Question

M.L. is a 50-year-old male who presents to his primary care provider for a yearly physical. The patient has noticed a change in bowel movements. He states that his stools are dark-colored and that he has been passing gas more frequently. His last bowel movement was this morning prior to the office visit. He has no other complaints at this time. The patient has a past medical history of depression and hemorrhoids. Vital signs are T 97.5, P 85, R 16, and BP 110/55.

Respond to each question for the following scenario. Use rationale to support your responses.

1. What would be three (3) additional pieces of subjective information that the nurse should obtain?

2. Because the patient has anorectal complaints, the nurse calls upon knowledge of anatomy as the nurse works through possible causes of the symptoms. What are the major structures of the rectum? What patient position would best facilitate an examination of the rectum? Use complete sentences and provide rationale.

3. Considering the patient's age and presenting complaints, what would be included in the subsequent evaluation (screening and diagnostic)? Provide at least four (4) examples, with proper rationale.

4. What health promotion concepts should the nurse teach this patient in light of his age and presenting complaints? Provide at least three (3) examples with rationale.

Answer 1

1. History about

• Food pattern
• Using any medication
• Habits - smoking or alcoholism

2. Rectal ampulla : Expanded section and feces are stored there.

Rectus is connected to the sigmoid colon

Anal canal is the distant part of rectum

Left lateral position

Used for easy viewing of rectum and anal canal.

3. Stool studies to rule out characteristics of blood

Rectoscopy : visualisation of rectum and anal canal.

Anoscopy : view anal canal

Auscultation to identify bowel movements

4.

• Food maintenance, rich in fiber avoid constipation
• Switz bath for comfort.
• Avoid strain while defecating leads to bleed.