Assessment of rectum and anus

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Assessment of rectum and anus

Rectal   examination- involves inspection and palpation (digital examination). Extent of the assessment of the rectum and anus depends on the rectal problems stated by the client in the nursing history.
Equipment
·         clean gloves
·         Water-soluble lubricant
Digital examination can cause apprehension and embarrassment: help the client relax by encouraging the client to take slow, deep breaths (tension can cause spasms of the anal sphincters, making the examination uncomfortable).  Inform the client about potential sensations such as feelings of defecation or passing gas.
·         Perform hand hygiene, apply gloves
·         Observe appropriate infection control procedures for all rectal examinations.
·         Provide for client privacy.
·         Drape the client appropriately
·         Inquire for any history : bright blood in stools, tarry black stools, diarrhoea, constipation, abdominal
Pain, excessive gas, haemorrhoids, or rectal pain
Family history of colorectal cancer
 Signs or symptoms of prostate enlargement
Position: 
·         In adults, a left lateral or Sims' position with the upper leg acutely flexed
·         For females, a dorsal recumbent position with hips externally rotated and knees flexed or a lithotomy position
·         For males, a standing position while the client bends over the examining table
·         Sims: Side-lying position with lowermost arm behind the body, uppermost leg flexed at hip and knee, upper arm flexed at shoulder and elbow.
·         Lithotomy: Back-lying position with feet supported in stirrups; the hips should be in line with the edge of the table.
·         Dorsal recumbent: Back-lying position with knees flexed and hips externally rotated; small pillow under the head; soles of feet on the surface.

Inspect the anus and surrounding tissue for colour, integrity, and skin lesions

Ask the client to bear down as though defecating. Bearing down creates slight pressure on the skin that may accentuate rectal fissures, rectal prolapse, polyps, or internal haemorrhoids.

Describe the location of all abnormal findings in terms of a clock, with the 12 o'clock position
Intact perianal skin; more pigmented than the skin of the buttocks

Anal skin is more pigmented, coarser, and moister than perianal skin and is usually hairless

Presence of fissures (cracks), ulcers, excoriations, inflammations, abscesses, protruding haemorrhoids (dilated veins seen as reddened protrusions of the skin), lumps or tumours, fistula openings, or rectal prolapse (varying degrees of protrusion of the rectal mucous membrane through the anus)

Palpate the rectum for anal sphincter tonicity, nodules, masses, and tenderness.

* lubricate your gloved index finger, and instruct the client to bear downward slowly insert your finger into the anus and into the rectum in the direction of the umbilicus.

Anal  sphincter has good tone

Hypertonicity  of the anal sphincter (may occur in the presence of an anal fissure)

Hypotonicity  of anal sphincter (may occur after rectal surgery or result from a neurologic deficiency)

Never force digital insertion. if lesions are painful or bleeding occurs.

Ask the client to tighten the anal sphincter around your finger, and note the tone of the anal sphincter.  Rotate the pad of the index finger along the anal and the rectal walls, feeling for nodules, masses, and tenderness. On withdrawing the finger from the rectum and anus, observe it for faeces.

 document findings in the client record using forms or checklists

Rectal  wall is smooth and not tender











Brown  colour

Rectal  wall is tender and nodular









Presence of mucus, blood, or black tarry stool




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notes.nursium.com: Assessment of rectum and anus
Assessment of rectum and anus
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