiac fecal occult blood test
because it's more sensitive. Also, it doesn't require any dietary restrictions
before sample collection and testing can often be performed on a random stool
sample.

22
  Guaiac fecal occult blood test (gFOBT). For this test, your doctor typically
gives you test cards that are used to collect stool samples from multiple bowel
movements.

You collect a stool sample from each of two or three bowel movements in a
clean container, usually taken on consecutive days, and then use an applicator
stick to apply a smear of stool to a specific area of a card.

After the samples are dry, you return them to your doctor or a designated lab,
by mail or in person.

 Flushable reagent pad or tissue. You can get this kit at a store without a
prescription.

You place the pad or tissue in the toilet bowl after a bowel movement, usually
on three consecutive days. The pads change color when blood is present.

You then report the changes to your doctor, usually on a mail-in form.

For accurate results, follow the instructions and return the samples promptly.

Results

Your doctor will review the results of the fecal occult blood test and then share the results
with you.

 Negative result. A fecal occult blood test is considered negative if no blood is

detected in your stool samples. If you have an average risk of colon cancer,
your doctor may recommend repeating the test yearly.

 Positive result. A fecal occult blood test is considered positive if blood is

detected in your stool samples. You may need additional testing — such as a
colonoscopy — to locate the source of the bleeding.

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V. Medications

Correlation
Pertinent
Date Ordered Medication Indication with the
Nursing
Patient’s
Consideration
condition
JULY 02, 2021 Dibucaine 1% • It may cause  Temporary
rectal ointment . dizziness or relief of
(eg, drowsiness, do acute pain
Nupercainal) not drive a car, and pruritus.
or operate
 Intended for
machinery
short-term,
while taking
intermittent
this
use.
medication.

JULY 13, 2021 Dulcolax 5mg Laxative * May lead to The patient is for
hypokalemia 28 fractions IMRT
and 3 fractions of
*Monitor fluid cylinder
and electrolyte brachytherapy
level which must be
empty rectum and
*May cause full bladder
abdominal
cramps and pain

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 VI. Theoretical Framework

THEORY OF HUMAN CARING

 DEVELOPED BY JEAN WATGSON IN THE 1980

 OFFERS A NEW WAY OF CONCEPTUALIZING HUMAN TO
HUMAN TRANSACTIONS THAT OCCUR DAILY IN THE
NURSING PRACTICE
 COMPOSED OF 10 CURATIVE FACTORS WHICH ARE
CLASSFIED AS NUSRING ACTIONS OR CARING
PROCESSES.

Watson’s 10 carative factors are:

(1) forming humanistic-altruistic value systems
(2) instilling faith-hope
(3) cultivating a sensitivity to self and others
(4) developing a helping-trust relationship
(5) promoting an expression of feelings
(6) using problem-solving for decision-making
(7) promoting teaching-learning
(8) promoting a supportive environment
(9) assisting with the gratification of human needs
(10) allowing for existential-phenomenological forces

Nursing is defined by caring. Jean Watson contends that caring regenerates life energies
and potentiates our capabilities. Caring is a mutually beneficial experience for both the
patient and the nurse, as well as between all health team members.

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In addition, it is important to remember that Watson emphasizes that we must care for
ourselves to be able to care for others; self-healing is a necessary process for rejuvenating
our energy reserves and replenishing our spiritual bank.

VII.Concept Map

VAGINAL BLEEDING FLANK PAIN

* Heavier or last longer than usual or last more * Pain occurs at the same time each day lasting 1-2 hours
than seven days * Restless
* consume 5 pads in an hour *Weakness
INTERVENTION INTERVENTION
* Assess possible cause of bleeding * Assess pain and its characteristics, quality, frequency
* Getting plenty of rest and duration
* Administer appropriate Medication given by * Provide comfort measures and promote bed rest
physician * Encourage deep breathing when pain occurs
* Dilation and curettage (D&C)

ENDOMETRIAL
ADENOCARCINOMA

BLADDER CONTROL DIFFICULT TO DEFECATE

* The muscles in your bladder and urethra lose * Feeling of incomplete emptying
some of their strength. *lack of fluid intake
INTERVENTION *lack fiber in diet
* Maintain a healthy weight INTERVENTION
*Auscultate bowel sounds
* Avoid bladder irritants, such as caffeine,
* Increase fluid intake and fiber in diet
alcohol and acidic foods * Avoid gas forming food like nuts and spicy
* Encourage Pelvic Muscle Exercise food
(Kegel‘sExercise) * Take laxative as ordered by the doctor
* Bladder training by using regular timed void

She sought consultation

Had Dilation and curettage

Surgery for Exploratory Laparotomy

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Referral to Radio Oncologist

Had CT Simulation for Plan and Treatment

st
REFERENCES

References:

https://www.askapollo.com/physical-appointment/colorectal-surgeon
https://www.apollohospitals.com/patient-care/health-and-lifestyle/understanding-
investigations/stool-culture-test/

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