Question

M.L 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:

What subjective information should the nurse obtain?

The nurse is preparing to perform the physical examination. What are the major structures of the anus and rectum?

What is the proper procedure for this assessment?

What health promotion concepts should the nurse teach this patient regarding the anus, rectum, and prostate?

What health promotion concepts should the nurse teach this patient regarding the anus, rectum, and prostate?

Answer 1

Subjective data :

• Patient find changes in bowel movements
• He says color of stool is dark
• Frequently pass gas
• Had a past history of depression and hemorrhoids

Structure of anal and rectum:

These examination are important part of abdominal and genitourinary function. It not only helps to examine but aslo help full in finding other pelvic organ disorders.

• The rectum is the curved lower, terminal segment of large bowel. It is about 12 cm long and runs along the concavity of the sacrum.

The upper 2/3 of the anterior rectum is covered by peritoneum but the posterior rectum is not

• In men, the anterior rectal peritoneum reflects on to the surface of the bladder base.
  • In women, the anterior rectal peritoneum forms the rectouterine pouch (the pouch of Douglas). The pouch of Douglas is filled with loops of bowel.
• Anterior to the lower 1/3 of the rectum lie different structures in men and women:
  • In men, anterior to the lower 1/3 of the rectum lie the prostate, bladder base and seminal vesicles.
  • In women, anterior to the lower 1/3 of the rectum lies the vagina. At the tip of the examining finger it may be possible to feel cervix and even a retroverted uterus.
• The wall is 3-4 cm long and joins the rectum to the perineum.
• The wall of the anal canal is supported by powerful sphincter muscles. These muscles are made up of:These muscles are essential in the mechanism of defecation and the maintainance of continence
  • Voluntary external sphincter muscles.
  • Involuntary internal sphincter muscles.

Procedure of examination

• Indications for the procedure

1.constipation

2. Change in bowl habit

3. Assessment of prostate

• The reason for the procedure should be explained to the patient
• Procedure should not be painful

Equipments for the procedure.

• Gloves
• Screen to cover the patient
• Lubricant
• Adequate lighting
• Rectoscope

Positioning of patient

• Position the patient comfortably in the left lateral position. Flex hips and knees and position the buttocks at the edge of the couch.

  Gently part the buttocks to expose the anal verge and natal cleft.

  Inspection of the skin and anal margin with good light is important.

  Lubricate the examining index finger with suitable water-soluble gel and press the finger against the posterior anal margin (6 o'clock according to convention).

  The finger should slip easily into the anal canal, and the finger tip is directed posteriorly following the sacral curve.

  At this point, if appropriate, the anal tone can be checked by asking patients to squeeze the finger with their anal muscles.

  The finger is then moved through 180°, feeling the walls of the rectum. With the finger then rotated in the 12 o'clock position, helped usually by the examiner bending knees in a half crouched position and pronating the examining wrist, the anterior wall can be palpated. Rotation facilitates further examination of the opposing the walls of the rectum. In men, the prostate will be felt anteriorly. In women, the cervix and a retroverted uterus may be felt with the tip of the finger. It is important to feel the walls of the rectum throughout the 360°. Small rectal wall lesions may be missed if this is not done carefully.

  Examination of the prostate gland (felt anteriorly):

  Normal size is 3.5 cm wide, protruding about 1 cm into the lumen of the rectum.

  Consistency: it is normally rubbery and firm with a smooth surface and a palpable sulcus between right and left lobes.

  There should not be any tenderness.

  There should be no nodularity.

  Massage of the prostate may enable prostatic fluid to be examined at the urethral meatus.

  On removal of the examining finger check the tip of the glove (for stool, blood).

Health Promotion

• Have a periodical check up done by health care provider
• Ask the patient to check for any bleeding or irregular bowel pattern
• It helps to detect the early sign of prostate in men
• Early detection helps in the prevention of disease like cancer , hemorrhoids etc