3 Hemorrhoids Nursing Care Plans

By
Matt Vera, BSN, R.N.
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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: 

  1. Impaired Tissue Integrity
  2. Constipation
  3. Acute Pain

2. Constipation

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Constipation

Nursing Diagnosis

  • Constipation

May be related to

  • Low residue diet
  • Lack of dietary bulk
  • Hemorrhoidal pain
  • Medications

Possibly evidenced by

  • Passage of hard, formed stool
  • Decreased bowel sounds
  • Inability to evacuate stool
  • Severe, exquisite rectal pain
  • Abdominal pain
  • Abdominal distention
  • Ileus
  • Absent bowel sounds
  • Frequency of stool is less than normal
  • Less than the usual amount of stool
  • Palpable mass
  • A feeling of rectal fullness
  • Flatulence

Desired Outcomes

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  • Patient will have normal elimination pattern reestablished and maintained.
Nursing Interventions Rationale
Determine the patient’s bowel habits, lifestyle, ability to sense an urge to defecate, painful hemorrhoids, and history of constipation. Assists with the identification of an effective bowel regimen and/or impairment, and need for assistance. GI function may be decreased as a result of decreased digestion. Functional impairment related to muscular weakness and immobility may result in decreased abdominal peristalsis and difficulty with the identification of the urge to defecate.
Assess patient’s stool frequency, characteristics, presence of flatulence, abdominal discomfort or distension, and straining at stool. Aging, such as decreased rectal compliance, pain, impairment of rectal sensation can lead to constipation.
Auscultate bowel sounds of presence and quality. Abnormal sounds, such as high-pitched tinkles, suggests complications like ileus.
Monitor diet and fluid intake. Adequate amounts of fiber and roughage provide bulk and adequate fluid intake of at least 2 L per day is important in keeping the stool soft.
Monitor for complaints of abdominal pain and abdominal distention. Gas, abdominal distention, or ileus, could be a factor. Lack of peristalsis from impaired digestion can create bowel distention and worse to the point of ileus.
Monitor patient’s mental status, syncope, chest pain, or any transient ischemic attacks. Notify the physician if these symptoms occur. Undue straining may have harmful effects on arterial circulation that can result in cardiac, cerebral, or peripheral ischemia.
Assess for rectal bleeding. Excessive straining may produce hemorrhoids, rectal prolapse, or anal fissures, with resultant pain and bleeding.
Provide bulk, stool softeners, laxatives, suppositories, or enemas as warranted. May be used to stimulation evacuation of stool.
Provide a high-fiber diet, whole grain cereals, bread, and fresh fruits. Improves peristalsis and promotes elimination.
Monitor medications that may predispose patient to constipation. Analgesics, anesthetics, anticholinergics, diuretics, and other drugs are some medications that are known to cause constipation.
Instruct patient in activity or exercise programs within limits of the disease process. Activity promotes peristalsis and stimulates defecation. Exercises help to strengthen the abdominal muscles that aid in defecation.
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2. Constipation

See Also

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Gastrointestinal Care Plans

Care plans covering the disorders of the gastrointestinal and digestive system:

Matt Vera, BSN, R.N.
Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.

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