1

55642 - Week 5: Standardized Procedure Worksheet

Student Name

College Name

Course Number: Course Title

Instructor’s Name

Assignment Due Date

 2

Hemorrhoids also called piles are a result of inflammation of the veins around the anus or

the lower rectum. This inflammation results in swelling and may manifest with various

symptoms such as having blood in stool, pain during bowel evacuation, and if left untreated

anemia due to bleeding. Hemorrhoids can either be external hemorrhoids that affect the area

under the skin around the anus or internal hemorrhoids which affect the lining of the anal canal

(Yamamoto et al., 2020)

Pathophysiology

The development of hemorrhoids comes along when the vascular structures located in the

anal canal are subjected to high pressure possibly from chronic constipation, diarrhea, and

increased intra-abdominal pressure that could alter venous return, pregnancy, and dietary factors.

These factors cause trimming force to the three anal cushions causing the internal hemorrhoids.

The increased pressure applied in the defecation of hard stool in case of chronic constipation

may lead to prolapse and consequently lead to external hemorrhoids (Lohsiriwat, 2012).

Incidence and prevalence

Hemorrhoids are a common condition among older adults above 50 years in the us.

Studies have shown that over 50% of people over 50 years old suffer from hemorrhoids in the us.

It is attributed to a couple of factors among them being low-fiber diets, prolonged periods of

sitting and inactivity, obesity, and weakening of rectal tissue. Hemorrhoids are more prevalent in

women than in men (Al-Masoudi et al., 2024)

 3

Assessment and physical examination.

Intense patient assessment and physical examination are key before any other

intervention. It helps formulate an effective and evidence-based plan of action for the patient.

This results in holistic individualized care of the patient’s needs. During the first encounter with

a patient, the nurse should be an active listener to obtain subjective data reported by the patient

and also supplement the findings with objective data obtained from a comprehensive physical

examination. In this scenario, the patient is likely to report painful defecation, itching around the

anus, passing of bloody stool, and may also report a feeling of fullness in the anal area due to

swelling (National Institute of Diabetes and Digestive and Kidney Diseases, 2019).

During the physical examination, the nurse should start with an inspection of the patient

from head to toe. However, emphasis is put on the areas of interest during the documentation

process. For instance, report paleness because it’s an area of interest since the patient may have

suffered blood loss, and inspect for prolapse, leakage of stool, anal fissures, and skin tags.

During palpation, the nurse should feel for lumps and swelling. Perform a digital rectal exam to

feel for muscle tone of the anal canal and the rectum as well as check for tenderness, and blood

from masses and lumps of internal hemorrhoids (National Institute of Diabetes and Digestive and

Kidney Diseases, 2019).

State of collaboration.

Based on the findings from the patient’s assessment and physical examination, the nurse

will come up with a proper intervention to address the patient’s. The plan of action may include

multidisciplinary collaboration if the intervention needed is beyond the nursing scope of practice.

For instance, the nurse might need to collaborate with the physician in a situation where the

hemorrhoids are huge and require surgical interventions. Furthermore, collaboration with other
 4

cadres such as the nutritionist and the physiotherapist is vital in the mitigation of hemorrhoid

relapse or complication (Yamamoto et al., 2020).

Diagnostic tests.

To determine the size and location of the hemorrhoid, procedures to visualize the lining of

the anal canal are done. These are anoscopy and proctoscopy which involves the use of medical

diagnostic devices, an anoscope, and a protoscope to visualize the inner lining of the anus,

rectum, and lower digestive tract. A colonoscopy may also be done to rule out other causes of

rectal bleeding and may determine the various underlying reasons leading to hemorrhoids

(National Institute of Diabetes and Digestive and Kidney Diseases, 2019).

Management.

The management of hemorrhoids is based on the patient’s state regarding the symptoms

and the discomfort or complications caused. For instance, in cases where the hemorrhoids can

complicate to cause blockage of the anal canal or bleeding that can cause anemia, surgical

intervention is the best. However, hemorrhoids are managed using medication to manage pain,

soften the stool, and reduce swelling. These activities boost patient comfort and prevent

complications (Hemorrhoids: MedlinePlus Medical Encyclopedia, 2019).

The first-line medications used to manage hemorrhoids include topical cream containing

hydrocortisone to reduce inflammation and alleviate the symptoms. An example of these creams

is hydrocortisone cream with the trade name preparation H applied on the affected area four

times daily. Witch hazel referred to as tucks in the market is used to improve comfort. Also

applied to the affected part. Stool softeners are administered to reduce the straining during

defecation. An example is the docusate sodium with a trade name of Colace and a typical dose of

100mg orally once daily. The second-line treatment is in case of allergy to the first-line treatment
 5

where now topical lidocaine is preferred due to fewer side effects and drug interaction

(Hemorrhoids: MedlinePlus Medical Encyclopedia, 2019). With the management of

hemorrhoids, no major contraindications and drug interactions have been identified.

Other recommended treatments.

To supplement the medical management and promote patient comfort, the following are

recommended therapies and preventive measures the patient should adhere to. The patient should

do sitz baths in warm water to alleviate symptoms and increase comfort, the patient should

consider increasing the intake of a diet high in fiber as well as adequate fluid intake to reduce

chances of constipation. On the preventive measures, the patient should wear cotton underwear,

apply medication with a cotton swab, and use baby wipes instead of colored and perfumed toilet

paper (Hemorrhoids: MedlinePlus Medical Encyclopedia, 2019).

Expected client follow-up and possible referral.

The nurse should book the patient on follow-up visits to assess the progress of the patient.

This is very crucial especially when surgery has been done. The follow-up visits will help detect

any health risk factor that may counteract the therapeutic measures. However, the patient should

be allowed to make visits in case the signs and symptoms persist. This will help evaluate the

intervention given and prevent complications.

In cases where the patient does not respond to the initial treatment, referral to a

gastroenterologist may be considered to provide surgical intervention and more specialized care.

The referral might also be requested by the patient and it’s precisely their right to seek medical

assistance according to their preference.

.
 6

References

Al-Masoudi, R. O., Raghad Shosho, Dhuha Alquhra, Alzahrani, M., Mohanned Hemdi, & Lujain

Alshareef. (2024). Prevalence of Hemorrhoids and the Associated Risk Factors Among the

General Adult Population in Makkah, Saudi Arabia. Cureus.

https://doi.org/10.7759/cureus.51612

Hemorrhoids | NIDDK. (2022, January 14). National Institute of Diabetes and Digestive and Kidney

Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids

Hemorrhoids: MedlinePlus Medical Encyclopedia. (2019). Medlineplus.gov.

https://medlineplus.gov/ency/article/000292.htm

National Institute of Diabetes and Digestive and Kidney Diseases. (2019, September 18). Diagnosis of

Hemorrhoids | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases.

https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids/diagnosis

Yamamoto, M., Ikeda, M., Matsumoto, T., Takemoto, M., Sumimoto, R., Kobayashi, T., & Ohdan, H.

(2020). Hemorrhoidectomy for elderly patients aged 75 years or more, before and after studies.

Annals of Medicine and Surgery, 55, 88–92. https://doi.org/10.1016/j.amsu.2020.04.045