Colon

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# 1

Daniela Abreu

St Thomas University

NUR 418

Instructor: Rafael Rojas

Date: 10/05/2022

 

A Rectal Examination of an Older Adult

The Steps Followed in Examining the Older Adult and the Rationale That is Used

The rectal examination allows the patient to determine the people that need to be in the room as the examiner performs the process. In a rectal examination for a male patient, the patient will be asked to squat on the examination table, or the patient may decide to lie on the examination table side but needs to pull up the upper knee to a level comparable to the chest in a fetal position, the examiner can ask the patient to bend forward at a waist. The examiner now gets gloves and a lubricated finger gently inserted through the patient's anal to give the examiner room to detect any potential abnormality (Hillman et al., 2019). To start the rectal examination, the examiner must ensure the patient is relaxed and take a deep breath. The examiner now wants to determine the prostate size and will use a gloved, lubricated finger to correctly assess the anal muscles' strength and identify any soft and hard spots and bumps.

The examiner should ask a female patient to lie on the back and make the feet in a raised stirrup. The examiner must ensure the patient is relaxed and can take a deep breath before starting the examination. The examiner inserts a gloved, lubricated finger in the patient's rectum to determine the bowel and the reproductive organs (Hillman et al., 2019). The examiner may also use the other hand to apply pressure on the pelvic area and the lower abdomen to detect or identify any abnormality in the internal organs.

Potential Findings While Assessing the Rectal Sphincter?

A digital rectal exam is conducted to evaluate the resting tone of the anal sphincter, which represents the internal function of the sphincter, and to assess the squeeze pressure of the anal sphincter, which represents the external function of the sphincter (Coura et al., 2017). During a voluntary squeeze, the puborectalis function is assessed through proximal posterior palpation of the top of the anal sphincter complex. Defects of the anal sphincter are palpated as ridges in the region of perianal scars.

Differences in the Acute Prostatitis Rectal Examination and Benign Prostatic Hypertrophy Rectal Examination

When conducting a rectal examination in patients with acute prostatitis, examiners should avoid massage prostatic (Khan et al., 2017). While prostate cancer may feel like bumps on the prostate's surface, which is usually smooth during a digital rectal examination, enlarged prostate feels like a bulge behind the rectum wall.

The Expected Findings on the Physical Examination of Acute Prostatitis and Benign Prostatic Hypertrophy

During physical examination in patients with acute prostatitis, the prostate is usually tender, boggy, or enlarged. Physical examination in patients with acute prostatitis may reveal abdominal tenderness in the suprapubic area and an enlarged tender bladder resulting from urinary retention (Khan et al., 2017). On the other hand, during the digital rectal examination of benign prostatic hypertrophy, an examiner assesses the size and contours of the prostate, detects areas that suggest malignancy, and evaluates for nodules (Woodard et al., 2017). During a physical examination, the prostate feels enlarged and non-tender. In most cases, the prostate has lost the median furrow and has some consistent rubbery. The urinary bladder may also be palpable during the abdominal examination if it is distended. Hard or firm areas in the prostate may indicate prostate cancer.

 

References

Coura, M. D. M. A., Silva, S. M., Almeida, R. M. D., FORREST, M. C., & Sousa, J. B. (2017). Is digital rectal exam reliable in grading anal sphincter defects?. Arquivos de gastroenterologia, 53(4), 240-245.

Hillman, R. J., Berry-Lawhorn, J. M., Ong, J. J., Cuming, T., Nathan, M., Goldstone, S., ... & Bouchard, C. (2019). International Anal Neoplasia Society guidelines for the practice of digital anal rectal examination. Journal of lower genital tract disease, 23(2), 138- 146.

Khan, F. U., Ihsan, A. U., Khan, H. U., Jana, R., Wazir, J., Khongorzul, P., ... & Zhou, X. (2017). Comprehensive overview of prostatitis. Biomedicine & Pharmacotherapy, 94, 1064- 1076.

Woodard, T. J., Manigault, K. R., McBurrows, N. N., Wray, T. L., & Woodard, L. M. (2017). Management of benign prostatic hyperplasia in older adults. The Consultant Pharmacist®, 31(8), 412-424.

# 2

Cassandre Castor

St. Thomas University

NUR-418-AP2

Rafael Rojas, FNP, PMHNP-BC

October 4, 2022

Steps to examine this patient

First, collect the patient's subjective data. The nurse should inquire about the patient's usual bowel habits, changes in bowel habits, rectal bleeding, and blood in the stool. The nurse must ask whether the patient is taking laxatives and stool softeners. The nurse must question the family's rectal diseases, polyps, colon or rectum cancer, inflammatory bowel illness, and prostate cancer (Jarvis, 2019). The nurse should inquire about the typical daily intake of high-fiber foods. It is crucial to the date of their most recent digital rectal examination, blood test for prostate-specific antigen, or stool blood test. The assessment of this area is mainly private, so the nurse must ensure the patient's comfort throughout the entire procedure. During this happy time, it is essential to put the patient at ease by explaining what the nurse is doing at each step.

Particular positions such as the left lateral, lithotomy, and standing are utilized to evaluate the region. The nurse will also require a penlight, lubricating jelly, gloves, and a fecal occult blood test container. The nurse must inspect the perineal area for lesions, scars, or inflammation. Utilizing a drop of lubricating jelly, the nurse would perform advanced palpation of the anus and rectum. Instruct the client to hold their breath and gently place the pad of their index finger against the anal verge. As the sphincter contracts, the client should exhale and feel the finger move into the anal canal toward the umbilicus (Jarvis, 2019). The nurse must palpate the entire muscle ring by rotating her examining finger.

To evaluate muscle tone, the client must contract the muscle. Using two fingers, the nurse can assess whether the bulbourethral glands are enlarged or painful. The nurse should evaluate the prostate gland adjacent to the front wall. The nurse can feel decreased, increased, or tenderness in the rectal sphincter while an older patient performs a Valsalva maneuver. Relaxation of the perineal muscles and diminished sphincter control is seen (Jarvis, 2019).

Any area of the prostate can be palpated for the presence of prostatic nodules. True nodules must be distinguished from rectal mucosal lesions; they may be caused by benign prostatic hypertrophy (BPH), palpable prostatic calculi, or prostate cancer. All prostatic nodules, with rare exceptions, must be biopsied since the etiology of a nodule cannot be ruled out (Villanueva Herrero et al., 2022).

Acute or chronic, bacterial or nonbacterial prostatitis can be either acute or chronic. Is abacterial prostatitis referred to as prostatitis? Irritative urine symptoms co-occur with acute bacterial prostatitis, including dysuria, frequency, and urgency (Villanueva Herrero et al., 2022).

In this situation, the prostate examination should be confined to establishing the diagnosis, as prostatic massage can cause significant morbidity, including septicemia. The nurse would evaluate a gland that is tender, hot, and swollen; a swollen, tender bladder; or suprapubic abdominal soreness (Villanueva Herrero et al., 2022).

Rationale

Each phase of the technique can be either positive or negative results. According to the book (Jarvis, 2019), the results of perianal and rectal wall examinations should be documented. A visual examination is performed to detect external hemorrhoids, skin tags, drainage, and anomalies. The nurse initially evaluates the anal sphincter tone. When the patient is squatting, the nurse examines for sphincter constriction. Palpation of the rectal wall provides information regarding masses, discomfort, and nodules. In male patients, prostate glands are typically palpable from the rectum. The prostate is palpated to assess its size, sensitivity, modules, and masses. Additionally, the collection of fecal samples is necessary for the detection of occult blood.

Findings while assessing the rectal sphincter

Normal findings

The results of a rectal examination vary in healthy individuals and those with rectum issues. The rectal sphincter is a set of muscles that regulate the release of feces and, as such, plays a crucial function in maintaining continence. The rectal sphincter is tight in a healthy individual; the fingers can feel the tightness as the patient bears down; it is strong and can control the flow of stool. In individuals with weak sphincter muscles, the finger cannot perceive the contraction of the muscles (Jarvis, 2019). They are so soft that they cannot contain their bowels when exercising or passing gas.

Unusual findings

External inspection may reveal skin disease, for example, natal cleft dermatitis in seborrheic eczema, skin tags, pilonidal sinus, genital warts, anal fissures, anal fistula, external hemorrhoids, rectal prolapse, skin discoloration with Crohn's disease, and external thrombosed piles.

A thorough internal examination may reveal

Simple piles, rectal carcinoma, rectal polyps, tenderness, diseases of the prostate gland, and malignant or inflammatory conditions of the peritoneum.

Acute Prostatitis and Benign Prostatic Hypertrophy

Acute prostatitis and benign prostatic hypertrophy are both prostatic gland disorders. Acute prostatitis is an inflammation of the prostatic glands, whereas benign prostatic hypertrophy is an age-related expansion of the glands. On rectal examination, acute prostatitis manifests as soreness due to the glandular inflammatory response. Benign prostatic hypertrophy is characterized by an enlargement of the glands (Jarvis, 2019). Upon palpation of the prostate, the size of the glands is notably enlarged.

Physical Examination Results

A pus-like discharge from the penis characterizes acute prostatitis. In addition, some symptoms include fever, chills, and erectile dysfunction. In contrast, the symptoms of benign prostate enlargement are urinary incontinence, a weak urine stream, and even an inability to pee. People need health education and other health promotion support for good rectal health. Health programs teach people how to live healthier lives and avoid some diseases by doing so.

References

Jarvis, C., Tarlier, D., Pelt, V. L., Labrecque, M. E., & Newton, L. (2019). Jarvis Physical Examination & Health Assessment. Elsevier.

Villanueva Herrero, J. A., Abdussalam, A., & Kasi, A. (2022). Rectal Exam. NIH. https://www.ncbi.nlm.nih.gov/books/NBK537356/