Health Medical Homework Help

Below I have 2 posts please provide a response for both. 150 words each with reference.

Part 1

Your response to your peers by extending, refuting/correcting, or adding additional nuance to their posts.

Steps In Performing Rectal Examination

Before performing the rectal examination, one should create a good rapport with the patient and ask for consent. Explain the procedure to the patient to know what to expect, including the discomfort associated with the procedure, and ensure a chaperone. Confirm the details of the client and the examination. Ensure there is privacy for confidentiality issues. Ensure all the required supplies for the procedure, such as a lubricating agent, hand gloves, and tissue paper, are available. To begin, wash hands and pat them dry with a clean cloth. Second, have the patient lie on his or her left side, buttocks at the edge of the examining table or bedside, with the right knee and hip slightly flexed (Patel et al.,2019). Begin by looking over the gluteal and anal areas with clean, gloved hands. Check for warts, discoloration of the skin, hemorrhoids, fissures, and skin tags (Seidel, H. M. 2017). Apply lubrication to the index finger of the right hand after the inspection. The patient should be notified when starting the procedure. The finger should be positioned in that it is anteriorly pointing and putting pressure on the anus’s midline. Continue pressing until the index finger enters the rectum, then measure the tone of the anal sphincter by having the patient press on your inspecting finger (College, R. 2018).

Assess all of the rectal walls systematically by rotating the right and left finger around the rectal canal. Examine the prostate gland, which should be palpable from the front. Assess for tenderness, nodularity, and consistency (College, R. 2018). Abnormalities such as tumor masses, hardened feces, or bleeding ulcers can be felt by doing so. Examine the size, regularity, and presence of a groove on the midline in men (Seidel, H. M. 2017). Remove the finger and examine it for feces, blood, and mucous stains. Remove the lubricant from around the anal canal and discard the used gloves in the trash. Allow the patient to dress and thank them before documenting the results of your assessment. Lastly, document the findings.

Rationale For Rectal Examination

The rectal examination helps identify several disease processes pertaining to the perineum, rectum, the seminal vesicles, the bladder, the prostate, and the anus, such as bleeding, incontinence, constipation, pain and prostate cancer in men.

Assessing Rectal Sphincter

Assessing the rectal sphincters evaluates the anal sphincter resting tone and squeeze pressure, representing internal and external sphincter function, respectively (Dawson, J. 2016). Proximal posterior palpation of the top of the anal sphincter complex during voluntary squeeze will assess puborectalis function (Seidel, H. M. 2017). In patients with diarrhea and stool incontinence, the tone of the rectal sphincter will be poor and will be unable to squeeze the examining finger. It is common in people with neurological deficits resulting from trauma.

Differences In Rectal Examination in Benign Prostatic Hypertrophy and Acute Prostatitis

During the rectal examination of acute prostatitis, a careful procedure is indicated. When examining, refrain from massaging the prostate because it is painful and can cause unbearable discomfort to the patient (Patel et al.,2019). A 3600 rectal sweep of the inside of the rectum can be performed in both then followed by careful prostatic palpation in benign prostatic hypertrophy (College, R. 2018). In a patient suspected of having acute bacterial prostatitis, palpation of the prostate will be painful and lead to the spread of bacteria to surrounding tissues. In benign prostatic hyperplasia, prostatic massage is indicated.

Physical Examination Findings in Acute Prostatitis and Benign Prostatic Hyperplasia.

The physical examination findings are somehow related to the two, but a difference can be noted. When assessing the gland, physical examination findings of benign prostatic hyperplasia may reveal unequal sized lobes, increased fibrous elements, firm to hard nodules, and stony hard feeling. Findings of acute prostatitis may reveal a boggy, nodular, tender, hot normal feeling prostate gland. Suprapubic tenderness might also be present. Urinary continence may result in an enlarged tender bladder.

References

College, R. (2018). Digital rectal examination: guidance for nurses working with children and young people. Royal College Of Nursing.

Dawson, J. (2016). The Rectal Examination. Res Medica, 6(3). https://doi.org/10.2218/resmedica.v6i3.854 (Links to an external site.)

Patel, M. I., Kakala, B., & Beattie, K. (2019). Teaching medical students digital rectal examination: a randomized study of simulated model vs rectal examination volunteers. BJU International. https://doi.org/10.1111/bju.14778

Seidel, H. M. (2017). Mosby’s guide to physical examination. Mosby/Elsevier.

Below I have 2 posts please provide a response for both. 150 words each with reference.

Part 2

Your response to your peers by extending, refuting/correcting, or adding additional nuance to their posts.

Rectal Examination

Procedure followed

Rectal examination is crucial in examining if there are any growths around the anal, rectum, and the reproductive areas. This examination is done by both inspection and palpation. The first step will involve inspecting the buttocks area to see if there are any fistulous tracts and traces of blood, hemorrhoids, and rectal prolapse. The second step will involve a rectal examination where both sides of the buttocks will be scratched with a gloved finger to elicit an anal reflex or a wink (Hillman et al., 2019). The final step will be another examination where the gloved finger will be inserted through the anal opening and the whole circumference inspected, first inspecting between 1 and 2cm deep and then inspecting up to 7 to 8cm.

Rationale for the procedure

The first inspection of just checking at the outer surfaces is meant to look for any signs of illnesses and infections that can be visibly identified. For instance, presence of blood may be an indication of a problem in the rectum which should be checked. The superficial rectal examination that goes up to 2cm is meant to help in identifying the presence of any inflammation and growth that may be an indicator of abnormal prostate. Lastly, doing a deeper examination is crucial in identifying any abnormalities in the rectum like growths that may be an indication of diseases like rectum or anal cancer.

Possible results from rectal examination

A rectal examination does not necessarily mean that one has complications, but it is an examination that can be done regularly to check on complications early enough. For the case of someone who does not have any complications, there will be fistulous tracts or blood on the anal surface. Equally, the prostate will not be more than 2.5cm in length, which is about half the size of the gloved finger. Equally, a normal person cannot have any kind of inflammation along the rectal wall. The rectal wall is expected to be smooth.

Acute Prostatitis and Benign Prostatic Hypertrophy

The main difference between acute prostatitis and benign prostatic hypertrophy is that the former is an inflammation that can begot someone at any time, while the latter is a growth in the prostate that mainly beget elderly people (Grewal et al., 2017). Whereas benign prostatic hypertrophy can mainly be diagnosed through a rectal examination, an acute prostatitis can be diagnosed through three methods namely blood test measuring PSA and urine analysis. A digital rectal examination can, however, be used to obtain more accurate results. The common symptom includes an acute pelvic pain and other urinary tract symptoms.

Rectal Examination in Acute Prostatitis and Benign Prostatic Hypertrophy

As stated before, benign prostatic hypertrophy mainly entails a growth while acute prostatitis entail inflammation. As such, if the patient has benign prostatic hypertrophy, then a growth will be felt when doing a rectal examination. If the patient has acute prostatitis, then an inflammation will be felt. Equally, a patient with acute prostatitis will have a prostate that is either enlarged, tender, boggy, or both. A digital rectal examination involving any of the two should be done gently because when done vigorously, bacteremia or sepsis can be induced. It is also crucial to note that the two conditions are not the same as cancer.

References

Grewal, N., Tuli, A., Sridhar, F. K., & Mammen, K. J. (2017). Xanthogranulomatous prostatitis with benign prostatic hyperplasia: A rare combination. CHRISMED Journal of Health and Research, 4(3), 214.

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