anus, rectum and prostate.330.gsu
TRANSCRIPT
Anus, Rectum and Prostate
Nursing 330
Governors State University
Shirley Comer
Relevant History
Usual bowel habits Change in habits Rectal bleeding Blood in stool Medication Hemorrhoids Pruritus Family hx Diet Hx colon disease Last rectal exam Last PSA (men)
Anus & Rectum Anatomy
Inspect Perianal Region
Anus– Normally moist and hairless (hair=pilonidal cyst?)– Coarse folded highly pigmented skin– Anal opening tightly closed– Hemorrhoids are shiny blue sacs– Fissure is a split in skin– Fistula is an opening to skin– Prolapsed is a red doughnut shaped tissue
Palpate Anus and Rectum
Use lubricant and glove Insert index finger into anus and rotate to
palpate rectal wall Anal sphincter may resist- touch and let relax
then insert finger Assess
– Decreased tone– Lesions, masses, hemorrhoids
Palpate Prostate Gland
In men only Located anteriorly Assess
– Size- 2.5 cm to 4 cm– Shape- heart shaped and smooth– Consistency- elastic, rubbery– Mobility- sl moveable– Sensitivity- nontender
Prostate exam
Benign Prostatic hypertrophy
Occurs in older men – no specific age Gland enlarges and remains smooth Impairs urination
– Must stand– Difficulty initiating a stream
May impair sexual function Any hard irregular nodules may indicate cancer
Pix enlargement
Fecal Exam
Inspect and feces on glove for blood or other discharge Test feces for Occult blood using hemacult slide Occult blood may indicate colon cancer Bright red bleed in indicates rectal bleeding Black tarry stools indicate upper GI tract bleeding Gray, tan or clay stool indicates absent bile Yellow or greasy stool indicates malabsorption of fat Jelly like mucus indicates inflammation Iron tablets = green/black sticky stool
Practice Exam Question
You 65 yo female pt just had a bowel movement with a few drops of bright red blood. You assess her rectum and find moderately large hemorrhoids but no masses or lesions. You notify the Primary HCP but what do you suspect causes the blood?
A. Colon cancer B. upper GI bleed C. Hemorrhoids D. iron tablets
Rationale
C is the correct answer. The hemorrhoids are the most likely source of the blood
A is a possibility and occult blood specimens should be ordered by PHCP
B is unlikely as Upper GI bleeds result in black tarry stool
D. iron tablets generally cause the stool to turn green/black and sticky