Discharge And Home Healthcare Guidelines

Teach the patient and family the early and late clinical manifestations of bleeding. Outline measures to prevent bleeding episodes, such as use of a soft-bristled toothbrush or sponge sticks, avoidance of activities that are likely to result in trauma, and avoidance of nonsteroidal anti-inflammatory drugs.

Emphasize the importance of carrying identifying medical information at all times. Teach the patient or caregiver to inform all healthcare providers about the patient's diagnosis. Describe immediate actions the patient or caregiver should take to control bleeding. List indicators of the need for medical assistance. Teach the patient or caregiver the purpose of each medication, the correct procedure for administration, and potential adverse effects. Provide the patient or family with a list of referrals for genetic counselors, social workers, vocational counselors, or psychologists to assist in the long-term adjustment as necessary.


DRG Category: 188

Mean LOS: 4.9 days

Description: MEDICAL: Other Digestive System

Diagnoses, Age > 17 with CC DRG Category: 157 Mean LOS: 4.4 days Description: SURGICAL: Anal and Stomal Procedures with CC

n emorrhoids are a common, generally insignificant swelling and distension of veins in the anorectal region. They become significant when they bleed or cause pain or itching. In the

404 Hemorrhoids

United States, at least 10 million people have hemorrhoids, and up to a third of these people seek treatment. Hemorrhoids are categorized as either internal or external. Internal hemorrhoids, produced by dilation and enlargement of the superior plexus, cannot be seen because they are above the anal sphincter, whereas external hemorrhoids, produced by dilation and enlargement of the inferior plexus, are below the anal sphincter and are apparent on inspection.

Hemorrhoids develop when increased intra-abdominal pressure produces increased systemic and portal venous pressure, thus causing increased pressure in the anorectal veins. The arterioles in the anorectal area send blood directly to the swollen anorectal veins, further increasing the pressure. Recurrent and repeated increased pressure causes the distended veins to separate from the surrounding smooth muscle and leads to their prolapse (enlarged internal hemorrhoids that actually protrude through the anus).

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