NUR 418 STU Rectal Examination Process Discussion – Description
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts.
All replies must be constructive and use literature where possible.
Discussion #1
Rectal examinations can have multiple indications such as bleeding, pain, constipation, incontinence, and prostate health. Before performing a rectal exam on a patient, the nurse must make sure that the patient understands why the procedure is necessary, and all the steps that will take place in order to complete the examination. When a patient has all the information available for a procedure, they tend to be more relaxed and willing to do it as they know what to expect. Cultural awareness is also essential when performing this kind of exam. Patients of Hispanic, and Caribbean descent have a hard time agreeing to get a rectal exam done because they believe it takes away from their manhood (Neumair et al., 2022).
In order to perform a rectal exam on an older adult, the position is the first thing that must be chosen. It all depends on how the patient is more comfortable, and if they need any type of special accommodation. There are three preferred positions left lateral, lithotomy, and the standing position. For the standing patient, they should be instructed to bend and place elbows on examining table, point toes together, and to relax. The perineal are should be assessed in order to notice any lesions, hemorrhoids, or bleeding. To palpate the anus and rectum, use lubrication and insert index finger of gloved hand by placing it against the anal verge, and when the sphincter relaxes, ask the patient to exhale and flex the tip of the finger as it goes in the anal canal pointing toward the umbilicus. Finger must rotate to palpate the entire muscular ring. Patient should not be feeling any pain, and the canal should feel smooth and even. On the anterior wall, the prostate gland is found, and its surface should feel smooth and muscular. If any masses, pain, or uneven strength in the sphincter should be documented and further assessed (Jarvis & Eckhardt, 2020).
When assessing the rectal sphincter, is important to know that there are several findings that can present, these findings include skin tags, warts, fissures, fistula, hemorrhoids, rectal prolapse, skin discoloration, dermatitis, or eczema. When palpating the area of the sphincter we should ask the patient to contract the muscles and we can feel the muscle tone. This should not be painful, and we should feel the muscle tightening around the finger with no gaps.
Acute prostatitis is an acute infection of the prostate gland that causes pelvic pain, fever, chills, malaise, urethral discharge, and urinary tract symptoms like urinary frequency or retention. Benign prostatic hypertrophy is a non-cancerous condition in which there is an overgrow of prostatic tissue (Li et al, 2022). The growth pushes against the bladder and the urethra blocking the passage of urine. During a rectal examination the patients with BPH will have a bulgy non-tender prostate, and those with prostatitis will have tender, slightly asymmetrical nodular feeling in the prostate gland (Jarvis & Eckhardt, 2020). Things to consider when performing a rectal examination include the patient’s use of anticoagulants, and immunosuppression.
Discussion #2
The rectal examination is an important diagnostic tool for evaluating the rectal sphincter, prostate gland, and rectal wall. Acute prostatitis and benign prostatic enlargement, among other disorders, rely heavily on it for diagnosis. The examination is conducted in a methodical fashion, beginning with preparation and ending with documenting of the results of a digital rectal examination. Medical personnel must have a firm grasp of the technique and its relevance.
Steps to examine the patient:
First, get the patient in a relaxed posture, with their legs flexed toward their chest while they lie on their left side. Second, you must get the patient’s informed permission by detailing the surgery and answering any questions they may have. Third, put on some disposable gloves and lubricate your finger well with some water-based lubricant. Look for skin lesions, fissures, or hemorrhoids in the perineal region in Step 4’s external examination. Step 5: Digital Rectal Examination (DRE) Feel for abnormalities in the rectal wall, prostate gland (size, shape, nodules), and rectal sphincter tone by inserting a lubricated finger into the rectum and palpating the area (Rao, 2019). Step Six: Removing Your Finger and Examining It As you remove your finger from the glove, look for signs of feces, blood, or other abnormal discharge. Step Seven: Documentation – Be sure to carefully document anything you uncover, especially anything that seems out of the ordinary.
Rationale:
The rectal examination aids in the identification of prostate problems, rectal cancer, and rectal prolapse by assessing the rectal sphincter, prostate gland, and rectal wall. Exam results complement those from other diagnostic procedures and help doctors decide what more tests to order or what kind of care to provide a patient.
Findings while assessing the rectal sphincter:
Sphincter muscle tone should be normal, meaning that the muscle is robust and in good shape. Weak sphincter tone might be an indication of spinal cord injury or other neurological problems. Sphincter tone increases may result from anxiety, rectal irritation, or anal fissures.
Differences during the rectal examination of acute prostatitis and benign prostatic hypertrophy:
Symptoms of acute prostatitis include pain, swelling, and regions of induration (hardness) in the prostate gland. Palpating the prostate may cause severe discomfort for the sufferer. The prostate gland may feel larger, but it will normally have a rubbery smooth texture if you have benign prostatic hypertrophy (BPH) (Bostwic et al ., 2021). The prostate may show signs of having a median sulcus (a depression in its middle). Unless difficulties emerge, the patient may not feel too much discomfort during the palpation.
Findings expected on physical examination of acute prostatitis and benign prostatic hypertrophy:
Fever, chills, urinary frequency and urgency, dysuria (painful urination), and perineal or lower back discomfort are all possible signs of acute prostatitis. The prostate gland may feel painful, heated, and swollen during a physical examination. The benign kind of prostate enlargement: urine hesitation, weak urine stream, incomplete bladder emptying, and nocturia (frequent urinating at night) are common urinary obstruction symptoms in patients with BPH. The prostate gland may be big and feel smooth and nontender during a physical examination. Always remember that the proper examination, diagnosis, and treatment of any medical issue requires the assistance of a trained medical expert.
The post NUR 418 STU Rectal Examination Process Discussion first appeared on .
