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Hemorrhoids
INTRODUCTION
Obesity
Jobs that require sitting
or standing for long
periods
Lack of physical activity
Loss of pelvic floor
muscle tone due to age,
pregnancy, childbirth, or
surgery
Severe heart disease or
liver disease
Hemorrhoidectomy is a
surgical procedure that is
performed to remove
hemorrhoids. As the
surgical site is very
sensitive area,
hemorrhoid surgery
causes a lot of pain. It is
a simple operation.
Surgery is completely
effective in about 95% of
cases. However,
additional surgery may
be required if the
hemorrhoids recur.
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OBJECTIVES
Within 2 days of preparing and devising a case
study regarding External Hemorrhoids, we will be
able to:
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COGNITIVE
Review Medical-Surgical Nursing concepts
specifically Hemorrhoids comprehensively.
Identify the predisposing and precipitating
factors that lead to the clients present health
condition.
Formulate a concrete and systematic
pathophysiology of the Hemorrhoids.
Develop a specific, measurable, attainable,
realistic and time-bounded nursing care plan.
Formulate appropriate discharge plan
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PSYCHOMOTOR
Gather all pertinent data comprehensively.
Conduct a thorough physical assessment
using cephalocaudal approach.
Assess the clients level of understanding
regarding present health condition.
Conduct health teaching effectively.
Implement effective and reliable nursing
interventions.
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AFFECTIVE
Display the virtues of a globally competitive
Augustinian student nurse at all times.
Establish trust, open communication and
teamwork within the members of the group
throughout the study.
Respect clients rights, beliefs, norms and
values at all times.
Exhibit enthusiasm and patience in rendering
effective nursing care.
Maintain confidentiality regarding the clients
PATIENTS
INFORMATION
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HISTORY OF PRESENT
ILLNESS
According to the patient, he experienced pain in his
anal area after defecating 1 year ago. He noticed that
every time he defecates there is always a present of
blood in his stool. He also noticed that there is a
painful lump near his anus that becomes itchy every
after he defecates. He didnt take any medications
and didnt seek for any consultation at that time. Last
Saturday, July 16, 2016, he experienced constipation
and force himself to defecate. He defecated watery
stool and according to him, the pain near his anus
worsened after. According to the patient, 1 day before
he was admitted, he noticed that the symptoms are on
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PAST MEDICAL
HISTORY
According to the client, he was hospitalized at the
age of 14 due to urinary tract infection and he was
given medications in the hospital. He was admitted
for 1 day and was discharged after.
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PAST SURGICAL
HISTORY
The patient didnt undergo any surgery
before.
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PSYCHOSOCIAL
HISTORY
According to the client, he doesnt engage in
any vices, because he believes that it will only
harm his health. He spends most of his time
with his girlfriend, family and work. He has a
good relationship with his family and opens up
with them whenever he has problems.
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OCCUPATIONAL
HISTORY
The client is currently working as a call
center agent at Teleperformance for 3 years.
His shift starts at 7 am to 4pm (SaturdayWednesday) with a two 15 minute-break and
1 hour lunch time.
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FAMILY HISTORY
According to the client, both of his parents
has hypertension. He stated that there are no
other diseases that run in the family like DM
or Cancer. He also mentioned that there was
no history of hemorrhoids in their family.
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GENERAL SURVEY
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Microsoft Word
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Gordons
Functional
Assessment
Tool
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Elimination Pattern
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CEPHALOCAUD
AL APPROACH
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SYSTEMS
APPROACH
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Doctors Orders
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Time
July 17,2016
7:40 pm
Doctors Order
Diet:
NPO Post midnight
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Medication:
Metoclopromide (Plasil) 10g IVTT
IV Fluids:
PNSS @ 120 cc/hr
Laboratory Test:
SGPT(Serum Glutamic-Pyruvic
Transamirase),
Significance
-To reduce the chances of
elimination during the surgery.
July 18,2016
Medication:
6 am
Faktu suppositories
1 suppositories per rectum
8:10 am
Cefoxitin (Alfoxin)
1 gm IVTT Q8H
8:15 am
Celecoxib (Celenex)
400mg / 1 cap P.O. once a day
for 4 days
Paracetamol (Naplex)
600mg IVTT Q6H x 24 hrs
-For pain
Norgesic forte
1 tablet P.O. TID x 3 days
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IV Fluids:
D5LR @ 120 cc/hr
Procedure:
Monitor vital signs every 15
minutes until stable,
Continue post op care
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Laboratory
Results
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Date
July 17,2016
7:24 pm
Examination
WBC Count
Result
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Reference
Significance
5.00-10.00 x 10^ Increase in
9/L
number of WBC
indicates an
infection
Monocytes
2.00-6%
A high
monocyte count
might be a sign of
a chronic infection
Eosinophil
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1.00-4%
Rise in the
number of
eosinophil
indicates infection
PATHOPHYSIOL
OGY
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PROBLEM LIST
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Document
NURSING CARE
PLAN
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GENERAL OBJECTIVE
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SUBJECTIVE CUES
Gasakit pa ang akon buli.
as verbalized by
the client
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OBJECTIVE CUES
Pain scale of 7/10 noted
Anxiety noted
Vital signs are as follows:
Temperature: 36.8C
Pulse Rate: 65 bpm
Respiratory rate: 18 cpm
Blood Pressure: 140/100
OTHERS
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Date
Examination
Result
Reference
July 17,2016
7:24 pm
WBC Count
12.1
5.00-10.00 x 10^
9/L
Monocytes
2.00-6%
Eosinophil
15
1.00-4%
Lymphocytes
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25.00-40.00%
NURSING DIAGNOSIS
RATIONALE
Alteration in comfort:
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Pain related to post
operation wound
secondary to External
Hemorrhoids
SPECIFIC OBJECTIVES
After 16 hours of rendering
effective nursing care the client
will be able to:
Demonstrate use of
relaxation skills and other
methods to promote
comfort and alleviate pain
Reduce pain level
NURSING INTERVENTIONS
Independent:
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Investigate pain reports, noting location, duration,
intensity (0-10 scale), and characteristics (dull, sharp,
constant).
RATIONALE
NURSING INTERVENTIONS
RATIONALE
Collaborative:
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Celecoxib (Celebrex)
400mg / 1 cap P.O.
EVALUATION
After
7 hours of rendering effective nursing interventions, the patient was able to:
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Demonstrate use of relaxation skills, other methods to promote comfort such as deep
breathing exercise
Verbalized pain scale of 5/10
Goal is fully met.
DISCHARGE
PLAN
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EVALUATION
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THANK YOU!
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