The Surgical nurse
Surgical unit
02 November 2021
Dear Nurse,
Re: Ms Guana Ferrocia, DOB:01/06/1964
I am referring Ms Ferrocia , who has been diagnosed with haemorrhoids grade 4 admitted for haemorrhoidectomy the following day, requires care and further management.
On 29 October 2021, she was admitted with complaints of rectal bleeding with burning pain, slightly tender prolapse and passing of fresh blood while defecating.She has Type 2 diabetes mellitus, inflamed bowel syndrome and had past history of bowel complaints, proctitis and inflammation of appendix for which treated with medication management.
She was instructed to follow measures like maintaining high fiber rich diet, and to soak the area with warm water for relief. Meditations like Tylenol, lidocaine and proton pump inhibitors were also commenced.
Regardless of these measures, she has complaints of constipation and hard stools ;therefore, hemorrhoidectomy was recommended and pathology investigations and pre - procedure assessment was ordered.
Ms Ferrocia’s vital signs are unremarkable. Preoperative protocols were initiated, administered IV fluids, enema given and education on anesthesia, hospital policies were instructed. Consent was completed and there is pending of pathological results. NPO to be started 6 hours prior to the surgery.
Based on the above mentioned details, it would be greatly appreciated if you could provide further care and management.
If you have any queries, please do not hesitate to contact me.
Yours faithfully
Ms Marry Mouse
Registered nurse
General unit
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