NR 601 Week 4 Safety for the Older Adult Discussion
Chamberlain University NR 601 Week 4 Safety for the Older Adult Discussion– Step-By-Step Guide
This guide will demonstrate how to complete the Chamberlain University NR 601 Week 4 Safety for the Older Adult Discussion assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NR 601 Week 4 Safety for the Older Adult Discussion
Whether one passes or fails an academic assignment such as the Chamberlain University NR 601 Week 4 Safety for the Older Adult Discussion depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NR 601 Week 4 Safety for the Older Adult Discussion
The introduction for the Chamberlain University NR 601 Week 4 Safety for the Older Adult Discussion is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
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How to Write the Body for NR 601 Week 4 Safety for the Older Adult Discussion
After the introduction, move into the main part of the NR 601 Week 4 Safety for the Older Adult Discussion assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NR 601 Week 4 Safety for the Older Adult Discussion
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NR 601 Week 4 Safety for the Older Adult Discussion
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NR 601 Week 4 Safety for the Older Adult Discussion
By 2035, it is projected that the number of older persons in the United States will surpass the number of children and young adults, as around 10,000 individuals reach the age of 65 each day (Kennedy‐Malone & LaManna, 2023). The greying of America necessitates an increased need for healthcare personnel capable of aiding the elderly population in coping with the persistent ailments and functional impairments associated with the aging process. The objective of this discussion is to facilitate the professional development of nurse practitioners in their role of ensuring the safety of older patients within their present living conditions.
Assessment
Two evaluations that may be used to ascertain the safety of clients in their present living surroundings are the Home Safety Self-Assessment for Older Adults and the Katz Independence in Activities of Daily Living (Zonsius et al., 2019). Utilizing the Home Safety Self-Assessment, one can ascertain whether a patient’s present living environment is secure. This process facilitates the identification of potential dangers and enables the implementation of modifications and suggestions to enhance their level of safety. Compiling a comprehensive inventory of potential dangers inside the patient’s residence, such as slick flooring, loose carpets, or exposed cables, might facilitate the establishment of a more secure domestic setting. The Katz Index of Independence in Activities of Daily Living is a useful tool for assessing the functional capabilities of older individuals. This assessment may assist us in ensuring that dependent elderly individuals get the necessary assistance in their homes. This includes questions on grooming, eating, using the restroom, transferring, bathing, and continence. Subsequently, the patient is asked to indicate whether they can carry out these tasks alone or with assistance, and their cumulative score is calculated at the conclusion.
Additional Assistance Or A Transition In The Care Environment
Indicators of the client’s need for further support include recurrent falls, inadequate cleanliness, inability to manage medicines, cognitive impairment, and unintended weight loss. When we see signs of forgetfulness or memory loss, we may use cognitive tests and instruments like BCAT to measure the extent of the condition’s severity (Zonsius et al., 2019). I have seen a lot of usage of this instrument in assisted living and memory care environments to assess whether a patient needs to be in one of these facilities. Another method for detecting cognitive impairment is the Mini-Mental State Examination (MMSE).
NP’s Role
During a patient’s and their family’s transition of care, a nurse practitioner’s job is to make sure that treatment is easily available and to help cut down on unnecessary trips to the emergency department and hospitalizations. The nurse practitioner encourages compliance with the treatment plan established by the patient, nurse practitioner, and family. Liu et al. (2021) state that their services include medication reconciliation, barrier identification, enhancement of overall health, and referral of patients to community resources. The ultimate objective is to enhance patient health and diminish healthcare expenses.
Referrals
When discussing the transfer of a patient to a rehabilitation or skilled nursing facility, the necessary recommendations would typically include a social worker, physical therapist, and case manager. If it is judged that rehabilitation or a skilled nursing facility (SNF) is necessary, the social worker will help in organizing the placement for the individual. Physical therapists would provide their assessment on areas where the patient might improve after being discharged from the hospital. Prior to hospital release, the patient’s requirements would be evaluated by the case manager. Another instance is when the patient is undergoing a transition to hospice care, in which case the main referral would be for hospice care. The NP must make all necessary orders, add any necessary information, and ensure the patient is ready for the transition (Liu et al., 2021). The nurse practitioner facilitates the participation of all members of the multidisciplinary team and minimizes the likelihood of any conflicts or disagreements.
Resources/Conclusion
Two services that are accessible for older clients with little means in my targeted practice region are Helping Hands Senior Care and visiting nurse organizations. The visiting nurse association offers a range of services to patients at their homes, therefore reducing the need for frequent visits to the doctor. The nurse may evaluate the patient’s condition at home and decide whether a visit to the doctor is necessary while also communicating with the healthcare provider. Assistance Elderly care services include 24-hour live-in assistance, food preparation, bathing, laundry, and housekeeping (Kennedy-Malone & LaManna, 2023). Assistance from carers may enable patients to continue living in their own homes, thus prolonging their feeling of autonomy before eventually transitioning to assisted living.
References
Kennedy‐Malone, L., & LaManna, J. B. (2023). Delivering nurse practitioner care in the decade of healthy aging. The Journal for Nurse Practitioners, 19(1), 104541. https://doi.org/10.1016/j.nurpra.2023.104541Links to an external site.
Liu, P., Chilatra, J. a. H., & Phelan, A. (2021). Examining nurses’ role in Adult Protective Services related to safeguarding older people. Journal of Advanced Nursing, 77(5), 2481–2497. https://doi.org/10.1111/jan.14792
Zonsius, M. C., Miller, J., & Lamb, K. (2019). An innovative course to prepare advanced practice registered nurses to spearhead quality and safety initiatives for older adults. Journal of the American Association of Nurse Practitioners, 33(1), 57–65. https://doi.org/10.1097/jxx.0000000000000314Links to an external site.
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Sample Answer 2 for NR 601 Week 4 Safety for the Older Adult Discussion
Hello Erica. Thank you for your post. I appreciate your ability to provide succinct and precise answers to the discussion prompts. Nevertheless, I would like to propose an additional assessment approach called the Home Safety Assessment. This method involves a comprehensive evaluation of the client’s living environment to identify potential hazards and safety issues. The evaluation includes a comprehensive analysis of elements such as ease of access, potential hazards related to falls, fire safety measures, and the effective operation of utilities (Cotte et al., 2022). This evaluation aims to verify that the client’s residence is appropriate and secure for their particular requirements and capabilities.
Regarding care transitions, it is important to note that NPs serve as primary healthcare providers and care coordinators throughout these events, which could include shifting from a hospital to a home or between various healthcare facilities. The nurse practitioner facilitates uninterrupted communication among healthcare professionals, cooperates with the client’s primary care physician, and engages family members in care planning (Österlind et al., 2020). The professionals evaluate the client’s physical and mental requirements, enlighten them and their families on the transition process, and provide customized care strategies to enhance their well-being throughout this crucial phase.
References
Cotte, F., Mueller, T., Gilbert, S., Blümke, B., Multmeier, J., Hirsch, M. C., Wicks, P., Wolanski, J., Tutschkow, D., Brittinger, C. S., Timmermann, L., & Jerrentrup, A. (2022). Safety of Triage Self-assessment using a symptom assessment app for walk-in patients in the emergency care setting: an observational prospective cross-sectional study. Jmir Mhealth and Uhealth, 10(3), e32340. https://doi.org/10.2196/32340Links to an external site.
Österlind, J., Gerhardsson, J., & Myrberg, T. (2020). Critical care transition programs on readmission or death: A systematic review and meta‐analysis. Acta Anaesthesiologica Scandinavica, 64(7), 870–883. https://doi.org/10.1111/aas.13591
Sample Answer 3 for NR 601 Week 4 Safety for the Older Adult Discussion
. Identify at least TWO assessments that can be used to determine whether a client is safe in their current living environment.
The Stopping Elderly Accidents, Deaths and Injuries (STEADI) algorithm is one of the assessment tools used to determine the safety of a patient’s living environment (Centers for Disease Control and Prevention, 2019). This tool, which includes a fall risk screening, assessment, and intervention, is intended to give guidelines for measuring fall prevention for adults 65 years of age and older.
The second evaluation instrument is known as the Katz Activities of Daily Living. It is the most widely used instrument for assessing functional status when older patients move from the hospital to their homes. This aids in monitoring the progressive loss of abilities observed in hospitalized patients, and its original purpose was to track the development of hip fracture patients. Assessing additional chronically ill patients 40 years of age and older proved to be beneficial. The six items are feeding, dressing, using the restroom, transferring, and bathing (Liebzeit et al., 2018).
b. Discuss results that indicate the client may require additional assistance or a transition in the care environment.
Determining whether these patients require extra help at home is made easier by the findings of these two evaluations. It assists in anticipating risk factors so that they can lessen the likelihood of injury during the hospital-to-home transition. The lack of grab bars, the raised toilet seat in the shower, and the slick carpeting in the area are among the risk factors. Orthopediatric patients, for example, might struggle at home if they live in two-story homes and must use stairs frequently to carry out daily tasks. Preventing these risks ahead of time will reduce the likelihood of falls, which will decrease the likelihood of being readmitted to the hospital.
c. Describe the NP’s role in working with the client and family to assist with care transitions.
It is imperative for nurse practitioners to take into account their living environment. For reasons of safety, it is crucial to evaluate their living arrangements. Acquiring comprehensive histories and surroundings does affect the prognosis of patients and illness prevention.
d. Identify at least TWO appropriate referrals for a client who requires a transition in the care environment. How does the NP ensure coordination of care during transitions?
- Home health care service: A home health care nurse visits a patient’s living space to assess the safety of the home and to offer nursing care, physical therapy, and other services. Social workers may also be referred by the home care nurse if the patient’s surroundings are impoverished.
- Coordination of care with other medical staff: It is essential for nurse practitioners to coordinate care with other specialties. Patients can continue to take care of their health and receive the best care possible by asking for referrals to appropriate providers. Make sure patients’ insurance covers enough for NP to see specialists or get diagnostic tests. To ensure seamless transitions from the hospital to the patient’s home, the NP should play a crucial role as a link between healthcare services.
e. Identify at least TWO public or private resources that are available for clients with limited resources in your intended practice area.
- OC healthcare agency: My county offers a range of public health services, including clinical care, health promotion, and assistance with service access. These services are free of charge and available to all Orange County residents (Orange County Health Care Agency, 2024).
- Community Health Centers: The centers offer social services, food, translation, and transportation. According to a survey, patients who receive high-quality care can afford private practices and medical services. These federally funded programs support health equity. It lessens the likelihood of tragedy for those without insurance (National Association of Community Health Centers, 2023).
References
Centers for Disease Prevention and Control. (2019). Algorithm
for fall risks of screening, assessment, and intervention. https://www.cdc.gov/steadi/pdf/steadi-algorithm-508.pdf.Links to an external site.
County of Orange California. (2024). PUBLIC HEALTH SERVICES. https://www.ochealthinfo.com/about-hca/public-health-services.Links to an external site.
Liebzeit, D., King, B., & Bratzke, L. (2018). Measurement of function in older adults transitioning from hospital to home: an integrative review. Geriatric nursing (New York, N.Y.), 39(3), 336–343. https://doi.org/10.1016/j.gerinurse.2017.11.003Links to an external site.
National association of community health centers. (2023). WHAT IS A COMMUNITY HEALTH CENTER? https://www.nachc.org/community-health-centers/what-is-a-health-center/.Links to an external site.
Sample Answer 4 for NR 601 Week 4 Safety for the Older Adult Discussion
I also use the HOME-fast tool for my home health care job. This allows us to check whether the patient has a grab bar in the bathroom, numbers of stairs, clutter of rugs, and is accessible by wheelchair. Based on the total number, healthcare workers come up with a decision about whether the patient is at low, mid, or high risk of falling. Although it is a great tool, there are a few downsides to it. It can be subjective, meaning that visiting a patient’s home just once will not always provide a thorough understanding of all potentially dangerous environments. Elderly home safety interventions could include teaching patients or caregivers how to identify fall hazards and how to walk safely. The second issue descends from this point. At least during the transition from a hospital or other facility to their home, patients should have a caregiver in order to reduce the risk of falling. In actuality, a large number of elderly people live alone, and this number will only rise as the number of elderly people increases. (Davis and Davis, 2023).
Reference
Davis, K., & Davis, D. (2023). Home Safety Techniques. https://www.ncbi.nlm.nih.gov/books/NBK560539/.Links to an external site.
Sample Answer 5 for NR 601 Week 4 Safety for the Older Adult Discussion
Thanks for your response to the discussion! I have heard of both the STEADI and the Katz tools but have no experience using the STEADI tool. Regardless, both tools would be useful in assessing if a patient is safe to be in their home environment, so good job! The Katz in particular has proven to be both valid and reliable and is also quick and easy to administer!
Two referrals: Home health is an option, just be aware that home health is quite expensive and has limited coverage with insurance. For example, a patient with dementia would need around the clock care until death and would likely not qualify for home health (or be able to afford it). What could be done for a patient like this?
Also, where is the second referral? Coordination of different specialties is an expectation as the primary care provider, not a referral.
NR 601 Week 5 Standardized Procedure Worksheet
Standardized Procedure
Nurse practitioners are crucial in promoting optimum health and well-being for their populations. Nurse practitioners use their clinical knowledge, skills, and experience to diagnose patients and develop patient-centered interventions to promote recovery. This study’s primary objective is to create standardized care procedures for hemorrhoids in older adults. The paper is segmented into four core sections encompassing the identification and description of hemorrhoids, disease assessment processes, diagnostic tests, and an evidence-based management plan for this condition. Protocolized (standardized) care establishes explicit clinical pathways for managing medication interventions, ensuring that desirable treatments are administered systematically, correctly, and on time.
Description of Hemorrhoids
The assigned topic of discussion is hemorrhoids in older adults. Júnior et al. (2020) define them as normal vascular cushions comprising connective tissue, veins, smooth muscle fibers, sinusoids, and arterioles found in the anal canal, which in pathological conditions present as venous hypertension and dilation leading to mucous discharge, edema, intense pain, thrombosis, and prolapse. Júnior et al. (2020) and Sheikh et al. (2020) acknowledge that this condition is a common occurrence in adulthood, with more than 50% of persons aged over 50 years experiencing related symptoms at some point in their lives. Age is a risk factor for hemorrhoids, which, according to Sheikh et al. (2020), contributes to the weakening of the connective tissue framework supporting the anorectal apparatus. Intra-abdominal pressures as a result of obesity, constipation, physical inactivity, chronic cough, or pregnancy also contribute to hemorrhoids development (Sheikh et al., 2020). The former factor explains the high prevalence rate of up to 50% among older adults aged over 50 years (Júnior et al., 2020; Sheikh et al., 2020). Concerning the general population, the prevalence of hemorrhoids varies across countries, with Italy and Russia registering an incident rate of 16%, while the Czech Republic, Brazil, France, Spain, and Romania recording 11%, 6%, 7%, 11%, and 10% prevalence rate, respectively (Sheikh et al., 2020). In the United States, Sheikh et al. (2020) accentuate that about 1 million new cases of hemorrhoids are reported annually in the United States, which translates to an annual incidence rate of 4.4% or 10 million people. Overall, these figures may be considerably high because most hemorrhoid cases are underreported as patients desist from seeking medical intervention due to associated shame.
The pathophysiology of hemorrhoids is yet to be fully ascertained. However, according to Margetis (2019), the sliding anal canal model, also known as the cushion theory, is the universally accepted explanation of hemorrhoids development. It attributes this condition to the abnormal slippage of cushions through the anal canal. In particular, Margetis (2019) cites four critical pathophysiological events that account for its development and progression. These events entail the anal cushion slippage process, cushions’ connective tissue deterioration, incomplete venous return from sinusoids to the superior (SRV) and middle (MRV) rectal veins during defecation, and blood accumulation (stagnation) in the dilated plexus (Margetis, 2019). While these events may be attributed to various factors, Margetis (2019) considers sinusoid congestion the hallmark of the onset of hemorrhoidal disease. In layperson’s terms, hemorrhoids develop from blood accumulation in the blood vessels around the lower abdomen and anus due to reduced venous return during defecation and heightened abdominal pressure. According to Margetis (2019), the impaired or dysfunctional arteriolar sphincteric mechanism, relaxed and hypertrophied connective tissue, and decreased vascular tone contribute to the accumulation of blood, underling the congestion of the sinusoids. Conversely, fibrous tissue hypertrophy and the growth of new blood vessels (neovascularization) contribute to cushion enlargement (Margetis (2019). These events account for the pathophysiology of hemorrhoids. In conclusion, the resulting venous hypertension and dilation lead to mucous discharge, edema, intense pain, thrombosis, and prolapse, which are the primary presenting symptoms of hemorrhoids.
Assessment
Over and above diagnostics tests, a comprehensive assessment of the patient’s presenting symptoms, social and family history, and an in-depth physical examination are paramount to diagnosing. According to Jakubauskas and Poskus (2020) and Wang et al. (2023), common subjective findings (symptoms) consistent with hemorrhoid encompass rectal bleeding, prolapse (a feeling of a lump around the anal region), itching, mucus discharge after bowel movements, and throbbing pain that might be experienced several hours after a bowel movement. Patients also report feelings of tissue prolapse, mild fecal incontinence, and the presence of painless external skin tags. Moreover, Jakubauskas and Poskus (2020) note that a careful history examination is necessary to correlate the presenting symptoms with hemorrhoids or to make a differential diagnosis. In particular, the examiner should inquire about an individual’s obstetric history to establish the presence of episiotomies, instrumental delivery, and perineal tears for female patients and perianal trauma for men. Equally, the examiner should question patients about their defecation habits (assess for signs of prolonged sitting and strain during defecation) and history of polyps, cancer, and inflammatory bowel disease (IBD) (Jakubauskas & Poskus, 2020). These variables constitute pertinent subjective data associated with hemorrhoids.
A comprehensive physical examination is necessary to establish pertinent objective data consistent with hemorrhoids. This condition’s primary physical exam indicator is the presence of a perianal thrombosis, which, according to Jakubauskas and Poskus (2020), appears as a tender, firm purple nodule. Besides a thrombosed external hemorrhoid, the examiner should take note of a tender lump to palpation and observe the presence of ulcerations and bloody drainage on the hemorrhoids, and skin tags. Following a general physical exam, Jakubauskas and Poskus (2020) suggest that the examiner should proceed to perform a digital rectal examination to establish the presence of a distal rectal mass, anorectal fistula, fissures, and abscess. This procedure is essential for differentiating these pathologies from hemorrhoids (Jakubauskas & Poskus, 2020). Furthermore, Jakubauskas and Poskus (2020) and Picciariello et al. (2021) suggest that medical professionals should also perform an examination of the anal canal and rectum with an anoscope (anoscopy) to visualize the left lateral, right anterior, and right posterior cushions to establish the extent of prolapse and for differential diagnosis. Picciariello et al. (2021) assert that an anoscopy is essential for examining internal hemorrhoids, rectal masses, or fissures. A physical exam corroborates subjective findings and helps establish a preliminary diagnosis pending a diagnostic test for confirmation.
Nurse practitioners in California are required to work in collaboration with a physician. In particular, physicians supervise nurses as they practice. Nurse practitioners must have an agreement with a physician who leads their practice. California nurse practitioners collaborate with physicians in certain circumstances, such as developing new care models for integrated collaborative patient care and education. Unlike in California, nurses in the District of Columbia and 22 other states in the country, including New Hampshire, Washington, Oregon, Wyoming, Nevada, Iowa, Arizona, Montana, Massachusetts, and Maryland, have approved full practice status, which means that they can practice without physician supervision, undertaking case management, including assessment, diagnosis, interpretation of diagnostic tests, and prescription of medications (American Association of Nurse Practitioners [AANP], 2024). However, they may require prompt surgical consultation in the management of grade IV internal hemorrhoids, which require surgical intervention (Perry, 2022). The idea is that nurses’ scope of practice varies across states, meaning they may require physician supervision or practice independently depending on local regulatory requirements.
Diagnostic Tests
Medical practitioners can perform various diagnostic tests, including anoscopy, total colonoscopy, digital rectal examination, and complete blood test to confirm preliminary differential diagnosis. Anoscopy is one of the diagnostic tests performed in older adults who are suspected of having hemorrhoids. According to Jakubauskas and Poskus (2020) and Picciariello et al. (2021), an anoscopy is essential for visualizing the left lateral, right anterior, and right posterior cushions to establish the extent of prolapse and for differential diagnosis. Equally, it is instrumental in examining internal hemorrhoids, rectal masses, or fissures (Picciariello et al., 2021). In particular, an anoscopy allows the diagnosis of internal hemorrhoids or fissures and rules out the presence of rectal masses. A total colonoscopy might also be performed if there are uncertainties in the diagnoses. According to Jakubauskas and Poskus (2020), it is recommended for older adults (over 45 years) who have not been screened for colorectal cancer, with a history of polyps, cancers, or IBD, and those presenting with atypical symptoms, including blood-stained stool and significant changes in defection habits. A digital rectal examination should also be performed to determine the presence or absence of anorectal mass, scar, stenosis, and patency of the sphincter tone (Jakubauskas & Poskus, 2020). A complete blood test is also recommended to rule out anemia. Conversely, Soeseno et al. (2021) suggest performing a stool occult test for mild cases in earlier stages of development to rule out infections. The expected abnormal results include the presence of an anal lump, bleeding hemorrhoids, anal fissures, non-patent anal sphincter, bleeding after bowel movements, skin tags, and anal ulcerations, which are the pertinent indicators of hermorrhoids.
Management
Hemorrhoid management encompasses pharmacological and nonpharmacological interventions. Prescription therapy used as part of the first-line treatment of hemorrhoids in older adults includes oral flavonoids such as chrysin 400 mg once daily because of its anti-hemorrhoid properties and its capacity to improve vascular function while decreasing vascular resistance, according to Razdar et al. (2023). Although flavonoid therapy is superior to calcium dobesilate, Changazi et al. (2020) note that oral calcium dobesilate 0.5 mg once daily may be used as a second-line treatment for hemorrhoids if patients react to the first-line medication. Vahabi et al. (2019) also recommend topical treatments such as glyceryl trinitrate 0.2% for pain management, particularly following a hemorrhoidectomy surgery. Pharmacotherapy in hemorrhoid treatment is mainly used to reduce pain and constipation.
Hemorrhoids are best managed using nonpharmacological interventions. Perry (2022) considers a treatment regimen comprising increased fiber and adequate fluid intake as the first line of treatment for this condition. While this treatment approach entails the primary plan for managing hemorrhoids, case management varies according to disease severity levels. In particular, Perry (2022) notes that grade I and II hemorrhoids can be effectively managed through banding, sclerotherapy, and infrared coagulation. Complicated cases, including instances in which patients present with large III and IV hemorrhoids are often referred for surgical intervention (Perry, 2022). These operative treatments, encompassing sclerotherapy, rubber band ligation, and infrared coagulation, are highly recommended for patients that are allergic to hemorrhoid treatment-related medications. Other relevant treatment modalities entail cryotherapy, radiofrequency ablation, hemorrhoidectomy, plication, Doppler-guided hemorrhoidal artery ligation, and stapled hemorrhoidopexy. Overall, patients must seek doctors’ guidance to determine the treatment plan.
The post-treatment plan encompasses patient education centered on adherence to the prescribed treatment regimen and recommended lifestyle changes, discussion of indications for referral, and expected client follow-up. Ektov et al. (2020) indicate that the predicted client follow-up depends on the adopted treatment. For example, a client presenting with persistent or recurrent symptoms should be referred for surgical intervention after initial treatment. It might also entail starting the patient on drugs if lifestyle and dietary modification had been considered. Conversely, indications for referral include hemorrhoids unresponsive to treatment, severe bleeding, anemia, rectal prolapse, and absence of specialized care in a facility. Most importantly, patients must be advised to adhere to the prescribed treatment regimen and recommended lifestyle changes.
Conclusion
Hemorrhoids are a common occurrence in adulthood, with more than 50% of persons aged over 50 years experiencing related symptoms at some point in their life. To make a definitive diagnosis, nurses should be aware of pertinent subjective and objective findings relevant to hemorrhoids. The former encompasses symptoms such as rectal bleeding, prolapse, itching, mucus discharge after bowel movements, and throbbing pain that might be experienced several hours after a bowel movement. Conversely, the latter entails the presence of a perianal thrombosis, ulcerations and bloody drainage on the hemorrhoids, and skin tags. Equally, they are advised to perform a comprehensive assessment of the patient’s presenting symptoms, social and family history, and an in-depth physical examination and conduct diagnostics tests to simplify the differential diagnosis process. Most importantly, they must understand that hemorrhoid management encompasses pharmacological and nonpharmacological interventions.
References
American Association of Nurse Practitioners. (2024). Practice information by state. AANP. https://www.aanp.org/practice/practice-information-by-state
Changazi, S. H., Bhatti, S., Choudary, A., Sr, Rajput, M. N. A., Iqbal, Z., & Ahmed, Q. A. (2020). Calcium dobesilate versus flavonoids for the treatment of early hemorrhoidal disease: A randomized controlled trial. Cureus, 12(8). https://doi.org/10.7759/cureus.9845
Ektov, V. N., Николаевич, Э. В., Somov, K. A., Алексеевич, С. К., Kurkin, A. V., Васильевич, К. А., Muzalkov, V. A., & Александрович, М. В. (2020). Treatment options for chronic hemorrhoids. Journal of Experimental and Clinical Surgery, 13(4). https://doi.org/10.18499/2070-478X-2020-13-4-353-361
Jakubauskas, M., & Poskus, T. (2020). Evaluation and management of hemorrhoids. Diseases of the Colon & Rectum, 63(4), 420-424. https://doi.org/10.1097/DCR.0000000000001642
Júnior, C. W. S., de Almeida Obregon, C., e Sousa, A. H. D. S., Sobrado, L. F., Nahas, S. C., & Cecconello, I. (2020). A new classification for hemorrhoidal disease: The creation of the “BPRST” staging and its application in clinical practice. Annals of Coloproctology, 36(4), 249-255. https://orcid.org/0000-0002-0304-9999
Margetis N. (2019). Pathophysiology of internal hemorrhoids. Annals of Gastroenterology, 32(3), 264–272. https://doi.org/10.20524/aog.2019.0355
Perry, K. R. (2022, May 31). Hemorrhoids treatment & management. Medscape. https://emedicine.medscape.com/article/775407-treatment
Picciariello, A., Tsarkov, P. V., Papagni, V., Efetov, S., Markaryan, D. R., Tulina, I., & Altomare, D. F. (2021). Classifications and Clinical Assessment of Haemorrhoids: The Proctologist’s Corner. Reviews on Recent Clinical Trials, 16(1), 10–16. https://doi.org/10.2174/1574887115666200312163940
Razdar, S., Panahi, Y., Mohammadi, R., Khedmat, L., & Khedmat, H. (2023). Evaluation of the efficacy and safety of an innovative flavonoid lotion in patients with haemorrhoid: A randomized clinical trial. BMJ Open Gastroenterology, 10(1). https://doi.org/10.1136/bmjgast-2023-001158
Sheikh, P., Régnier, C., Goron, F., & Salmat, G. (2020). The prevalence, characteristics and treatment of hemorrhoidal disease: Results of an international web-based survey. Journal of Comparative Effectiveness Research, 9(17), 1219–1232. https://doi.org/10.2217/cer-2020-0159
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