Hemorrhoids, also called "'piles," are swollen tissues that contain veins.

They are located in the wall of the rectum and anus and may cause minor bleeding or develop small blood clots. Hemorrhoids occur when the tissues enlarge, weaken, and come free of their supporting structure. This results in a sac-like bulge that extends into the anal area. Hemorrhoids are unique to humans - no other animal develops them. They are very common - up to 86% of people will report they have had hemorrhoids at some time in their life, though people often use this as a catch-all label for any ano-rectal problem including itching. They can occur at any age but are more common as people get older. Among younger people, they are most common in women who are pregnant. Although they can be embarrassing to talk about, anyone can get hemorrhoids, even healthy young people in good shape. They can be painful and annoying but aren't usually serious. Hemorrhoids differ depending on their location and the amount of pain, discomfort, or aggravation they cause. Internal hemorrhoids are located up inside the rectum. They rarely cause any pain, as this tissue doesn't have any sensory nerves. These hemorrhoids are graded for severity according to how far and how often they protrude into the anal passage or protrude out of the anus (prolapse): Grade I is small without protrusion. Painless, minor bleeding occurs from time to time after a bowel movement. A grade II hemorrhoid may protrude during a bowel movement but returns spontaneously to its place afterwards.

In grade III, the hemorrhoid must be replaced manually. A grade IV hemorrhoid has prolapsed - it protrudes constantly and will fall out again if pushed back into the rectum. There may or may not be bleeding. Prolapsed hemorrhoids can be painful if they are strangled by the anus or if a clot develops.

External hemorrhoids develop under the skin just inside the opening of the anus. The hemorrhoids may swell and the area around it may become firm and sore, turning blue or purple in colour when they get thrombosed. A thrombosed hemorrhoid is one that has formed a clot inside. This clot is not dangerous and will not spread through the body, but does cause pain and should be drained. External hemorrhoids may itch and can be very painful, especially during a bowel movement. They can also prolapse. (bodyandhealth.canada.com) hemorrhoids Nursing Assessment for Hemorrhoids 1. The identity of patients 2. The main complaint Patients came with complaints of continuous bleeding during defecation. There was a lump in the anus or pain during defecation. 3. History of disease o History of present illness Patients were found in a few weeks there was only a bump coming out and a few days after defecation there is blood dripping out.
o

Past history of disease Have there been previous hemorrhoidal disease, heal / reoccur. In patients with hemorrhoids when not in doing the surgery will be back. Family history of disease Are there family members who suffer from the disease Social History Disease in question to be asked.

Pre-operative and Post-operative Nursing Diagnosis Nursing Care Plan for Hemorrhoids Pre-operative Nursing Diagnosis and Nursing Interventions Impaired sense of comfort: acute pain related to the mass of the anal or anus, anal area marked lumps, pain and itching in the anal region PURPOSE: To fulfill the criteria of comfort with reduced pain itching reduced mass decreases. INTERVENTION: 1. Give soak seat Rationalization: Reduce local discomfort, reduce edema and promote healing.

2. Give lubricant during defecation would Rationalization: Assist in the conduct of defecation so it does not need straining. 3. Give a diet low in residual Rationalization: Reduce stimulation of the anus and weaken the feces. 4. Instruct the patient to do a lot of standing or sitting (must be in balance). Rationalization: The force of gravity will affect the incidence of hemorrhoids and sitting can increase intra-abdominal pressure. 5. Observation of patient complaints Rationalization: It helps to evaluate the degree of discomfort and lack of effectiveness of actions or states of complications. 6. Provide an explanation of the emergence of pain and explain briefly Rationalization: Education about it helps in patient participation to prevent / reduce pain. 7. Give the patient suppository Rationalization: It can soften the stool and can reduce the patient to avoid straining during defecation. Post-operative Nursing Diagnosis and Nursing Interventions Impaired sense of comfort: acute pain related to the sutures in surgical wound PURPOSE: Fulfillment of comfort with the criteria there is no pain, and patients can perform light activity. INTERVENTION: 1. Give the patient a pleasant sleeping position. Rationalization: May decrease the voltage of the abdomen and increase the sense of control. 2. Change the bandage every morning according to aseptic techniques Rationalization: Protecting the patient from cross contamination during replacement of bandages. Wet bandage acts as an absorber of external contamination and cause discomfort. 3. Exercise road as early as possible Rationalization: It can reduce the problems that occur due to immobilization. 4. Observation of the rectal area if there is bleeding Rationalization: Bleeding on the network, local imflamasi or the occurrence of infection may increase the pain.

5. Chimney anus is released according to physician advice (orders) Rationalisation: Improve physiological functions anus and gives comfort to the patient's anal region because there is no blockage. 6. Provide an explanation of the purpose of installation of flue-anus (anus to funnel to drain the remnants of bleeding that occurs in order to get out). Rationalization: Knowledge of the benefits of the chimney can make the patient understand the anus to funnel anus to cure the wound

Six Factors that Affect Pain

Pain is a sensory and emotional experience that the unpleasant result of tissue damage, actual and potential. Similarly, understanding the pain of Brunner & Suddarth, 2002. This pain can only be felt by a person without being perceived by others, and will include patterns of thought, activity someone directly, as well as changes in a person's life. Pain is an important signs and symptoms which may indicate the occurrence of a physiological disorder. For a nurse or other health professionals should consider the factors that influence pain in the face of patients who experience pain. It is very important in the accurate assessment of pain and for nursing action. Here are Six Factors that Affect Pain, including: 1. Age Factor. Age is an important variable that affects the pain, especially in children and adults. Developmental differences were found between the two age groups may affect how children and adults react to pain. Children difficulty to understand the pain and think that what nurses can cause pain. Children who do not have a lot of vocabulary, have difficulty verbally describing and expressing pain to parents or caregivers. Children can not express the pain, so the

nurse should assess pain responses in children. In adults often report pain if it is pathological and malfunction. 2. Anxiety Factor. Although it is generally believed that the anxiety will increase the pain, may not be entirely true in all circumstances. Research does not show a consistent relationship between anxiety and pain also showed that preoperative stress reduction training at lower postoperative pain. However, the relevant anxiety, or dealing with the pain can increase the patient's perception of pain. In general, an effective way to relieve pain is to direct the treatment of pain rather than anxiety (Smeltzer & Bare, 2002). 3. Gender Factor. Gender factor this in conjunction with the factors that affect pain is that men and women did not have significant differences regarding their response to pain. It is doubtful that gender is an independent factor in the expression of pain. For example, boys must be brave and not cry in which a woman can cry at the same time. 4. Family and Social Support Factors. Other factors that also affect the response to pain is the presence of people nearby. People who are in a state of pain often rely on family for support, help or protect. The absence of family or close friends might make the pain increased. The presence of parents is particularly important for children in the face of pain (Potter & Perry, 1993). 5. Cultural Factors. Beliefs and cultural values influence the way individuals cope with pain. Individuals learn what is expected and what is acceptable to their culture. This includes how to react to pain (Calvillo & Flaskerud, 1991). Recognizing the cultural values that have one and understand why these values differ from the values of other cultures helps to avoid evaluating a patient's behavior based on a person's expectations and cultural values. Nurses are aware of cultural differences will have a greater understanding of the patient's pain and be more accurate in assessing pain and behavioral responses to pain are also effective in relieving pain patients (Smeltzer & Bare, 2003). 6. Coping Pattern Factor. When a person is experiencing pain and undergoing treatment at the hospital is very unbearable. Continually client lost control and was not able to control the environment, including pain. Clients often find a way to overcome the effects of physical and psychological pain. It is important to understand the sources of individual coping during painful. Sources of coping is like communicating with family, exercise and singing can be used as a plan to support the client and the client reduce pain.

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