Medical Surgical Constipation #5

Question

A client with hemorrhoids needs to have a bowel movement but expresses fear of defecating due to the pain experienced. Which intervention might the nurse try first to help facilitate a bowel movement and prevent constipation?

Answers

  1. Apply cold packs to anal area followed by a warm sitz bath
    • Rationale:

      This answer is correct because it is the least invasive. The cold packs will decrease inflammation and shrink the veins. The warm water from the sitz bath relaxes muscles before an attempt to release the bowels.

  2. Obtain an order for hemorrhoid medication
    • Rationale:

      This answer is not correct because hemorrhoid medication only helps mild discomfort of hemorrhoids. The client admitted with pain caused by defecation and expressed fear. The pain experienced by the client does not sound mild.

  3. Administer stool softeners as prescribed
    • Rationale:

      This answer is not correct since it is the most invasive. Though stool softeners will help a client with hemorrhoids relieve the bowels more comfortably, it is not the first intervention the nurse should try.

  4. Encourage a high fiber diet and increase fluids
    • Rationale:

      This answer is not correct because although encouraging a diet high in fiber and fluids promotes bowel movements without straining, it will not help the client at the moment relax before attempting defecation. The nurse needed an intervention at that moment to minimize discomfort so the client can defecate without severe pain.

Overview

Hemorrhoids are dilated veins in the anal canal and can be very painful. Hemorrhoids can develop from straining during difficult bowel movements due to constipation.

Explanation

Learning Outcomes

Hemorrhoids are dilated veins in the anal canal and can be very painful. Hemorrhoids can develop from straining during difficult bowel movements due to constipation. Constipation leads to hemorrhoids and hemorrhoids lead to constipation. The straining involved during constipation causes increased pressure in the lower rectum which results in hemorrhoids. When hemorrhoids become very painful, clients may avoid defecating due to the pain involved. Applying cold packs to the anus followed by a warm sitz bath will help decrease inflammation and shrink the veins, as well as relax the muscles before attempting defecation. Other interventions include hemorrhoid preparations, stool softeners, and a diet high in fiber and water.

Test Taking Tip

Always choose the less invasive answer option first. Also, look at key words in the question to make concise answer options.

Video Rationale