You are about to perform a rectal examination of an older adult.
What are the steps to examine this patient?
Explain your rationale.
What are some findings you can have while assessing the rectal sphincter?
Describe the differences during the rectal examination of acute prostatitis and benign prostatic hypertrophy.
What findings would expect on physical examination of acute prostatitis and benign prostatic hypertrophy?
500 words, formatted and cited in proper current APA style with support from at least 2 academic sources
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Rectal examination is a clinical procedure that involves the manual inspection of the rectum and surrounding structures. It is commonly performed to assess the rectal sphincter tone, evaluate for abnormalities or masses, and gather diagnostic information in various medical conditions.
The steps involved in performing a rectal examination on an older adult typically include the following:
Explain the procedure: Begin by explaining the examination to the patient, emphasizing the need for the procedure and obtaining informed consent. Ensure the patient’s privacy and comfort throughout the process.
Positioning: Have the patient lie on their left side with their knees bent towards their chest. This position facilitates easier access to the rectum and promotes patient comfort.
Gloving and lubrication: Put on disposable gloves and apply a water-based lubricant to your gloved finger. Lubrication helps ease the insertion of the finger into the rectum and reduces discomfort for the patient.
External examination: Begin by inspecting the perianal area for any abnormalities, such as rashes, fissures, hemorrhoids, or external masses. Note any findings and document them accordingly.
Digital rectal examination: Gently insert your gloved, lubricated finger into the rectum, feeling for any abnormalities or masses. Assess the rectal sphincter tone by asking the patient to squeeze their anal muscles around your finger. Palpate the rectal wall and assess for tenderness, nodules, or any other abnormalities.
Prostate assessment (for males): In male patients, palpate the prostate gland by placing your finger along the anterior rectal wall, feeling for its size, shape, and consistency. Note any abnormalities, such as enlargement, tenderness, or nodularity.
Withdrawal and documentation: After completing the examination, slowly withdraw your finger while observing for any signs of bleeding or discomfort. Document your findings accurately, noting any abnormal findings, tenderness, or relevant observations.
During the assessment of the rectal sphincter, normal findings would include a strong, well-toned sphincter that contracts and relaxes appropriately upon voluntary contraction. Abnormal findings may include decreased sphincter tone, which can be indicative of neurological conditions or muscle weakness.
Now, let’s discuss the differences between acute prostatitis and benign prostatic hypertrophy in terms of rectal examination findings:
Acute prostatitis is an infection of the prostate gland, which can cause inflammation, swelling, and tenderness. During rectal examination, the prostate gland may feel enlarged, firm, and extremely tender. The patient may experience severe pain upon palpation, and there may be signs of systemic infection such as fever and chills. The sphincter tone may be normal unless there is concurrent proctitis or rectal inflammation.
On the other hand, benign prostatic hypertrophy (BPH) refers to the non-cancerous enlargement of the prostate gland, typically seen in older men. During rectal examination, the prostate gland may feel uniformly enlarged, rubbery, and smooth. The sphincter tone is usually unaffected, unless there are associated complications or concurrent proctitis.
It’s important to note that the findings mentioned above are general and may vary depending on individual patient characteristics and the stage or severity of the condition. A thorough clinical
