Hospitalized patients are often unaware of much of the work performed by nurses on their behalf. The care plan for a patient after the surgical removal of hemorrhoids is determined by one nurse and followed by all of the nurses caring for the patient until hospital discharge. This care plan outlines the responsibilities of the nursing staff to ensure the patient's safe recuperation.
Monitor Post-operative Patient
The patient is monitored post-operatively for excessive bleeding and drainage. Vital signs, including blood pressure, pulse, respiratory rate and temperature, are checked on a regular basis and more often if needed. The patient is monitored closely for the first few hours and then less frequently as his condition stabilizes.
Administer Pain Medication
Pain medicine is administered either on a regular schedule or as needed, depending on physician orders. Medicine given on the day of the surgery is often via an intravenous line or as a shot into the muscle. Later, pain medication may be given orally. The nurse monitors the patient for pain, regardless of whether she is expressing pain verbally or not. A rise in blood pressure, pulse and respiratory rate may indicate pain. Guarding of the surgical area, sweating, grimacing or moaning during sleep are other indicators the nurse is alert for.
Other measures to relieve pain include frequent repositioning, sitz baths, warm compresses and back massages. Creams or dressings may need to be applied to the surgical site on a regular basis.
Monitor for Urinary Retention
"Nurses Pocket Guide" explains that the hemorrhoidectomy patient is at risk for urinary retention due to swelling, pain, surgical trauma, surgical drugs or catheter use during surgery. It is the nurse's responsibility to maintain adequate fluid intake to facilitate urination and to ensure the patient is voiding a normal amount of urine. The patient who is unable to void after surgery may require intermittent or continuous catheterization.
Administer Stool Softener
The "Lippincott's Manual of Nursing Practice Handbook" explains that the nurse should administer a laxative or stool softener to the hemorrhoidectomy patient to facilitate soft bowel movements. This helps the patient avoid getting an anal stricture. The nurse then monitors the patient to ensure that he successfully has a bowel movement within a couple of days after the procedure.
Educate the Patient
The nurse educates the patient about her at-home care, including when to resume various normal activities, such as returning to work, lifting or engaging in sexual activity. The patient is taught how to monitor herself for complications and how to lessen the recurrence of hemorrhoids in the future. The nurse encourages the patient to ask any questions she has about her condition.
References
- "Medical-Surgical Nursing"; Donna Ignatavicius, M.S., R.N. and Linda Workman, Ph.D., R.N.; 2002
- "Nurses Pocket Guide: Diagnoses, Interventions and Rationales"; Marilynn E. Doenges, R.N., M.A. and Mary F. Moorhouse, R.N.; 2000
- "Lippincott Manual of Nursing Practice Handbook"; Sandra M. Nettina, M.S.N.; 2005
