Rectal bleeding

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Counseling

Small streaks of bright red blood with hard stools usually come from a small tear that heals once stools are soft. Recommended supportive care with an emphasis on soft daily stools, fruits, vegetables, and water, and warm baths for comfort. Return precautions given including more than streaks of blood, dark or black stools, dizziness or paleness, fever, severe belly pain, diarrhea with blood, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

CounselingNot in the note with these choices

We will look into the cause of the bleeding with the tests and visits above. Recommended supportive care with an emphasis on hydration and a regular diet. Return precautions given including more than streaks of blood, dark or black stools, dizziness or paleness, fever, severe belly pain, vomiting, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

CounselingNot in the note with these choices

Discussed the need for emergency evaluation today, and the caregiver will take the patient now. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Rectal bleeding
• Reviewed the amount and pattern of bleeding, stool consistency, pain, growth, systemic symptoms, and medications
• Small streaks of bright red blood on the stool or tissue
• Well appearing with normal vital signs
• Anal fissure on exam, with constipation
• Recommended miralax to keep stools soft
• Recommended sitz baths and petroleum jelly to the area
• Stable for outpatient management
• Follow up if bleeding continues or recurs

Small streaks of bright red blood with hard stools usually come from a small tear that heals once stools are soft. Recommended supportive care with an emphasis on soft daily stools, fruits, vegetables, and water, and warm baths for comfort. Return precautions given including more than streaks of blood, dark or black stools, dizziness or paleness, fever, severe belly pain, diarrhea with blood, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Amount (large sets ED)
Vital signs and appearance
Cause: fissure, FPIAP, infectious, strep, polyp, IBD
Soften stools; sitz
GI referral by reason

Return precautions in the template

more than streaks of blooddark or black stoolsdizziness or palenessfeversevere belly paindiarrhea with blood

Sources

Pediatric Care Online Key Points: Perianal Disease

Few formal guidelines cover this topic, so the template also leans on expert opinion.