Running head: GASTROINTESTINAL HEMORRHAGE
Gastrointestinal HemorrhageFirstName LastNameUniversity title
Rectal bleeding is a common complaint in the clinical setting. According to Sabry and Sood (2022), the condition presents with frank anal bleeding, with symptoms ranging from mild to severe, depending on the primary causative factor or etiology. From this perspective, the mild cases, such as in this client’s case, who is suffering from internal hemorrhoids, the patient would report a streak of fresh and bright red blood on the toilet paper once they visit the toilet. On the contrary, the client will report heavy and brisk bleeding in severe cases, as happens in patients with rectal bleeding secondary to anorectal cancer.
Several conditions can contribute to rectal bleeding. Colorectal cancer is one of the most significant contributors to rectal bleeding, and nurse practitioners must rule out the condition in any client presenting with a positive history of rectal bleeding. Another major cause of rectal is an inflammatory bleeding disease, which commonly presents with a history of abdominal pain and diarrhea (Sabry & Sood, 2022). Another major cause of rectal bleeding is hemorrhoids, which can be internal or external, depending on their location in relation to the dentate line. In this case study, the client had internal hemorrhoids, indicating that the symptomatic anal cushions are above the dentate line. Other potential contributors to rectal bleeding include diverticular diseases. Thus, various conditions can cause rectal bleeding.
If the rectal bleeding remains untreated, the client will likely develop microcytic hypochromic anemia. In this context, the client was already diagnosed with iron deficiency anemia. With excessive bleeding, the client will also become symptomatic of anemia. In this perspective, the patient will start experiencing headaches, and dizziness and, in severe cases, could experience syncope. Amin and Antunes (2021) argue that the mortality rates among clients presenting with a history of lower gastrointestinal bleeding can be as high as twenty-one percent, indicating the need for proper and prompt assessment and initiation of early treatment among such clients. For example, diagnosing an early stage of colon cancer can help the patient get a surgical operation done before its metastasis, increasing the client’s survival rate.
The primary objective when managing this client would be to ensure normal stool consistency. From this perspective, the client should acquire treatment for diarrhea or constipation. For example, if the client has constipation, she will benefit from increased fluid and intake of at least 30 grams of fiber daily. Combining this with stool softeners, such as MiraLAX, once daily would also be crucial to treat constipation. Offering such conservative treatment would benefit the client since there are no signs and symptoms of prolapse or strangulation, such as pain. A rubber band ligation or sclerosant would also be effective for this client. The client would also require some blood boosters with a positive history of rectal bleeding. In this case, the client should take ferrous sulfate 60 mg per oral once daily. However, the nurse must request a complete blood count to determine whether the client will require a blood transfusion. In such a case, the client would also require an operation. Assessing the client’s vital signs will also be crucial since she is hypertensive. Advising the client on the DASH diet will also enhance blood pressure control. Performing a stool test for occult blood will also be critical. The nurse should encourage the client to consume small meals to allow the bowel to heal. With the patient being on hydrocortisone 2.5% cream BD since the diagnosis of internal hemorrhoids on 6th June 2022, she was not demonstrating any rectal bleeding by 11th June 2022. Consequently, the patient acquires a discharge with improved hemorrhoids and no rectal bleeding.
Amin, S. K, & Antunes, C. (2021, July 19). Lower gastrointestinal bleeding. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK448126/
Sabry, A. O, & Sood, T. (2022, May 4). Rectal bleeding. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK563143/
Running head: GASTROINTESTINAL HEMORRHAGE