MSN Exam for Hemorrhoids

EXPLANATION

 

✔Correct answer:

He has a history of polyps in his colon. Nurse Johnson is correct in identifying a history of polyps in the colon as a risk factor for colorectal cancer. Polyps are growths on the inner wall of the colon or rectum. Some types, especially adenomatous polyps (adenomas), can develop into cancer over time if they are not removed during colonoscopy. While not all polyps become cancerous, the presence of polyps indicates an increased risk, and monitoring and potential removal are important preventive measures.

Think of polyps like weeds in a garden. Not all weeds are harmful, but some can overtake and damage the garden if not removed. Regularly checking for and removing these "weeds" (polyps) can prevent them from becoming a bigger problem (cancer).

In the case of colorectal cancer, the pathology often begins with a benign adenomatous polyp that, over time, undergoes genetic changes (mutations) leading to uncontrolled cellular growth. This process can eventually lead to malignancy. Regular screenings like colonoscopies allow for the detection and removal of polyps before they can progress to cancer.

 

✘Incorrect answer options:

He has had duodenal ulcers. While duodenal ulcers indicate issues within the gastrointestinal tract, they are not directly linked to an increased risk of colorectal cancer. Duodenal ulcers are primarily associated with Helicobacter pylori infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and their pathophysiology is different from that of colorectal cancer.

He has experienced significant weight gain. Obesity is indeed a risk factor for colorectal cancer. However, weight gain in itself is a more general health concern and, without more specific information linking it to other risk factors (like changes in diet, decreased physical activity, or metabolic changes associated with obesity), it's not as directly indicative of colorectal cancer risk as a history of colon polyps.

He has suffered from hemorrhoids. Hemorrhoids are swollen veins in the lowest part of the rectum and anus and are often the result of straining during bowel movements or the increased pressure on these veins during pregnancy, among other causes. While they can be painful and cause discomfort, they are not considered a risk factor for colorectal cancer.

 

References

• American Cancer Society. (2020). Colorectal Cancer Risk Factors.
• National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Definition & Facts for Peptic Ulcers (Stomach Ulcers).

EXPLANATION

 

✔Correct answer:

Hemorrhage. The primary reason Nurse Tom advises the client to avoid using a sitz bath immediately (until at least 12 hours) after a hemorrhoidectomy is to prevent the risk of hemorrhage. The warmth of the water in a sitz bath can cause vasodilation, which increases blood flow to the area. While this can be beneficial for healing and pain relief later in the recovery process, in the immediate postoperative period, it can also potentially lead to increased bleeding from the surgical site. By waiting at least 12 hours, the risk of disrupting the clots that have formed and causing excessive bleeding is reduced.

Think of the surgical site as a fresh repair on a water hose. If you run water through the hose too soon, the pressure might cause the repair to leak. Similarly, immersing the surgical area in a sitz bath too soon after surgery might increase blood flow to the area too much, potentially leading to bleeding.

During a hemorrhoidectomy, blood vessels are cut and then closed off to remove the hemorrhoids. After the surgery, the body starts the healing process, which includes forming blood clots at the sites of the cut vessels to stop bleeding. Introducing heat to the area too soon can promote vasodilation, increasing blood flow and potentially dislodging these clots before they are stable, leading to hemorrhage. After an appropriate amount of time has passed, the risk decreases as the clots become more stable and the initial phases of healing progress.

 

✘Incorrect answer options:

Urinary retention. While urinary retention can be a complication after a hemorrhoidectomy, it is not directly related to the use of a sitz bath. Urinary retention is more commonly associated with the anesthesia used during the procedure or with pain and muscle spasms after the surgery.

Constipation. Constipation can be a concern after hemorrhoidectomy due to the pain and the reluctance of the patient to have a bowel movement, which can cause straining and stress on the surgical site. However, it is not specifically related to the use of a sitz bath soon after the operation.

Rectal spasm. Rectal spasms (anal spasms) can occur after hemorrhoid surgery due to pain, inflammation, or irritation in the anal area. While a sitz bath is often recommended to help relieve these symptoms, avoiding it immediately after surgery is not specifically targeted at preventing rectal spasms but rather at preventing hemorrhage.

 

References

• Beck, D. E., Roberts, P. L., Saclarides, T. J., Senagore, A. J., Stamos, M. J., & Wexner, S. D. (2014). The ASCRS Textbook of Colon and Rectal Surgery. Springer.
• Rivadeneira, D. E., Steele, S. R., Ternent, C., Chalasani, S., Buie, W. D., & Rafferty, J. L. (2011). Practice parameters for the management of hemorrhoids (revised 2010). Diseases of the Colon & Rectum, 54(9), 1059-1064.

EXPLANATION

 

✔Correct answer:

Having gone through three pregnancies with vaginal deliveries. Pregnancy, particularly experiencing multiple pregnancies with vaginal deliveries, is a significant risk factor for the development of hemorrhoids. During pregnancy, the enlarged uterus puts pressure on the veins in the pelvic and rectal areas. Hormonal changes also cause the blood vessels to relax and swell. The straining during vaginal delivery can also exacerbate the condition, making hemorrhoids more likely or more severe.

Think of traffic on a highway (blood flow in veins). During pregnancy, the increased size of the uterus is like a roadblock that slows down traffic, causing a buildup of cars (blood) behind it. This buildup increases pressure in the veins, just like more cars increase pressure on a particular section of the highway.

Hemorrhoids are essentially varicosities (swollen veins) in the rectum and anus. The increased pressure in the pelvic and rectal areas during pregnancy, coupled with the efforts and straining during vaginal delivery, can lead to the swelling of these veins, resulting in hemorrhoids.

 

✘Incorrect answer options:

Her age. While the risk of hemorrhoids does increase with age due to the weakening of the tissues that support the veins in the rectum and anus, it's not as directly impactful as the physical strain and hormonal changes associated with pregnancy and childbirth.

The presence of varicosities in her legs. Varicose veins in the legs indicate a predisposition to circulatory problems, which might suggest a general weakness in the venous walls and valves. However, this is not as direct a cause of hemorrhoids as the physical and hormonal changes experienced during pregnancy.

Her occupation as a school teacher. Prolonged standing or sitting can contribute to the development of hemorrhoids by increasing pressure in the lower extremities and the pelvic area. However, this factor is typically less significant than the physiological changes and pressures experienced during pregnancy and childbirth.

 

References:

• Staros, E. B., & Kellerman, R. (2020). Hemorrhoids. In Primary Care: A Collaborative Practice (5th ed., pp. 563-567). Elsevier Health Sciences.
• Beck, D. E., & Wexner, S. D. (2020). Fundamentals of Anorectal Surgery. Springer.

EXPLANATION

 

✔Correct answer:

Lying on the side (Side-lying). After a hemorrhoidectomy, positioning the patient in a side-lying position is most beneficial for promoting comfort and healing while minimizing pressure on the surgical site. This position helps to reduce swelling and pain by decreasing the direct pressure and pooling of blood at the site of the surgery. It also facilitates drainage, if needed, and minimizes the risk of complications such as bleeding and infection.

Think of the surgical site like a fresh bruise. When you have a bruise, you try not to press on it because it's tender and pressure can make it hurt more. Lying on your side after a hemorrhoidectomy is like carefully choosing a position in bed to avoid putting direct pressure on a bruise, ensuring you don't aggravate it and allowing it to heal.

The side-lying position helps in reducing venous pressure in the rectal area, which is particularly beneficial after hemorrhoidectomy to minimize swelling and discomfort. It also helps in avoiding direct pressure on the surgical site, promoting better blood flow for healing and reducing the risk of complications.

 

✘Incorrect answer options:

Trendelenburg's position. This position, where the body is laid flat on the back (supine) with the feet higher than the head, is not ideal post-hemorrhoidectomy. It is generally used in situations where improved venous return to the heart is needed. In the case of hemorrhoidectomy, it might increase pressure in the pelvic area, exacerbating pain and swelling at the surgical site.

Lying on the back (Supine). Lying on the back puts direct pressure on the rectal and anal area, which can be very uncomfortable and may impede healing after hemorrhoidectomy surgery. This position can increase pain, swelling, and the risk of bleeding.

Sitting up at a high angle (High Fowler’s). While this position may be used at certain times, especially during meals or certain activities, it's not ideal for prolonged periods immediately after hemorrhoidectomy. Sitting up puts pressure on the perineal and rectal areas, which can aggravate pain and swelling and may disrupt the healing process.

 

References:

• Beck, D. E., & Wexner, S. D. (2020). Fundamentals of Anorectal Surgery. Springer.
• Cleveland Clinic. (2020). Hemorrhoid Surgery: Home instructions.

EXPLANATION

 

✔Correct answer:

Induces coagulation (clumping) of proteins in the cells of the perianal skin or the lining of the anal canal. Witch Hazel is known for its astringent properties due to the presence of tannins. When applied to the skin, it causes proteins to coagulate, leading to the constriction of body tissues. This action reduces bleeding from minor abrasions, tightens and soothes the skin, and can reduce inflammation and irritation, making it a common ingredient in treatments for conditions like hemorrhoids and minor skin irritations.

Think of Witch Hazel like a gentle "shrink wrap" for your skin. Just like shrink wrap can tighten and secure the contents of a package, Witch Hazel tightens and firms up the skin, reducing swelling and creating a protective barrier.

The astringent properties of Witch Hazel are primarily due to the tannins it contains, which have the ability to precipitate proteins and tighten tissues. When applied to the perianal skin or the lining of the anal canal, Witch Hazel reduces swelling and secretion, which can be particularly soothing for irritated skin or hemorrhoids.

 

✘Incorrect answer options:

Inhibits the growth of bacteria and other microorganisms. While Witch Hazel can have some antimicrobial properties, it is not primarily used or recognized for its ability to inhibit the growth of bacteria and other microorganisms. Its main action is astringent, not antimicrobial.

Temporarily alleviates pain, burning, and itching by numbing the nerve endings. Witch Hazel does not have anesthetic properties to numb nerve endings. Its soothing effect on itching and burning is more due to its astringent and anti-inflammatory properties, not because it numbs the skin.

Leads to the disintegration of the outer layers of skin or other tissues. Witch Hazel does not cause the disintegration of skin or other tissues. It works to tighten and soothe the skin rather than causing any disintegration or peeling of the skin layers.

 

References:

• Thring, T. S., Hili, P., & Naughton, D. P. (2011). Anti-collagenase, anti-elastase and anti-oxidant activities of extracts from 21 plants. BMC Complementary and Alternative Medicine, 11, 50.
• MacKay, D. (2001). Hemorrhoids and varicose veins: A review of treatment options. Alternative Medicine Review, 6(2), 126-140.

EXPLANATION

 

✔Correct answer:

Advising to avoid straining during bowel movements. Nurse Thomas's advice to avoid straining during bowel movements is an important part of managing discomfort caused by hemorrhoids. Straining can increase pressure in the lower rectum, aggravating hemorrhoids and potentially causing them to swell more. This advice aligns well with the overall management plan for hemorrhoids, which aims to reduce the pressure and strain on the rectal area.

Think of a water balloon being squeezed at the neck. The more pressure you apply, the more the balloon expands at the bottom. Similarly, straining during bowel movements increases pressure in the veins of the lower rectum, causing hemorrhoids to swell and become more painful.

Hemorrhoids are swollen veins in the rectum and anus that can cause discomfort, itching, and bleeding. Straining during bowel movements increases venous pressure, leading to or worsening existing hemorrhoids. By avoiding straining, individuals can reduce the pressure on these veins, helping to manage symptoms and promote healing.

 

✘Incorrect answer options:

Suggesting the use of silk undergarments for comfort. While wearing comfortable, loose-fitting clothing can help avoid additional irritation to hemorrhoids, the specific recommendation of silk undergarments is not substantiated by evidence as a standard management strategy for hemorrhoids. More commonly, cotton undergarments are recommended because they are breathable and less likely to cause irritation or increase moisture in the affected area.

Recommending a diet low in roughage to ease bowel movements. This advice is actually contrary to what is typically recommended. A diet high in fiber (roughage) is usually recommended to ensure soft stools and regular bowel movements, which help prevent straining and reduce pressure on hemorrhoids during defecation.

Recommending the use of a sitz bath, but for a duration of 30 minutes. While sitz baths are often recommended for the treatment of hemorrhoids to help relieve pain, itching, and muscle spasms, the typical duration advised is around 10-15 minutes. Soaking for too long (30 minutes) can lead to increased moisture in the anal area, potentially leading to irritation or an increased risk of infection.

 

References:

• Stewart, D. B., & Gaertner, W. (2020). Hemorrhoids. In J. L. Rombeau, R. D. Madoff, & T. E. Fleshman (Eds.), Diseases of the Colon (pp. 341-356). Springer.
• Mayo Clinic. (2020). Hemorrhoids: Diagnosis & treatment.