3 Hemorrhoids Nursing Care Plans

February 2, 2016

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

Impaired Skin Integrity: Altered epidermis and/or dermis [The integumentary system is the largest multifunctional organ of the body.]

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.