ASSESSMENT Subjective: Wala pakoy libang-libang ky sakitan ko malibang as verbalized by patient

DIAGNOSIS Constipation maybe related to: Pain on defecation and reluctance to defecate

Objective: - Decrease frequency / amount of stool - Hard formed stool - Straining at stool

PLANNING After 8 hrs of nursing interventions, the patient will returns to normal pattern of bowel functioning with regular production of soft formed stool

INTERVENTION Independent: - Ascertain usual bowel habits

RATIONALE -Aids in identifying individual problem areas and appropriate intervention -Improves consistency of stool to facilitate defecation without straining -regular evacuation helps maintain softer stool -Discuss the importance of using high fiber foods and low roughage in the diet. E.g.; whole grain products -maintain soft stool by softening and adding bulk and moisture to stool to facilitate defecation

- Encourage minimum intake of 2,000 ml of fluid per day, within cardiac tolerance - Establish routine bowel habits and remind patient to held defecation urge - Discuss the importance of using high fiber foods and low roughage in the diet e.g.; whole grain products Collaborative: - administer stool softener as ordered e.g.; dulcolax, lactulose, and standardized sena concentrate

EVALUATION After 8 hours of nursing interventions, the patient was able to establish/ returns to normal pattern of bowel functioning with regular production of soft formed stool

ASSESSMENT Subjective: galisud ug sakitan ko malibang as verbalized by patient

DIAGNOSIS Acute pain may be related to inflammation and edema of prolapsed varices.

PLANNING After 8 hrs of nursing interventions, the patient will report feeling of lesser pain

INTERVENTION Independent: - encourage patient to report pain - Asses reports of abdominal cramping or pain, noting location, duration, intensity (010 scale). Investigate and report changes in pain characteristics. - note verbal cues such as restlessness, reluctance to move and abdominal guarding.

RATIONALE -May try to tolerate than request analgesics -changes in pain characteristics may indicate spread of disease or developing complications -body language/ non verbal cues may be both physiological and psychological and may be used in conjunction with verbal cues to determine the extent or severity of the problem. -may pinpoint precipitating or aggravating factors such as stressful events, food intolerance or to identify developing complications. -reduces abdominal relaxation, refocuses attention, and may enhance coping abilities.

EVALUATION After 8 hrs of nursing interventions, the patient was able to report feeling of lesser pain.

Objective: - Guarding behavior - Restlessn ess - Facial mask of pain

-review factors that aggravate or alleviate pain.

- encourage patient to assume measures

-Cleanse rectal area with mild soap and water or wipes after each stool and provide skin care. -Provide sitz bath as appropriate.

-protect skin from bowel acids, preventing excoriation. -enhances cleanliness and comfort in the presence of inflammation of varices.

Collaborative: - Implement prescribed dietary modifications. - For complete bowel rest and can reduce pain and cramping.

ASSESSMENT Subjective: wala ko kabalo nganong nakakuha ko ani nga sakit as verbalized by patient

DIAGNOSIS Knowledge deficit maybe related to: unfamiliar with information resources

PLANNING After 8 hrs of nursing intervention the patient will be able to correctly perform necessary procedures and explains reasons for the actions initiates necessary lifestyle changes and participates in treatment regimen.

INTERVENTION Independent: -Review cause of condition and prognosis -Encourage continuation of lowresidue diet with addition of roughage as tolerated and adequate fluid intake.

RATIONALE -Provides knowledge base on which patient can make informed choices. -Promotes formation of adequate amount/ soft formed stool to reduce occurrence of constipation and straining at stool. -Stimulates evacuation and should be use judiciously along with dietary, activity and fluid management in order to prevent dependence on laxatives or injury to incisional tissues. -Prevents liquid bowel movements (formed stool helps maintain lumens size of anal canal) and reduces painful peristalsis/ cramping).

EVALUATION After 8 hrs of nursing intervention the patient was able to correctly perform necessary procedures and explains reasons for the actions initiates necessary lifestyle changes and participates in treatment regimen.

Objective: -Questions; request for information -Statement of misconception -Inaccurate follow-through of instruction

-Discuss use of stool softeners, mild cathartics, suppositories, enemas.

-Encourage patient to avoid use of strong laxatives.

-Discuss activity limitations e.g.; avoidance of prolonged sitting/standing, heavy lifting, straining for stool.

-May help to prevent recurrence of hemorrhoids.

-Review incision care, e.g.; perianal cleansing, sitz bath when appropriate.

-Promotes healing, reduces risk of infection following hemorrhoidectomy. -Dilatation of pelvic blood vessels during sitz bath may result in hypotension and dizziness. -Early intervention may prevent more serious complications; e,g.; wound infection, anal stricture.

-Stress importance of exercising caution when exiting sitz bath

-Identifying symptoms requiring notification of health care provider e.g.; rectal bleeding, fever, local erythema, purulent drainage, ribbon-shape stool, inability to pass stool.

Interference
Hemorrhoids are simply varicose veins in the anal canal. They may come and go, and almost everyone has them at some time. They are very common in pregnancy. When they fade away, they may leave a telltale skin tag. They occur in two locations. Those occurring above the internal sphincter are called internal hemorrhoids, and those appearing outside the external sphincter are called external hemorrhoids. They cause itching, bleeding during bowel movements, and pain, internal hemorrhoids prolapse frequently through the sphincter and cause considerable discomfort. If the blood within them clots and becomes infected, they grow painful and are said to be thrombosed.