HEMORRHOIDECTOMYFROM GROUP 5

Recommended For…….

• third- and fourth-degree internal hemorrhoids (with or without external hemorrhoids).

• For patient with severe bleeding, intolerable pain , pruritus & large prolapse

Contraindicated For….

• Blood dyscrasias ( acute Leukemia)• Aplastis anemia or hemophilia• GI carcinoma• During the first trimester of

pregnancy

PRE OPERATIVE

CARE

• Explain procedure and ensure consent form signed

• Stop any anticoagulant medication like aspirin & NSAIDS 1 or 2 weeks before procedure

• Check baseline vital sign, such as urine test, chest x-ray, ECG and bleeding profile

• Administer premedication drug to relieve anxiety

• Keep patient NBM for 6 to 8 hour before procedure

• Administer laxative or enema to empty bowel• Skin preparation at perianal area & clean with

antiseptic detergent

• Administer second enema 3 hours before surgery

• Administer sedative for patient to relax and induced drowsiness

• Make sure patient have IV line to administer fluid & medication before,during and after surgery

POST OPERATIVE

CARE

• Monitor vital sign• Observe for prolonged rectal hemorrhage

and urinary retention• Administer analgesic to reduce post

operative pain• Administer a bulk medication such as

psyllium, one hour after the evening meal to ensure daily stool

• Warn against using stool softening medication soon after surgery, because a firm stool act as natural dilator to prevent anal stricture from the scar tissue.

• Teach anal hygiene, measures to control moisture to prevent itching

• Keep the wound site clean to prevent infection and irritation

• Before discharge, stress the importance of regular bowel habits and good anal hygiene

• Warn against too-vigorous wiping with washcloths & using harsh soaps

• Encourage the use of medicated astringent pads and white toilet paper ( the fixative in colored paper can irritate the skin)

CONTRAINDICATION……• Anal fistula or fissure • Constipation • Excessive bleeding • Excessive discharge of fluid from the rectum • Inability to urinate or have a bowel

movement • Severe pain, especially when having a bowel

movement • Severe redness and/or swelling in the rectal

area

CLIENT TEACHING……

• Prevent constipation by responding quickly to urge to defecate

• Modify diet to include fluid & high fiber

• Obtain regular ambulation, prevent standing or sitting for prolonged period of time

• Keep perineal area clean & dry• Avoid regular use of laxatives

Picture of stapled hemorrhoidectomy

procedure

Picture Internal Hemorrhoids in Anal

Canal

Picture of a Hollow Tube Inserted into the Anal Canal and Pushing

up the Hemorrhoids

Picture of Suturing the Anal Canal through the Hollow Tube

Picture of Bringing Expanded Hemorrhoidal Supporting Tissue into the Hollow Tube by Pulling

on Suture

Picture of Hemorrhoids Pulled Back Above Anal Canal after

Stapling and Removal of Hemorrhoidal Supporting Tissue

Hemorrhoids can occur inside the rectum, or at its opening (A). To remove them, the surgeon feeds a gauze swab into the anus and

removes it slowly. A hemorrhoid will adhere to the gauze, allowing its exposure (B). The outer layers of skin and tissue are removed (C), and then the hemorrhoid itself (D). The tissues and skin are then

repaired (E).

Reference….

• Lippincott content review for NCLEX-RN Book page: 507

• Mini Encyclopedia of Nursing (Page: 252)

• Professional guide of disease (Page: 290)

• www.surgerychannel.com/hemorroidectomy

• www.pubmedcentral.nih/gov/pagerender

My group

• Siti fatimah• Nurakma • Noor Azizah• Norfarhanimsuhaida• Nur Nadia Tasha• Nur Farihah

• Thilagavathy• Shamini Devi• Nathiaya• Latha• Mohd Fauzi• Zuraini