Health Assessment Ch.25

Front 1

What do we ask about usual bowel routine?

Back 1

---Frequency of bowel mm? How often?
---Is this normal for you?
what's the consistency?
What is it like (consistency)?
-*-*-*-Abnormal: Hard, they have to strain
-*-*-*-Normal: Soft
Do they strain?
---Has there been a change in bowel movements? If so how/what?
---Diet? --- Want a diet high in fiber (fresh fruits and veggies), and water)
---Rectal bleeding or blood in stool?
---Ask about meds (the use of laxatives, stool softeners, iron, etc.)
---Any hx of rectal conditions (pruritis/rectal itching, hemorrhoids, etc.)
---Ask about cancer (colon cancer, prostate cancer), and prostate enlargement.
---Self care behaviors (self examinations, regular exams such as prostate exams, monograms)

Front 2

Someone who suffers from chronic constipation is more at risk for what kind of bowel disorder?

Back 2

Diverticulosis - the out pouching of the colon that could become infected and become diverticulitis.

Front 3

What term is used for blood in the stool that has a dark brown or black color?

Back 3

Melena

Front 4

If a pt says they have black colored stools, what's a very specific question that you want to ask?

Back 4

Are you taking iron? --- (Iron causes a dark colored stool)

Front 5

Pruritis (itching) of the rectum or anus could be a sign of what?

Back 5

Hemorrhoids in adults

Pin Worms in children (adults can get pin worms too but it's more prevalent in children). The itching usually occurs at night (nocturnal pruritis).

Front 6

What could nocturnal pruritis indicate?

Back 6

Pin worms

Front 7

Fissure

Back 7

Can in the skin integrity

Front 8

Fistula

Back 8

An opening or a hole that is connecting two parts of the body that should not normally be connected... or it's connecting an organ to the outside that should not normally be connected.

e.g. Women can have a fistula between the vaginal walls and the rectum..
---gastro-esophageal, ---esophageal-tracheal fistula

Front 9

In what population is prostate cancer higher?

Back 9

African Americans

Front 10

What is the standard average recommended age to begin getting yearly prostate exams?

Back 10

Age 50

Front 11

If ppl are in a high risk group (such as African Americans) for prostate cancer, what is the age at which they should begin yearly prostate exams?

Back 11

Age 45

Front 12

If ppl are at really high risk for prostate cancer (such as a close family history), at what age should they begin yearly prostate exams?

Back 12

Age 40

Front 13

How is a prostate exam accomplished?

Back 13

Digital Rectal Exam (DRE)

Front 14

DRE

Back 14

Digital Rectal Exam

Front 15

What is a digital rectal exam done for?

???DRG???

Back 15

To examine for prostate cancer.

Front 16

What other method could be used to assess for the possibility of prostate cancer?

Back 16

Serum blood work (PSA)

PSA - Prostate Specific Antigen

Front 17

At what age should men do a PSA?

Back 17

PSA = Prostate Specific Antigen (Serum blood test for prostate cancer)

Age 50 unless they have other risk factors (recommended they begin earlier).

Front 18

What 2 exams assess for colon cancer?

Back 18

1. Colonoscopy

2. Sigmoidoscopy

Front 19

At what age and how often is a colonoscopy recommended?

Back 19

A colonoscopy (to check for colon cancer) is recommended to begin at the age of 50 and every 10 years thereafter.

Front 20

At what age and how often is a sigmoidoscopy recommended?

Back 20

A sigmoidoscopy (to check for colon cancer) is recommended to begin at the age of 50 and every 10 years thereafter.

Front 21

What is the major difference between a colonoscopy and a sigmoidoscopy?

Back 21

Sigmoidoscopy is much more limited in terms of how far up you're able to visualize .....
(that's why a colonoscopy has to be done every 10 years and a sigmoidoscopy has to done every 5).

Front 22

What is another test that could be done (either at the bed side or the pt can bring it in) to check for colon cancer?

Back 22

Occult blood test

Taking a sample of stool to check for occult blood.

Front 23

At what age should occult blood (in stool) tests be done to check for colon cancer?

Back 23

Age 50 (and then once a year) unless there are other indications to start earlier.

Front 24

Rectal exam positions (3)

Back 24

Lithotomy (female) - can be done after the GYN exam.

Left Lateral (Male & Female)

Standing (Male)

Front 25

Lithotomy position for rectal exam

Back 25

The same position females are in for a gynecology exam.

Female

Front 26

Left Lateral position for rectal exam

Back 26

Laying on the left side with the knees bent upward.

Male or Female

Front 27

Standing position for rectal exam

Back 27

Standing up and bending forward over the exam table.

Male

Front 28

Rectal Exam
Inspection

Back 28

Start with inspection of perianal area.

Examine for any lesions, or hemorrhoids (internal or external)

To examine for hemorrhoids, have the patient bear down (like the valsalva maneuver) to create more pressure in the rectal area so you can better assess for hemorrhoids or a rectal prolapse.

Also assess for any fissures.

Look at the Sacrococcygeal area. Assess for skin integrity and look for the presence of a pilonidal cyst.

Front 29

Rectal Prolapse

Back 29

When the rectal tissue prolapses (comes out). It looks more like a donut type of tissue.

Front 30

What one of the main ways that we assess for rectal bleeding in a brand new baby (newborn)?

Back 30

The presence of their first stool.

Front 31

Pilonidal Cyst

Back 31

Occurs in the Sacrococcygeal area. There may be a small tuft of hair with it and it may drain (it's like a sinus called a tract.... it is considered a draining wound, therefore, WEAR GLOVES!)

Clean the would. It sometimes requires intervention, incision, pain management, antibiotics, etc.)

Front 32

Rectal Exam
Palpation

Back 32

WEAR GLOVES!

Palpate the anus and the rectal wall. Use lubrication.

Insert your finger into the rectal area. Insert the finger slightly curved (facing the pt's belly button/umbilicus). Using a straight finger is not appropriate and is painful to the patient.

Start by palpating the rectal wall. Look for any polyps, masses (note if they/it is fixed/mobile, tender/nontender, etc. -- extreme pain is an abnormal finding).

Have the pt bare down to assess for rectal/sphincter tone.

Palpate the prostate.

Do an occult blood test of stool from finger when removed.

Front 33

What does a weak rectal sphincter cause?

Back 33

Stool incontinence

Front 34

What individuals are at higher risk for hypertrophy of the prostate?

Back 34

Elderly

Front 35

What are some signs and symptoms related to hypertrophy of the prostate?

Back 35

Hesitancy - difficulty starting a stream.
Urinary problems such as:

Frequency
Difficulty maintaining a stream
Nocturia - urinating at night
etc.

.... all signs of urinary obstruction.

Front 36

What could s/s of urinary obstruction be related to?

Back 36

Many things including...

Prostate Hypertrophy

Prostate Cancer

Front 37

What should a normal prostate feel like?

Back 37

Smooth

Nontender

The median solstice - a groove in the middle of prostate.

Elastic, rubbery consistency (typically described as what the tip of the nose feels like).

Front 38

What is the median solstice?

Back 38

The grove in the middle of the prostate between the two lobes.

Front 39

What are abnormal findings when palpating the prostate?

Back 39

Hard

Nodules - If felt, note if it's fixed, tender, etc.

Front 40

Should the prostate be moveable?

Back 40

Yes

Front 41

What should the pt avoid prior to a rectal exam and for how long?

Back 41

Red Meat

Horseradish

...... for at least three days prior.