Our Lady of Fatima University

College of Nursing

Regalado, Quezon City

Anal Fistula

A Case Presentation presented

To the faculty of the

College of Nursing

By:

GROUP 23

Ms. Rachel Anne Sarmiento, RN, MAN(C )

MS1 Lecturer

March 2011

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 Table of Contents

I. INTRODUCTION……………………………………………………………………………………………………… 3
II. GENERAL OBJECTIVE……………………………………………………………………………………………… 5
III. PATIENT’S PROFILE…………………………………………………………………………………………………. 6
IV. PATIENT’S HISTORY…………………………………………………………………………………………………. 7
a. Past health history
b. Present health history
c. Family health history
V. ACTIVITIES OF DAILY LIVING…………………………………………………………………………………….. 8
VI. PHYSICAL ASSESSMENT…………………………………………………………………………………………… 9
VII. LABORATORY FINDINGS…………………………………………………………………………………………...14
VIII. ANATOMY AND PHYSIOLOGY OF THE ORGAN INVOLVED………………………………………………..21
IX. PATHOPHYSIOLOGY…………………………………………………………………………………………………28
X. DRUG STUDY………………………………………………………………………………………………………….31
XI. NURSING CARE PLAN……………………………………………………………………………………………….35
XII. COURSE IN THE WARD………………………………………………………………………….………………….39
XIII. DISCHARGE PLAN…………………………………………………………………………………………………….40
XIV. INDEX…………………………………………………………………………………………………………………….42
XV. CURRICULUM VITAE…………………………………………………………………………………………………43

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 I. INTRODUCTION

Anal fistula is a small tunnel that forms under the skin and connects to a previously infected anal
gland to the skin on the buttocks outside the anus. It is usually a result of an infection that may have
developed from trauma, fissures and regional enteritis. It is a tiny channel or tract that develops in the
presence of inflammation and infection. It is associated with an abscess as a result of the infection. If
the opening of the fistula seals over before the fistula is cured, an abscess will develop behind it and
this will lead to an opening may be or may not be of another tunnel. The patient will then feel the
irritation of skin around the anus, drainage of pus that relieves the pain, fever, and feeling poorly in
general.

In our patient’s case, he just had a recurring abscess that led to a fistula. Two months prior to his
check up, he felt a small mass just at the margin line of his anus. After a couple of days, the mass had
just ruptured with the release of pus and some blood. And after a couple of days without applying any
medications, the wound become dry without him knowing that the fistula is worsening. It created a
fistula, forming a tunnel at the time of his check up last December 24, 2011. The doctor then advised
him to undergo fistulectomy.

Fistulectomy or the excision of the fistulous tract is the recommended procedure for surgery. The
lower bowel is evacuated thoroughly with several prescribed enema. It usually involves opening up the
fistula tunnel. Often this will require cutting a small portion of the anal sphincter, the muscle that
helps to control bowel movements. Joining the external and internal openings of the tunnel and then
allowing it to heal from the inside out.
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 Our patients have just undergone fistulectomy last January 9, 2011. One day prior to surgery, he
signed a consent regarding the surgical procedure. Preoperative procedures were done like NPO post
midnight, laboratory tests and pre operative medications. All laboratory tests were on normal results,
therefore the patient is already subjected to undergo fistulectomy. And at 800H patient was transferred
to operating room and surgical procedure was done. And Post operative care was done until patient was
discharged.

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 II. OBJECTIVES

This study was done with the following objectives:

GENERAL OBJECTIVE:

To have in depth understanding of the disease process and nursing management on Anal Fistula.

SPECIFIC OBJECTIVES:

1. To identify possible risk factors that may have contributed to the development of Anal Fistula.

2. To fully understand the etiology, predisposing factor, pathophysiology, diagnosis, sign and
symptoms of Anal Fistula.

3. To identify measures that could minimize the risk of occurrence of the Anal Fistula.

4. To elucidate and discuss the anatomy and physiology of the organs involve in the disease process of
Anal Fistula.

5. Perform a comprehensive assessment on a patient with Anal Fistula.

6. To have in depth analysis of disease process of Anal Fistula.

7. To have plan and implement nursing interventions to patient having Anal Fistula.

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 III. PATIENT PROFILE

General Information

Name: Mr. F.D.B.

Age: 36 years old

Gender: Male

Date of Birth: November 2, 1974

Place of Birth: Cebu City

Religion: Roman Catholic

Admission Date: January 9, 2011 Time: 1500H

Discharge Date: January 11, 2011 Time: 1600H

Chief Complain: “Sumasakit ang tumbong ko lapag umuupo ako” as verbalized by the
patient.

Reason for Visit: The patient visited because he noticed that there were two unidentified mass in his
anus.

Source of Information: Patient

Admission Diagnosis: Anal Fistula

Admitting physician: Dr. Sandoval

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 IV. PATIENT’S HISTORY

Present History:

2 months prior to admission, patient noted two pea sized mass at the anus, associated with pain
sitting. No other assessed signs and symptoms. No consult done and no meds taken. 1 month prior to
admission, still sitting with mass at the anus, patient also noted a yellowish discharge with blood.
Patient then sought consult at his private doctor and he was scheduled for fistulectomy. Patient was
admitted to the institution.

Past medical history:

The patient has no history of being hospitalized due to any diseases. He did not have a history of
hypertension, DM and cancer. He also has no allergies to any foods and drugs. He is taking vitamin
supplements like Strestabs and Potencee for protection against nay illness. He does not have the
complete immunization.

Family History:

Both on parent’s side have no history of hypertension, diabetes mellitus, cancer and asthma.

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 V. ACTIVITIES OF DAILY LIVING

Activity Before During Analysis

hospitalization hospitalization
Nutrition
Diet No restriction  ORNPO for the Post operative recovery
first 24 hours
 DATEDCF To check for the presence of
continuous bleeding in the site.
Elimination
Urination Regular every 2 Regular every 2 hours
hours
Bowel Painful No bowel movement Before: because of the presence
movement of fistula
During: post op recovery to the
surgical site.
Rest and sleep
Number of 6-8 hours 2-3 hours Before: he can get regular sleep
hours sleep During: he cannot get regular
sleep because he is still under
observation. Nurses need to take
his vital signs and administer
meds.
Naps 30 minutes-1 hour
Substance use
Smoking and 5 sticks a day N/A He cannot smoke or drink
Alcohol 2-3X a week because it may alter the effects of
medications
others N/A N/A N/A
Sexual Activity
2-3X a week none Limited activity in the hospital.

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 VI. PHYSICAL ASSESSMENT

Body part Technique used Findings Interpretation and

analysis
Mental
Asking question Responsive to all the Cooperative, able to follow
questions being asked. instruction,
understandable. Clear
tone and inflection

Anthropometric measurements
Height By the used of 5’7”
measuring stick

Weight By the used of weighing 76 kg

scale

Vital signs
Temperature Thermometer 37.6˚C Within normal range

Pulse Rate Counting 86bpm Within normal range

Respiratory Rate Counting 20 cpm Within normal range

Blood Pressure Sphygmomanometer 110/70 mmHg Within normal range

and Stethoscope

Head
Hair Inspection Evenly distributed thick Presence of dandruff
hair with scales in scalp
Eyes Inspection, penlight The pupil dilates to light Good eye reaction.

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 Checked the 6 occular and has good 6 occular
movements. movements
Vision Interview and asked The patient has good Indicates that patient has
patient to read in vision and is not wearing good vision.
distance any eyeglasses.
Ears and hearing Inspection ask patient The patient’s ears are Normal
to repeat the words I
symmetrical. And the
say
patient is able to repeat
the words I said.
Nose and sinuses Inspection and asked No discharges found. The Normal
patient to identify
patient is able to identify
different scents.
different scents.
Mouth,teeth, lips and Inspection 28 pcs of teeth, no
tongue dentures used. Tongue is
not inflamed.
Face Inspection Symmetrical, oily skin in Normal
the face, scar on the left
eyebrow.
Neck
Muscles Inspection Muscles are in equal size, normal.
coordinated movement
with no discomforts.
Lymph nodes Palpation No lymph nodes noted Normal
Trachea Inspection, palpation The trachea is firm and normal
intact.

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 Thyroid Inspection, palpation No tenderness, no masses normal
Chest and Back
Skin Inspection Light brown in color, no Normal
lesions, with stretch
marks on the side of the
breast.
Thorax and Back Inspection, auscultation Good breath sounds. Normal
Breast and axillae Inspection and palpation Breast is even with the Normal
chest wall.

Abdomen
Inspection, palpation Normal

Genitals
Interview No problem with the The patient is suffering
genitourinary tact. pain his anal part due to
The anal is part is the presence of pus and
painful. fistula.
Upper extremities
Hands Inspection, Nails are intact, no
swellin of hands.
Sensitivity of muscles Applied sharp object in The patient is able to Indicates good circulation
biceps and observed the determine which object is in the site.
response of his muscle sharp and blunt.
Flexes Asked patient to flex his He is able to flex his arms Good flexes
arms.
Lower extremities

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 Feet Inspection The palms of feet are Normal
callous, no wound seen.
Nails are intact with a
good capillary refill. No
swelling.
Sensitivity of muscles Applied sharp object and The patient is able to Indicates good circulation
observed the response of determine which object is in the site.
his muscle and asked if it sharp and blunt.
is blunt or sharp.
Flexes Asked patient to flex his He is able to flex his knee Motion is affected
knee. in 45 degree angle. because there is pain in
the site of surgery that
affects the lower part of
the body.
Gait and Balance Asked patient to sit. He is able to sit but needs Balance is affected
support because there is pain in
the site of surgery that
affects the lower part of
the body.

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 VII. LABORATORY FINDINGS

A. ECG

Done on: January 4, 2011 QRS: Axis

Rhythm: Linus PR: 0.16 secs

Rate Atrial: 65 bpm QRS: 0.06 secs

Rate ventricular position: QT: 0.28 secs

ECG interpretation: Normal sinus rhythm

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 B. Chest X-ray
Done on: January 4, 2011
Results:
Clear lung fields.
Heart is not enlarged.
Hemidiaphragm and sulci are intact.
Dextroscoliosis of the thoracic spine.

C. Clinical Chemistry

Done on: January 9, 2011

Result Normal Values

Fasting 3.34-6.12 mmol/L
blood sugar N/A
Blood urea N/A 2.50-6.43 mmol/L
nitrogen
Creatinine:
Male N/A 79.6-132.6 mmol/L
Blood uric N/A
acid 0.201-0.413 mmol/L
Male 0.142-0.336 mmol/L
Total 4.97 mmol/L 3.63-6.12 mmol/L
cholesterol
Triglycerides 0.76 mmol/L 0.41-1.86 mmol/L

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 HDL 1.12 mmol/L 1.04-1.56 mmol/L
LDL 3.50 mmol/L 2.40-3.80 mmol/L
SGOT N/A 0.40 u/dl
SGPT N/A 0-38 u/dl
Sodium, Na 145.5 mmol/L 135-148 mmol/L
Potassium, 3.74 mmol/L 3.5-5.8 mmol/L
K
Chloride, Cl N/A 97-108 mmol/L
HBAIC N/A 4.1%-6.2%

 All of the results were normal in this laboratory tests and this shows that the patient is a
candidate for the surgical procedure. Other tests are not applicable.

Serum Test

Test Concentratio Result Normal Values

n
BS 4.99 mmol/L Normal 3.59-5.95
Glucose mmol/L
BS 96.6 umol/L Normal 62.1-133.3
Creatinin umol/L
e
BS Uric 368.0 umol/L Normal 210.0-420
Acid umol/L
BS SGOT 44.03 u/L Normal Less than 47.33
u/L

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 BS SGPT 24.95 u/l Above the 10.00-17.33 u/L
normal level

As far as we see in the serum test, Glucose, Creatinine, Uric Acid, SGOT have normal results.
Above the normal level of the SGPT may be an indication of a liver problem.

D. Macroscopic Examination

Results Normal values

Color Dark yellow Straw amber
Transparency Slightly turbid Clear
Reaction Acidic Acidic or alkaline
Specific Gravity 1.015 1.005-1.025
Sugar Negative Negative
Protein Negative Negative

RBC 0-1/hpf 0-1 /hpf

Pus Cells 6-8/hpf 0-2 /hpf
Squamous Few
Epithelial Cells
Renal Epithelial N/A
Cells
Amorphous N/A
Urates/Phosphate
s
Mucous Threads Few

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 Bacteria Few Negative or Rare

 The color, the transparency, the pus cells have abnormal results than the other
examination.
 The result of the Bacterial in the patient examination was few so the bacterial in urine
sediment reflect genital urinary tract infection or contaminated of external genital.

E. Complete Blood Count

Result Normal Values

Hemoglobin
Male: 148.0 g/L 140-180 g/L
Hematocrit
Male: 0.44 g/L 0.42-0.54 g/L
WBC
Male: 6.5 g/L 5.0-10.0x10 g/L

Differential Result Adult

Count
Segmenters 0.60 50-65%
Lymphocytes 0.31 25-40%
Monocytes N/A 3-9%
Eosinophils 0.09% 1-3%

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 Stab N/A 2-5%
Basophiles 0-1% 0-1%

Complete blood count- blood count that includes separates count for red and white blood cells.
Hemoglobin- in the red blood cells of the normal human adult that consists of two alpha chains
and the two beta chains.
Hematocrit- determines the percentage of RBC in the plasma.
White Blood Cells- also produced, transport, and distribute antibodies as part of the body’s
immune response.
 The results for the hemoglobin, hematocrit, and WBC have a normal finding.
 In other differential count like Eosinophils this is the only have abnormal findings, than
other differential count results.

F. Hematology

Examination Normal Values Results

PT 10.4-12.6 sec 11.6 sec
% Activity 70-130% 103%
JNR N/A 0-89
Control N/A 11.4 sec
PTT 28-36 sec 22.7 sec
Control N/A 26.9 sec

Hematology- that deals with the blood and blood performing organs.

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  At the hematology examination the PT, % Activity have a normal result than the PTT examination
which have a abnormal result, so the PTT has a decreased level than the other examination of our
patient.

VIII. ANATOMY AND PHYSIOLOGY

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 Figure 1 The anatomy of digestive system

The Digestive Process:

The start of the process - the mouth: The digestive process begins in the mouth. Food is partly broken

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 down by the process of chewing and by the chemical action of salivary enzymes (these enzymes are
produced by the salivary glands and break down starches into smaller molecules).

On the way to the stomach: the esophagus - After being chewed and swallowed, the food enters the
esophagus. The esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic,
wave-like muscle movements (called peristalsis) to force food from the throat into the stomach. This
muscle movement gives us the ability to eat or drink even when we're upside-down.

In the stomach - The stomach is a large, sack-like organ that churns the food and bathes it in a very
strong acid (gastric acid). Food in the stomach that is partly digested and mixed with stomach acids is
called chyme.

In the small intestine - After being in the stomach, food enters the duodenum, the first part of the small
intestine. It then enters the jejunum and then the ileum (the final part of the small intestine). In the small
intestine, bile (produced in the liver and stored in the gall bladder), pancreatic enzymes, and other
digestive enzymes produced by the inner wall of the small intestine help in the breakdown of food.

In the large intestine - After passing through the small intestine, food passes into the large intestine. In
the large intestine, some of the water and electrolytes (chemicals like sodium) are removed from the food.
Many microbes (bacteria like Bacteroides, Lactobacillus acidophilus, Escherichia coli, and Klebsiella) in the
large intestine help in the digestion process. The first part of the large intestine is called the cecum (the
appendix is connected to the cecum). Food then travels upward in the ascending colon. The food travels

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 across the abdomen in the transverse colon, goes back down the other side of the body in the descending
colon, and then through the sigmoid colon.

The end of the process - Solid waste is then stored in the rectum until it is excreted via the anus.

Parts of the digestive system:

abdomen - the part of the body that contains the digestive organs. In human beings, this is between the
diaphragm and the pelvis
alimentary canal - the passage through which food passes, including the mouth, esophagus, stomach,
intestines, and anus.
anus - the opening at the end of the digestive system from which feces (waste) exits the body.
appendix - a small sac located on the cecum.
ascending colon - the part of the large intestine that run upwards; it is located after the cecum.
bile - a digestive chemical that is produced in the liver, stored in the gall bladder, and secreted into the
small intestine.
cecum - the first part of the large intestine; the appendix is connected to the cecum.
chyme - food in the stomach that is partly digested and mixed with stomach acids. Chyme goes on to the
small intestine for further digestion.
descending colon - the part of the large intestine that run downwards after the transverse colon and
before the sigmoid colon.
digestive system - (also called the gastrointestinal tract or GI tract) the system of the body that processes
food and gets rid of waste.

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 duodenum - the first part of the small intestine; it is C-shaped and runs from the stomach to the jejunum.
epiglottis - the flap at the back of the tongue that keeps chewed food from going down the windpipe to
the lungs. When you swallow, the epiglottis automatically closes. When you breathe, the epiglottis opens
so that air can go in and out of the windpipe.
esophagus - the long tube between the mouth and the stomach. It uses rhythmic muscle movements
(called peristalsis) to force food from the throat into the stomach.
gall bladder - a small, sac-like organ located by the duodenum. It stores and releases bile (a digestive
chemical which is produced in the liver) into the small intestine.
gastrointestinal tract - (also called the GI tract or digestive system) the system of the body that processes
food and gets rid of waste.
ileum - the last part of the small intestine before the large intestine begins.
intestines - the part of the alimentary canal located between the stomach and the anus.
jejunum - the long, coiled mid-section of the small intestine; it is between the duodenum and the ileum.
liver - a large organ located above and in front of the stomach. It filters toxins from the blood, and makes
bile (which breaks down fats) and some blood proteins.
mouth - the first part of the digestive system, where food enters the body. Chewing and salivary enzymes
in the mouth are the beginning of the digestive process (breaking down the food).
pancreas - an enzyme-producing gland located below the stomach and above the intestines. Enzymes from
the pancreas help in the digestion of carbohydrates, fats and proteins in the small intestine.
peristalsis - rhythmic muscle movements that force food in the esophagus from the throat into the
stomach. Peristalsis is involuntary - you cannot control it. It is also what allows you to eat and drink while
upside-down.

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 rectum - the lower part of the large intestine, where feces are stored before they are excreted.
salivary glands - glands located in the mouth that produce saliva. Saliva contains enzymes that break
down carbohydrates (starch) into smaller molecules.
sigmoid colon - the part of the large intestine between the descending colon and the rectum.
stomach - a sack-like, muscular organ that is attached to the esophagus. Both chemical and mechanical
digestion takes place in the stomach. When food enters the stomach, it is churned in a bath of acids and
enzymes.
transverse colon - the part of the large intestine that runs horizontally across the abdomen.

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Page | 25
 Figure 2. External anatomy of the anus
Figure 3. Internal anatomy of the anus

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 Figure 4. Anatomy of anal fistula

IX. PATHOPHYSIOLOGY

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 Usually, every abscess opens one day or the other and lets out the pus. Sometimes it needs

surgical intervention to drain, especially when it is deep. In any case, if it doesn’t heal up properly or

if it is not properly drained after letting out the pus then it will usually remain as infecting foci and

suppurates. Also this will constantly or intermittently discharge pus or fluid through the

outlet/tract. In due course, this tract gets lined with granulation tissue which resists healing (joining

the other surface). Fistula’s length and openings (internal and external) usually vary in size and

number according to the location of the abscess and care taken over it. Usually, the fistula tract will

be a curved one. Untreated fistula or clogged outlet of fistula (due to infection or draining debris

obstruction) will usually promote multiple internal/external openings with recurrent anal abscess

and re-formation of tract or tunnel.

Non – modifiable Modifiable

Age: Hygiene

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 Gender Practices

Infection of rectal
Area

Forming abscess lets

Out the pus

Remain as infecting foci

&

Discharge pus in fluid

through
The outlet/tract

Formation of fistula or
Abnormal path way

Untreated fistula or
clogged outlet of fistula

Promote
internal/external
openings
With recurrent anal
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abscess &
Formation of tract or
tunnel
 Untreated fistula

Figure 5. The Pathophysiology of Anal Fistula

X. DRUG STUDY

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Generic/Brand Classification & Contraindication Dosage and Side effect Nursing responsibility
name Indication route

Mefenamic NSAIDS Contraindicated with 500 mg per Head ache,  Give with food or
milk to decrease
Acid/ Dolfenal hypersensitivity to tablet orally dizziness,
 Relief of moderate GI upset Take
mefenamic acid, rash, drug with food:
pain when do not take the
aspirin allergy and as sweating, dry
therapy will not drug or longer
treatment of mucous, GI than 1 week
exceed 1 week  Discontinue drug
perioperative pain upset, renal
and consult your
with coronary artery impairment, health care
bypass graft. bronchospasm provider if rash,
diarrhea or
digestive
problems occurs
 Report sore
throat, fever,
rash, itching,
weight gain,
swelling in ankles
or finger, changes
in vision, severe
diarrhea, right
upper abdominal
pain
Paracetamol / Analgesic (non- Contraindicated with 500 mg per Headache,  Do not exceed the
recommended
Biogesic opiod) allergy in tablet orally chest pain,
dosage.
acetaminophen. dyspnea,  Reduce dosage
Anti-pyretic with hepatic
hepatic

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  Temporary toxicity, renal impairment
reduction fever,  Discontinue drug
failure,
temporary relief if hypersensitivity
of minor aches cyanosis, reactions occurs
and pains
rash, fever  Give drug with
food if GI upset
occurs
 Take the drug
only for
complains
indication; it is
not an anti-
inflammatory
agent
 Chew the
chewable tablets
before
swallowing;

Ketorolac Anti- pyretic Aspirin allergy, 3ml via IV Nausea and  Protect drug vials
from light
tromethamine / concurrent uses of vomiting,
Nonopiod Analgesic  Administering
Acular LS, NSAIDS; active peptic dizziness GI every 6 hours to
NSAIDS ulcer disease, recent pain, Renal maintain serum
levels and control

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  Short- term GI bleed or impairment, pain
management of  Every effort will
perforation, bleeding,
pain (up to 5 be made to
days) hypersensitivity to dyspnea, administer the
drug on time to
ketorolac as hempotysis,
control pain,
prophylactic pheriperal dizziness,
drowsiness, can
analgesic before edema, local
occur
major surgery. burning  Burning and
stinging on
application
 Report sore
throat, fever,
rash, itching,
weight gain,
swelling in ankles
or finger, change
of vision

Nalbuphine Opiod agonist- Contraindicated with 10 ml via Iv Sedation,  Reassure patient

about addiction
hydrochloride / antagonist analgesic hypersensitivity to clamminess,
liability, most
Nubain nalbuphine sulfites sweating, patient who
 Relief of receive
moderate to pruritus, dry
severe pain mouth,
 Preoperative

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 analgesic, as a hypotension,
supplement to
urinary
surgical
anesthesia urgency,
respiratory
depression,
dyspnea

Hemostan Anticoagulant 1g via IV GI disorder,  Not advisable to

use for prolonged
Biomedis / every 4 hours nausea and
Hemostatics periods in
Tranexemic acid for 3 days vomiting, patients
 For general predisposed to
headache,
surgeries Post thrombosis.
impaired  Not recommended
operative
medication renal,hypotens for prophylaxis
during pregnancy
ion & before delivery

XI. NURSING CARE PLAN

Problem # 1: Acute Pain

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

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 Subjective: Acute pain After 8 hours of Independent: After 8 hours of
related to fistula nursing  Encourage  May try to nursing
“ Sumasakit ang and abscess intervention, the patient to tolerate rather intervention, the
tumbong ko ‘pag formation as patient’s pain report pain to request pain patient’s pain
umuupo ako at evidenced scale will reliever scale was
masakit din ‘pag presence of pus, decrease from  Encourage  May promote decreased from
dumudumi ako”, irritability, 8/10 to 2/10. patient to sense of 8/10 to 2/10.
as verbalized by painfull assume control
the patient. defecation and position of  Goal was met
pain in the anal comfort
Objective: area when sitting
(pain scale of  Provide After 4-7 days of
 Pain scale of 8/10). After 4-7 days of comfort  Promotes nursing
9/10 nursing measures relaxation, intervention, the
 RR: 23 cpm intervention, the refocuses patient was able
 BP: 130/80 patient will be attention and to sit comfortably
mmHg able sit may enhance and defecate
 Temp: 36.8 C comfortably and coping abilities normally.
 PR: 98 bpm defecate  Provide  May decrease
 (+) irritability normally. plastic pain when  Goal was met
inflatable sitting
doughnut on
chair / bed
when sitting

 Provide sitz  May reduce

bath as pain and
appropriate discomfort

 Provide warm  Promotes

compress circulation

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 Collaborative:
 Implement  May prevent
prescribed constipation
dietary and straining
modifications
 Management
 Administer
for pain
pain reliever
 To prevent
 Give tool –
constipation
softener /
and straining
bulk laxatives

Problem #2: Constipation

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

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 Subjective: Constipation After 8 hrs. of Independent: After 8hrs. or
related to nursing nursing
“ Nahihirapan habitual denial / intervention, the  Encourage  Assist in intervention, the
akong dumumi ”, ignoring of urge patient will the patient to improving stool patient
as verbalized by to defecate as establish or increase fluid consistency established or
the patient. manifested by (+) return to normal intake returned to
 High-fiber diet
hard stool, (+) patterns of bowel normal patterns
 Instruct the helps in easy
straining w/ functioning of bowel
patient to eat defecation
Objective: defecation, (+) functioning.
higf-fiber
abdominal  To prevent  Goal was met
 (+) hard stool tenderness rich foods.
straining
 (+) straining Collaborative:
w/ defecation  Fiber resists
 (+) abdominal  Administer enzymatic
tenderness laxatives / digestion and
stool-softener absorbs liquids
in its passage
 Consult w/ along the
dietician to intestinal tract
provide well- and thereby
balanced produces bulk,
diet, high in w/c acts as a
fiber and stimulant to
bulk. defecation

Problem # 3: Self care deficit

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 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Independent:

“ wala na kasi Self-care deficit After 1 hr of  Teach the  To prevent After 1 hr. of
akong oras related to inability nursing patient the infection nursing
minsan para to carry out intervention, the importance of intervention, the
makapaglinis ng proper toilet patient will be proper toilet patient was able
katawan dahil sa hygiene as able to perform hygiene to verbalized the
 To promote
trabaho ko e ”, as manifested by (+) the proper toilet importance of
 Discuss to disease
verbalized by the rectal abscess hygiene. proper toilet
the patient the prevention
patient. hygiene.
proper toilet
hygiene.  Goal was
met
Objective:

 (+) infection
 (+) rectal
abscess
 (+) pus

XII. COURSE IN THE WARD

Day 1

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  A 36 years old male was admitted at exactly 3:00PM last January 04, 2011, accompanied by his
wife
 Chief complaint of pain in his anus.
 He was admitted under the service of Dr. Sandoval.
 The following orders were given:
 Diet as tolerated
 Vital signs monitoring
 The physician ordered a 5% Dextrose in Lactated Ringer’s Solution to be regulated at 30
gtts/min.
 Premedications administered via IVF
 At 12:00AM, the doctor ordered patient to be on NPO in preparation for the surgery.
Day 2
 Patient was transferred to the operating room via stretcher
 January 10, 2011 patient was transferred to the male surgery ward for recovery.
 Still to monitor Vital Signs every 15 minutes
 Maintain OR NPO to prevent further complications.
 Administered Nubain via IV to relief pain
 Administered Hemostan through IV to decrease risk for hemorrhage.
 All orders carried out that day
Day 3
 January 11, 2011 doctor ordered to remove anal jack and IVF.
 Diet as tolerated
 Due oral medications given:
 Mefenamic acid
 Cloxacillin for 7 days
 Patient discharged and all orders carried out.

XIII. DISCHARGE PLAN

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 M edication - continue medication as ordered by the doctor.

 Mefenamic acid (analgesic)- to relief pain, 500 mg

 Take immediately after meal.
 Cloxacillin (antibiotic)
 500 mg, 1 cap 4x a day
 Take on empty stomach- 1 hour before meal/ 2 hours after meal.
 Do not quit taking your medicines.
 Laxatives- to prevent straining.

E xercise- to maintain the proper circulation of the blood and a good condition.

 Ambulation
 Moderate exercise
 Avoid doing strenuous activity.
 Rest if necessary.

T reatment-will do a physical examination and medical history.

 Take the continous medicine by doctor’s order- ( mefenamic, cloxacillin).

 Follow-up check-up to monitor easily if there is further complications/ infections.
 Treating anal fistula as soon as possible gently may relieve your symptoms and help to resume the
activities.

H ealth Teaching- to be aware and know his responsibilities.

 Advise the patient to keep perineal care as dlean ad possible cy gently cleansing with warm water
and drying with absorbent cotton wipes.
 Instruct how to perform sitz bath.
-may be given in the bath tub or plastic sitz bath

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 - 3-4x each day

-should follow each bowel movement 1-2 weeks after surgery

 Comfortable clothing.
 Avoid stress; stress may low healing.
 Relax in a way of deep breathing exercise.
O pd- keep all appointments.

 Make a list of questions may you have for the next hospital visit.
 Do not stop taking medicines without first talking to your caregiver.
D iet

 Low fat/low cholesterol ( margay, peanuts, oil, vegetable).

 Avoid; butter, lard, sweets.
 High-fiber and protein, carbohydrates- for energy.
 Increase fluid intake to relieve constipation.
 Eating healthy foods may help you have more energy and heal faster.

S piritual/Support- to lessen depression/anxiety.

 Emotional support
 Prayer

XIV. INDEX

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 www.scribd.com/doc/19922021/Case-Study-Fistulectomy-Ppt -

www.fascrs.org/files/pp_0705.pdf

www.highbeam.com/doc/1G1-129362959.html 

en.wikipedia.org/wiki/Anal_fistula

www.absoluteastronomy.com/topics/Anal_fistula

XV. CURRICULUM VITAE

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 Ralph Kenneth B. Molo
Lot 13 Dahlia St. Almar Subd. Caloocan City
9054289228
+961 9610058
gangster_shit_2001@yahoo.com
Age: 21
Birthday: June 29 1980
Place of Birth: Quezon City
Height: 5’6”
Weight: 176 lbs
Religion: Roman Catholic
Status: Single

Elementary: St. Theresa School of Novaliches 1997-2003 S.Y.

High School: St. Theresa School of Novaliches 2003-2006 S.Y.

College: Our Lady of Fatima University 2006-2011 S.Y.

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 Jade Claire M. Morales
151 n Fabian Sabanal Compound,
Commonwealth Quezon City
09392577172
jclair_zmle@yahoo.com
Age: 20
Birthday: October 20 1990
Place of Birth: Ronda, Cebu
Height: 5’0”
Weight: 45
Religion: Roman Catholic
Status: Single

Elementary: Ronda Cebu Elementary School 1996-2002 S.Y.

High School: Our Lady Academy Inc. School 2002-2007 S.Y.

College: Our Lady of Fatima University 2007-2011 S.Y.

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 Libertine Naag
Blk 26 Lot 15 Citta Roma Subdivision
Gaya-gaya sjdm Bulacan
09066402339
naaglibertine@yahoo.com

Age: 21
Birthday: March 23, 1989
Place of Birth: Bicol, Oas Albay
Height: 5’1”
Weight: 105 lbs
Religion: Roman Catholic
Status: Single

Elementary: Commonwealth Elementary School 1996-2002 S.Y.

High School: Commonwealth High school 2002-2006 S.Y.

College: Our Lady of Fatima University 2007-2011 S.Y.

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 Minerva Jane Natividad
Blk 7 Lot 19 Solar Borban Homes North Ph.1
Bagumbong, Caloocan City
09352039320
mhimie_05@yahoo.com

Age: 22
Birthday: July 5, 1988
Place of Birth: Quezon City
Height: 5’4”
Weight: 110 lbs
Religion: Roman Catholic
Status: Single

Elementary: SSS Village Elementary School 1994-2001 S.Y.

High School: La Conciolacion College 2001-2005 S.Y.

College: Our Lady of Fatima University 2009-2011 S.Y.

Page | 46
 Veronica Anne S. Olivete
#6 Milton Hills St. John St. New Era, Quezon City
09053383111
09484680272
Vyakang@yahoo.com
Manika_na_puppet@yahoo.com

Age: 20
Birthday: June 3, 1990
Place of Birth: Quezon City
Height: 5’0”
Weight: 90 lbs
Religion: Roman Catholic
Status: Single

Elementary: NES Rosa L. Susano 1994-2003 S.Y.

High School: NHS Dońa Rosario Annex 2003-2007 S.Y.

College: Our Lady of Fatima University 2007-2011 S.Y.

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 John Derick Y. Pastrana
Blk 17 Lot 25 Ph.5 Lauan St. Corner Molave,
Pleasant Hills, SJDM Bulacan
386-75-17
09396417091
juandeck30@yahoo.com

Age: 19
Birthday: May 30, 1991
Place of Birth: Manila
Height: 5’6”
Weight: 143 lbs
Religion: Roman Catholic
Status: Single

Elementary: Lagro Elementary School 1994-2003 S.Y.

High School: Ramon Magsaysay High School 2003-2007 S.Y.

College: Our Lady of Fatima University 2007-2011 S.Y.

Page | 48
 Mary Ann R. Rebagoda
Evergreen Heights Ph.1 Subdivision
Barangay Gaya-gaya SJDM Bulacan
09396202656
mrebagoda@yahoo.com

Age: 19
Birthday: April 27, 1991
Place of Birth: Quezon City
Height: 5’5”
Weight: 110 lbs
Religion: Roman Catholic
Status: Single

Elementary: Ramon Magsaysay High School 1996-2008 S.Y.

Bagong Silang Elementary School 1998-2003 S.Y

High School: Kalayaan National High School 2003-2007 S.Y.

College: Our Lady of Fatima University 2007-2011 S.Y.

Page | 49
 Geovy P. Recoy
#5 Ph.3 Luzon Avenue Barangay Culiat, Quezon City
09392264699
deafcomposer@yahoo.com

Age: 24
Birthday: November 3, 1986
Place of Birth: Manila
Height: 5’3”
Weight: 110 lbs
Religion: Roman Catholic
Status: Single

Elementary: Union Elementary School 1994-2000 S.Y.

High School: Madrid National School 2003-2007 S.Y.

College: Our Lady of Fatima University 2007-2011 S.Y.

Page | 50
 Dexter B. Sanglay
#004 Ph. 111 Blk. & Lupang Pangako Barangay
Payatas B. Quezon City
09393512293
dexter_sanglay@yahoo.com

Age: 21
Birthday: December 14, 1989
Place of Birth: Quezon City
Gender: M
Height: 5’8”
Weight: 150 lbs
Religion: Born Again Christian
Status: Single

Elementary: Lupang Pangako Elementary 1994-2003 S.Y.

High School: Praise Emerald International 2003-2007 S.Y.

College: Our Lady of Fatima University 2007-2011 S.Y.

Page | 51
 Mark Paul T. Sulio
151 Virgo St. Panagarap Village,
Caloocan City
09166560363
bhezieverhad_14@yahoo.com

Age: 19
Birthday: June 23, 1991
Place of Birth: Quezon City
Gender: M
Height: 5’5”
Weight: 108 lbs
Religion: Roman Catholic
Status: Single

Elementary: University of La Salle 1994-2002 S.Y.

High School: University of La Salle 2003-2007 S.Y.

College: Our Lady of Fatima University 2007-2011 S.Y.

Page | 52
 Rodolfo S. Tan Jr.
# 58 Dońa Rosario Subdivision Novaliches,
Quezon City
418-13-67
09153537920
Rodolfo_sm_tan@yahoo.com

Age: 28
Birthday: November 19, 1982
Place of Birth: Cuyapo, Nueva Ecija
Gender: M
Height: 5’6”
Weight: 154 lbs
Religion: Roman Catholic
Status: Single

Elementary: San Agustine Elementary School

High School: DR. Ramon De Santos National

College: Our Lady of Fatima University

Page | 53
 Michael Talampas
# 40 Masikap St. Barangay
Pinyahan, Quezon City
09282150807
Tsubtsatagilidakin_26@yahoo.com

Age: 22
Birthday: September 26, 1988
Place of Birth: Quezon City
Gender: M
Height: 5’6”
Weight: 130 lbs
Religion: Roman Catholic
Status: Single

Elementary: Pinyahan Elementary School 1995- 2001 S.Y.

High School: Roosevelt College Quirino 2001-2005 S.Y.

College: Our Lady of Fatima University 2007-2011 S.Y.

Page | 54