Haemorrhoid

Care Conference on Haemorrhoid

1. CARE CONFERENCE
HAEMORRHOID
SRN NOORHAZAMIN HAMID
NURSING EDUCATION SERVICES

2. At the end of this session, you will be
able to :
State the definition of
haemorrhoid.
List the etiology of haemorrhoid.
Identify the pathophysiology of
haemorrhoid.
State the sign & symptom of
haemorrhoid.

3. LEARNING OBJECTIVES cont.
Identify the complication of
haemorrhoid.
Identify the nursing intervention &
appreciate the nursing care for
haemorrhoid patient.

7. Doctor=Dr DA
Diagnosis
= THROMBOSED
PILES

8. Mr. F was admitted to
5XX-1 with complaint of :
 PR Bleeding
 PR Pain
 Constipation
 Lethargic

9. Medical history
- Sinusitis (July 2011)
- HPT (Jan 2012)
Surgical history
- I&D abscess Lt big toe
(26/4/11)
- Exc. Wart Rt heel (2006)

10. Family medical history
- HPT (Both parents)
Allergic
- ? Antibiotic taken from
GP (facial swelling)

11. Current Medication
-Plendil 2.5mg OD
-Zyrtec 1 daily
-Sy Lactulose 15ml BD
-Norgesic 1 TDS

13. VITAL SIGNS
Temp =37.1˚C
Pulse =86 bpm
Resp =20 bpm
B/P =140/90 mmHg
Weight=99 kg

14.  Daily BO but hard
stool & small amount
 Bleeding PR & pain
Other ADL normal

15. PHYSICAL EXAMINATION
• Pain & swelling at
anus

16. S/B Dr DA :
HAEMORRHOIDECTOMY under Spinal on
12/6/12

17. SURGERY FINDINGS
 Thrombosed piles at 7
o’clock

22. HAEMORRHOID
•A network of small veins (blood vessels)
within the inside lining of the anus and lower
rectum become wider and engorged with
more blood than usual.
•These engorged veins and the overlying
tissue may then form into one or more small
swellings called haemorrhoids.

24. WHAT CAUSES IT?
 Low fiber intake
 Low fluid intake
 Frequent constipation & straining
 Pregnancy
 Hereditary
 Painkiller
 Aging

28. SIGN & SYMPTOM
•Swelling.
•Bleeding.
•Pain.
•Irritation or itch.
•Mucous discharge.
•Sense of fulness at anus or not fully
emptying rectum.

30. External
Internal
•Anoderm
•Swell,
discomfort,
difficult hygiene
•Pain?
-> Thrombosed
•Pain?
-> painless
•Bright red
bleeding
•Prolapse
associated with
defecation

31. A:Thrombosed external
B:First-degree internal
viewed through
prothoscope
C:Second-degree
internal prolapsed,
reduced spontaneously
D:Third-degree internal
prolapsed, requiring
manual reduction
E:Fourth-degree
strangulated internal
and thrombosed
external

33. GRADE 1
•Small swellings on the inside lining of
the back passage.
•They cannot be seen or felt from
outside the anus.

34. GRADE 2
•Are larger.
•They may be partly pushed out
(prolapse) from the anus when you go
to the toilet, but quickly spring back
inside again.

35. GRADE 3
•Hang out (prolapse) from the anus.
•You may feel one or more as small, soft
lumps that hang from the anus.
•However, you can push them back
inside the anus with a finger.

36. GRADE 4
•Permanently hang down from within
the anus, and you cannot push them
back inside.
•They sometimes become quite large.

39. SURGICAL PROFILE
LIPID PROFILE
•HDL Cholesterol
-0.70 (> 1.42 mmol/L)
•LDL Cholesterol
-3.3 (< 2.6 mmol/L)
•Chol/HDL Chol
- 6.9 (up to 4.0)

40. URINE FEME
•Bacteria
-Occasional (Nil)

43. DRUGS
ORDERED ON PRE MED
DATE
ORDERED
DATE
OFF
Tab Zantac 150 mg STAT 12/6/12 12/6/12
Tab Maxalon 10 mg STAT 12/6/12 12/6/12
Tab Celebrex 200 mg STAT 12/6/12 12/6/12

44. DRUGS
POST OPERATIVE
DATE
ORDERED
DATE
OFF
IV Rocephin 1gm Dly 12/6/12 15/6/12
IV Dynastat 40mg BD 12/6/12 15/6/12
Sy Lactulose 15ml OD 12/6/12 14/6/12
Tab Flagyl 400mg TDS 12/6/12 15/6/12
Tab Arcoxia 120mg Daily 12/6/12 15/6/12
Tab Daflon 1 TDS 12/6/12 15/6/12
Eusol Sitz Bath BD 13/6/12 15/6/12
Bactroban Cream to anus BD 13/6/12 15/6/12

46. DRUGS
ON DISCHARGE
DATE
ORDERED
Eusol Sitz Bath BD (5 sets) 15/6/12
Batroban Cream PRN (2 tubes) 15/6/12
Tab Arcoxia 120mg Daily 15/6/12
Tab Daflon 1 TDS 15/6/12
Tab Flagyl 400mg TDS 15/6/12

54. Alteration in comfort
related to anal pain.
NURSING DIAGNOSIS

55.  Alteration in emotional
status anxiety related to
surgical procedure and
bleeding piles.
NURSING DIAGNOSIS

56.  Potential bleeding
related to abrasion at
anus.
NURSING DIAGNOSIS

58. NURSING DIAGNOSIS
 Potential bleeding related
to surgical wound.

59. NURSING DIAGNOSIS
Potential infection related
to surgical incision.

60. NURSING DIAGNOSIS
 Alteration in ADL related to
post spinal anaesthesia.

61. NURSING DIAGNOSIS
 Potential infection
related to intravenous
cannula insertion.

62. NURSING DIAGNOSIS
 Potential infection related
to CBD catherization.

63. NURSING DIAGNOSIS
 Knowledge deficit related
to treatment regime and
post operative hygeine care.