Question

Part 2

T.A. is a 50-year-old male who presents to the family practice for a yearly physical. The patient has noticed a change in bowel movements. He states that his stools are dark-colored and that he has been passing gas more frequently. His last bowel movement was this morning prior to the office visit. He has no other complaints at this time. The patient has a past medical history of depression and hemorrhoids. Vital signs are T 97.5, P 85, R 16, and BP 110/55.

Questions:

1. What subjective information should the nurse obtain?
2. The nurse is preparing to perform the physical examination. What are the major structures of the anal and rectum?
3. What is the proper procedure for this assessment?
4. What health promotion concepts should the nurse teach this patient regarding the anus, rectum, and prostate?
5. What health promotion concepts should the nurse teach this patient regarding the anus, rectum, and prostate?

Answer 1

The subjective information nurse should obtain is ,a}Documentation: Name: T.A,

   sex: Male

  medical record number:------

     age: 50 years

date:---------

time:-----------

probable medical diagnosis: IBS

chief complaint: change in bowel movement and colour and passing gas

in this way the nurse will also note down:

b}Past medical history: Prior hospitalizations and major illnesses and surgeries.Assess pain: Location, severity, and use of a pain scale

1. Allergies: Medications, foods, and environmental; nature of the reaction and seriousness; intolerances to medications; apply allergy band and confirm all prepopulated allergies .

2. Medications: Confirm accuracy of the list, names, and dosages of medications by reconciling all medications promptly using electronic data confirmation, if available, from local pharmacies; include supplements and over-the-counter medications

3. Valuables: Record and send to appropriate safe storage or send home with family following any institutional policies on the secure management of patient belongings; provide and label denture cups

4. Rights: Orient patient, caregivers, and family to location, rights, and responsibilities; goal of admission and discharge goal

5. Activities: Check daily activity limits and need for mobility aids

6. Falls: Assess Morse Fall Risk and initiate fall precautions as dictated by institutional policy

7. Psychosocial: Evaluate need for a sitter or video monitoring, any signs of agitation, restlessness, hallucinations, depression, suicidal ideations, or substance abuse

8. Nutritional: Appetite, changes in body weight, need for nutritional consultation based on body mass index (BMI) calculated from measured height and weight on admission

9. Vital signs: Temperature recorded in Celsius, heart rate, respiratory rate, blood pressure, pain level on admission, oxygen saturation

10. Any handoff information from other department Distally, the large intestine opens into the rectum, which is continued by the anal canal. The rectum forms the final 20cm of the GI tract. It is continuous with the sigmoid colon and connects with the anal canal and an*s . The rectum ends in an expanded section called the rectal ampulla, where faeces are stored before being released; the rectum is usually empty since faeces are not normally stored there for long.The anal canal located in the perineum (outside the abdominopelvic cavity), is 3.8-5cm long and opens to the exterior of the body at the an*s. It has two sphincters:Internal anal sphincter, which is controlled by involuntary muscles;External anal sphincter, which is made of skeletal muscle and is under voluntary control.Except during defecation, both anal sphincters normally remain closed. Proper procedure for the check of IBS is all patients with suspected IBS, a complete blood count must be done. The test can help confirm the disease if your main symptom is diarrhea. But scientists are still studying how well the test works when constipation is your chief complaint.One thing to keep in mind: Sometimes the results are inconclusive. Your doctor may need to do more tests to find the root cause of your symptoms.

    Diagnostic procedures can include:Colonoscopy. Your doctor uses a small, flexible tube to examine the entire length of the colon.X-ray or CT scan. These tests produce images of your abdomen and pelvis that might allow your doctor to rule out other causes of your symptoms, especially if you have abdominal pain. Your doctor might fill your large intestine with a liquid (barium) to make any problems more visible on X-ray. This barium test is sometimes called a lower GI series.Upper endoscopy. A long, flexible tube is inserted down your throat and into the tube connecting your mouth and stomach (esophagus). A camera on the end of the tube allows the doctor to inspect your upper digestive tract and obtain a tissue sample (biopsy) from your small intestine and fluid to look for overgrowth of bacteria. Your doctor might recommend endoscopy if celiac disease is suspected. Laboratory tests can include:Lactose intolerance tests. Lactase is an enzyme you need to digest the sugar found in dairy products. If you don't produce lactose, you may have problems similar to those caused by IBS, including abdominal pain, gas and diarrhea. Your doctor may order a breath test or ask you to remove milk and milk products from your diet for several weeks.Breath test for bacterial overgrowth. A breath test also can determine if you have bacterial overgrowth in your small intestine. Bacterial overgrowth is more common among people who have had bowel surgery or who have diabetes or some other disease that slows down digestion.Stool tests. Your stool might be examined for bacteria or parasites, or a digestive liquid produced in your liver. Cancer is the second leading cause of death in the United States, but in many cases it can be prevented. Skin cancer, for instance, is largely preventable by protecting people from sun damage to the skin, starting at an early age. Other cancers are close to 100% curable when precancerous conditions are caught and treated, as with cervical and colorectal cancer. The chance for successful treatment and cure is greatly increased when cancer is identified early in its course. Community Health Workers should encourage community members to be aware of their risks for developing cancer, and help them to take advantage of screening options. The elements of a healthy lifestyle that we will be talking about in more depth will help to lower the risks.