Hemorrhoids are varicosities in the superior or inferior hemorrhoidal venous plexus. Internal hemorrhoids result from the dilation and enlargement of the superior plexus while external hemorrhoids result from the enlargement and dilation of the inferior plexus. Hemorrhoids are considered to be caused by increased venous pressure in the hemorrhoidal plexus.
- First-degree hemorrhoids may itch because of poor anal hygiene.
- Second-degree hemorrhoids are usually painless and spontaneously return to the anal canal following defecation.
- Third-degree hemorrhoids cause constant discomfort and prolapse in response to an increase in intra-abdominal pressure. They must be manually reduced.
Nursing Care Plans
Nursing management of hemorrhoids depends on the type and severity of hemorrhoid and on the patient’s overall condition. Treatment includes measures to ease pain, combat swelling and congestion, and regulation of the patient’s bowel habits. Patient care includes preoperative and postoperative support.
Here are three (3) nursing care plans (NCP) and nursing diagnosis for patients with hemorrhoids:
Impaired Tissue Integrity
Nursing Diagnosis
May be related to
- Hemorrhoidal surgery and procedures
- Alteration in activity
- Changes in mobility
- Aging process
- Loss of elasticity of the skin
Possibly evidenced by
- Disruption of skin tissue from incisional sites
- Destruction of skin layers
- Thrombosed hemorrhoids
- Internal prolapsed hemorrhoids
- Pain
- Swelling
- Drainage
Desired Outcomes
- Patient will have intact skin with no signs or symptoms of rectal prolapse or bleeding.
- Hemorrhoids will be reduced or removed.
- Patient will exhibit no evidence of thrombosed hemorrhoids or rectal bleeding.
- Patient will have normal CBC with no noted anemias.
- Patient will be able to accurately verbalize understanding of causes of hemorrhoids, methods of preventing the worsening of hemorrhoids, and comfort measures to employ.
- Swollen hemorrhoids will be reduced in size, with no pain evoked.
- Patient will be able to tolerate procedures to diagnose problem and to treat hemorrhoids without the presence of any complication.
| Nursing Interventions | Rationale |
|---|---|
| Assess patient for the presence of hemorrhoids, discomfort or pain associated with hemorrhoids, diet, fluid intake, and presence of constipation. | Provides baseline information as to the type of hemorrhoids (external or internal), degree of venous thrombosis, presence of complications, including bleeding, and risk factors that preclude patient to hemorrhoids to enable initiation of care plan appropriate for the patient. |
| Administer topical medication as ordered. | Reduces swelling, pain, and/or itching in order to make the patient more comfortable. |
| Provide “donut cushion” for the patient to sit on if needed. | Hemorrhoids are exquisitely painful and the patient may not be able to sit in a chair and apply pressure to delicate tissues.
Donut cushions can help remove pressure from hemorrhoid; caution on the occurrence of pressure areas. |
| Administer stool softeners as ordered. | Helps prevent straining and increases the pressure that may cause clotted vessels to rupture or cause further hemorrhoids to develop. Helps relieve pain by avoiding passage of hard fecal material. |
| Assist with procedures for the treatment of hemorrhoids. | Sclerotherapy may be used if the problem is detected early, it involves an injection of quinine urea hydrochloride or other agents into sclerosed vessels, with resultant swelling and dying of the vessel, with reabsorption within the body.
Banding hemorrhoid may also be performed, this involves the application of a rubber band around the base of each hemorrhoid, which ultimately results in the death and necrosis of hemorrhoid. Laser surgery may also be performed but symptomatic relief is not obtained immediately. Hemorrhoidectomy is performed if the patient has internal hemorrhoids with prolapse, or if the patient has both internal and external hemorrhoids. It relieves symptoms immediately but can create scar tissues and other complications; should be done as a last resort. |
| Instruct patient and/or family regarding causes of hemorrhoids, methods of avoiding hemorrhoids, and treatments that can be performed. | Hemorrhoids are caused by straining, heavy lifting, obesity, pregnancy, and any activity that distends rectal veins and causes them to prolapse. |
| Instruct patient and/or family regarding all procedures required. | Internal hemorrhoids are normally diagnosed by anoscopy or flexible sigmoidoscopy because the digital rectal exam cannot adequately detect hemorrhoids. Barium enemas or colonoscopy may be required to ensure that intestinal masses are not present as well. |
| Instruct patient and/or family in dietary management. | Increasing bulk, fiber, fluids, and eating fruits and vegetables can help by maintaining soft stools to avoid straining at bowel movements. |
| Instruct patient and/or family regarding the use of bulk producing agents, such as psyllium husk. | Bulk-forming laxatives help absorb water to increase moisture content in the stool, increases peristalsis, and helps promote soft bowel movements. |
| Instruct patient and/or family in comfort measures to use with the presence of hemorrhoids. | Use of rubber donuts remove pressure directly placed on the hemorrhoid. Warm sitz baths or suppositories containing anesthetic agents can help to alleviate pain temporarily. |
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses as reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of it’s evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions show how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
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- Ileostomy & Colostomy | 10 Care Plans
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- Subtotal Gastrectomy | 2 Care Plans
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