1. The client/caregiver can define hemorrhoids.
   1. They are dilated veins in swollen tissue around the anus.
   2. Hemorrhoids can be internal or external.
   3. Prolapsed hemorrhoids may come out during defecation.
2. The client/caregiver can identify factors that may increase the risk of hemorrhoids.
   1. Straining at stool because of constipation
   2. Pregnancy and constipation
   3. Heavy lifting
   4. Prolonged sitting and standing
   5. Cirrhosis of the liver
3. The client/caregiver can recognize signs and symptoms.
   1. External hemorrhoids
      1. Enlarged mass at the anus
      2. Inflammation
      3. Pain
      4. Bleeding with bowel movement
   2. Internal hemorrhoids
      1. Pain
      2. Bleeding with bowel movements
      3. Itching in perianal area
      4. Constipation
4. The client/caregiver can list measures to prevent or manage hemorrhoids.
   1. Relieve pressure and straining of constipation.
      1. Increase fluids to at least six to eight glasses per day. Avoid alcohol.
      2. Use stool softeners or laxatives as needed.
      3. Increase fiber in diet.
      4. Never delay urges to evacuate stool.
      5. Do moderate exercise daily such as walking.
   2. Use warm compresses or tub baths several times a day in plain, warm water for about 10 minutes.
   3. Apply hemorrhoidal cream or suppository as ordered.
   4. Gently wash and dry perianal area after each bowel movement.
   5. Avoid prolonged sitting, squatting, or standing.
   6. Contact the physician for evaluation.
   7. Surgical intervention may be necessary.
5. The client/caregiver is aware of possible complications.
   1. Iron-deficiency anemia
   2. Anal fissures (cracks in mucosa)
   3. Bleeding
   4. Blood clots within hemorrhoids
   5. Strangulated hemorrhoids

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. Philadelphia: Mosby Inc.
Cohen, B. J., & Wood, D. L. (2000). Memmler’s the Human Body in Health and Disease (9th ed.). Philadelphia: Lippincott Williams & Wilkins.
Nutrition made incredibly easy. (2003). Springhouse: Lippincott, Williams & Wilkins.
Portable RN: The all-in-one nursing reference. (2002). Springhouse: Lippincott, Williams & Wilkins.
Taylor, C., Lillis, D., & LeMone, P. (2005). Fundamentals of nursing. Philadelphia: Lippincott Williams & Wilkins.
Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com