The nurse is providing postoperative care to a client returning from a hemorrhoidectomy. Which action is the priority for the nurse to perform?

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11ecbb05_c9a3_d363_b433_53f0f41cd973_MD0009_00 Hemorrhoids (distended, inflamed veins located in the anus or lower rectum) are caused by increased anorectal pressure (straining to defecate, constipation). Clients may experience symptoms such as rectal bleeding, pain, pruritus, and prolapse. Although removal of hemorrhoids (hemorrhoidectomy) is a minor procedure, the pain associated with it is due to spasms of the anal sphincter and is severe. Nursing management for the post-hemorrhoidectomy client includes the following: Pain relief: Initially, pain is managed with pain medications, including nonsteroidal anti-inflammatory drugs (eg, ibuprofen) and/or acetaminophen; opioids can be prescribed initially but may worsen constipation. Beginning 1-2 days postoperatively, warm sitz baths are used as a means to relieve pain. Clients often dread their first bowel movement due to severe pain with defecation. Therefore, pain must be appropriately controlled to prevent further constipation (Option B). Preventing constipation: Encourage a high-fiber diet and adequate fluid intake (at least 1500 mL/day). Administer a stool softener such as docusate (Colace) as prescribed. An oil-retention enema may be used if constipation persists for 2-3 days (Option A). (Option C) Postoperatively, the health care provider may pack the rectum and apply a T-binder to hold the packing in place. The dressing is usually removed 1-2 days postoperatively unless excess soaking is noted before. (Option D) Warm sitz baths are used beginning 1-2 days postoperatively, 2-3 times daily (15-20 minutes each) for 7-10 days to provide pain relief, decrease swelling, and cleanse the rectal area. Educational objective: Post-hemorrhoidectomy pain is excruciating. Providing pain relief and preventing constipation are the primary goals for these clients. Sitz baths should begin 1-2 days postoperatively. Hemorrhoids may recur with increased anorectal pressure. Therefore, clients should maintain a high-fiber diet, use stool softeners, and drink adequate fluids (at least 1500 mL/day) to prevent constipation.

The Nurse Is Providing Postoperative Care to a Client Returning