Developing Standardized Procedures for Family Nurse Practitioners in Genitourinary Care

Developing Standardized Procedures for Family Nurse Practitioners in Genitourinary Care

Definition

1. Disease or condition

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, could lead to 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).

1. 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, to external hemorrhoids (Margetis, 2019).

1. 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)

2. Assessment

3. Symptoms

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 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. These signs and symptoms vary depending on the type of hemorrhoids the client is suffering from. For instance, external hemorrhoids may present with a skin tag around the anus resulting from a resolved hematoma. In this case, the patient will report pain and discomfort that is aggravated during sitting position and alleviated while standing (Peate, 2022).

1. Physical Exam

During the physical examination, the nurse should start by inspecting the patient from head to toe. During this procedure, it is important to inform the patient about what you are about to do and what they should expect. This is done to alleviate their worries about the happenings as well as psychologically prepare them. Ensure to obtain the informed consent from the patient. Be gentle and assure the patient’s privacy and confidentiality.  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 (Peate, 2022).

3. Diagnostic tests

4. Testing

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 proctoscope 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. To rule out other possible causes of rectal bleeding, a stool culture might be done to test for microorganisms such as H-pylori that might have resulted in bleeding (National Institute of Diabetes and Digestive and Kidney Diseases, 2019).

1. Expected results

When inspecting the patient, it is expected that they might look pale due to subjection to bleeding. The stool might be blood-stained with bright red blood, which signifies the presence of fresh bleeding. The patient might present with a rapid change in position during sitting, which signifies discomfort emanating from the irritation from the pressure applied to the inflamed tissue while sitting. It is expected to have lumps and swellings felt during palpation. Anoscopy and proctoscopy might reveal inflammation of the internal lining of the anal canal as well as the rectum. The digital rectal examination might leave fingers with blood stains after the examination. The patient might also verbalize pain during the digital-rectal exam (Peate, 2022).

4. Management

5. First-line medications

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, the trade name preparation H, which is applied to the affected area four times daily. Witch hazel, referred to as tucks in the market, is used to improve comfort, which is also applied to the affected part. Stool softeners are administered to reduce the straining during defecation. An example is docusate sodium, which is a trade name for Colace and is typically administered at 100mg orally once daily (Wechter & Dugdale, 2019).

1. Second-line medications

The second-line treatment is initiated in case of allergy to the first-line treatment, where topical lidocaine is preferred due to fewer side effects and drug interaction (Wechter & Dugdale, 2019). With the management of hemorrhoids, no major contraindications and drug interactions have been identified.

1. Other 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 to help increase stool bulkiness and avoid much pressure being applied during defecation. Encourage the patient to observe adequate fluid intake to reduce the chances of constipation. For 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. This is to avoid triggering an inflammation process around the anal tissue. The patient should avoid prolonged sitting periods, hard rubbing while cleaning the area around the anus to avoid irritation and worsening the symptoms. To sum up the other management approaches, it is important to observe the deworming schedule to avoid parasites that may impair the integrity of the digestive system, hence causing rectal bleeding (Wechter & Dugdale, 2019).

1. Follow-up

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

1. Referral

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 patient might also request a referral, influenced by factors such as preference of the facility, proximity to their residence, and environmental factors for example, some patients may be affected by the extreme weather seasons experienced in some parts. Financial factors might also be a factor for the referral, where the patient may request a referral to a facility that matches their financial strength. Lastly, the government policies, along with other employers, may request referral for their employees to a facility where they have signed a memorandum of understanding regarding the health insurance coverage for their employees. Regarding the above situations, the nurse should assess the consequences of the referral for the patient. When the merits outdo the demerits, the nurse facilitates the referral for the patient by, calling the receiving facility to inform them about the anticipated type of admission for them. The nurse gives a detailed professional report about the patient to ensure continuity of care. Also, the nurse ensures the discharge process from the facility is done and then hands over the patient to the receiving facility (Flaubert et al., 2021).

References

Al-Masoudi, R. O., Shosho, R. Y., Alquhra, D., Alzahrani, M., Hemdi, M., & Alshareef, L. (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

Flaubert, J. L., Menestrel, S. L., Williams, D. R., & Wakefield, M. K. (2021). The Role of Nurses in Improving Health Care Access and Quality. In www.ncbi.nlm.nih.gov. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK573910/

Margetis, N. (2019). Pathophysiology of internal hemorrhoids. Annals of Gastroenterology. https://doi.org/10.20524/aog.2019.0355

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

Peate, I. (2022). Hemorrhoids. British Journal of Healthcare Assistants, 16(10), 464–468. https://doi.org/10.12968/bjha.2022.16.10.464

Wechter, D. G., & Dugdale, D. C. (2019, September 9). Hemorrhoids: MedlinePlus Medical Encyclopedia. MedlinePlus. https://medlineplus.gov/ency/article/000292.htm

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/

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Week 5
Standardized Procedure Worksheet (SEE ATTACHED TEMPLATE)
Assignment
Purpose
The purpose of this assignment is to create a standardized procedure that may be applied to nurse practitioner practice.

This assignment will allow for discovery into the role of the family nurse practitioner (FNP) in providing primary care for clients with disorders of the genitourinary system and support the professional formation of the FNP practice role.

Course Outcomes
This assignment enables the student to meet the following course outcomes:

CO 2: Formulate appropriate diagnoses and evidence-based management plans for mature and aging individuals and families. (PO 5)
CO 4: Integrate theory and evidence-based practice in the care of mature and aging individuals and their families. (PO 5)
CO 6: Conduct pharmacologic assessment addressing polypharmacy, drug interactions, and other adverse events in the care of mature and aging individuals and their families. (PO 5)
Due Date
The Standardized Procedure Worksheet is due by Sunday 11:59 p.m. MT at the end of Week 5.

The Late Assignment Policy applies to this assignment. Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment.