Chapter 110: Anorectal Complaints Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient reports anal pruritis and occasional bleeding with defecation. An examination of the perianal area reveals external hemorrhoids around the anal orifice as the patient is bearing down. The provider orders a colonoscopy to further evaluate this patient. What is the treatment for this patient’s symptoms?

a. A high-fiber diet and increased fluid intake b. Daily laxatives to prevent straining with stools c. Infiltration of a local anesthetic into the hemorrhoid d. Referral for possible surgical intervention

ANS: A

Most hemorrhoids, unless incarcerated or painful, are treated conservatively. A high-fiber diet and increased fluid intake are recommended first. Daily laxatives are not recommended because the variation in stool consistency makes hemorrhoid management more difficult. Infiltration of a local anesthetic is performed for thrombosed external hemorrhoid prior to removing the clot. Hemorrhoidectomy is performed for severe or very painful hemorrhoids.

Multiple Response

1. What recommendations are appropriate for patients with chronic pruritus ani? (Select all that apply.)

a. Application of a topical antihistamine

NURSINGTB.COM b. Applying a of 1% hydrocortisone cream for several months c. Avoid tight-fitting or non-breathable clothing d. Avoiding perfumed soaps and toilet papers e. Using a hair dryer on the cool setting to control itching

ANS: C, D, E

Measures to control itching include avoiding tight-fitting clothing as well as perfumed products and keeping the area clean and dry and using a cool hair dryer to dry the skin. Topical antihistamines are not used. Using a topical steroid longer than 2 weeks causes thinning of the skin.