Case Study (Indirect Inguinal Hernia Left Incarcerated ) 3-11-2015

I. Demographic DataName: Patient fAge: 24Sex: MaleBirthday: 9-11-1990Birthplace: San Jose CityAddress: San Jose City N.ECivil Status: SingleReligion: CatholicNationality: FilipinoHighest Educational Attainment: College GraduateOccupation: ProgrammerDate Admitted: 3-9-15Time Admitted: 12:33pmChief Complaints: HerniaAdmitting Diagnosis: Indirect Inguinal Hernia Left Incarcerated

II. Past Medical HistoryNoneIII. Family Illness History

The mother side- asthma

IV. Diagnostics:

HematologyHGB-139HCT-0.40WBC- 10.54RBC- 4.46MCV- 90MCH-31.6Differential CountNeutrophil- 0.72Lymphocyte-0.17Monocyte- 0.05Eosinophil- 0.01APC- 300 X 10

C. List of All Drugs

Co Amoxiclav one tab TID per oremMefenamic Acid 500mg one tab TID per orem

V. Physical Assessment

A. Psychological StatusThe patient is a 24 year old male, Single and was born in San Jose City.

B. Mental & Emotional StatusThe Patient is conscious, coherent and can responds to external and verbal stimuli. The patient is cooperative during the nurse-patient interaction.C. Environment StatusThe patient is on the 2nd admission day. The Patient is in the Male Surgical Ward with his aunt.D. Sensory StatusThe patient is able to read & write.E. Motor StatusThe patient has having a hard time ambulating in relate to his lower left abdominal pain, he stays in the bed all the time.F. Nutritional StatusThe patient is on full diet, he ate rice soup for breakfast and one serving of vegetable for lunch.G. Elimination StatusThe patient hasnt defecate since admission. The Patient has voided 3 times the shift.H. Fluids & Electrolytes StatusThe IVF of the patient was D5LRS 1 liter was ongoing.

VI. Drug Guide

Name of the DrugClassificationActionIndication

Mefenamic AcidNSAIDcompetitive inhibitor of COX-1 and COX-2, which are responsible for the first committed step in prostaglandin biosynthesis.For relief of mild to moderate pain in patient

Co-amoxiclavAnti bioticsbactericidal and works by inhibiting the synthesis of bacterial cell walls.Acute bacterial sinusitis, acute otitis media, acute exacerbations of chronic bronchitis, community acquired pneumonia, cystitis, pyelonephritis, SSTI, bone and joint infections.

VII. Inguinal Hernia OverviewAninguinal herniais a condition that occurs in the groin area when fatty or intestinal tissues push through the inguinal canal. The inguinal canal is located at the base of the abdomen and is closed. Men and woman have an inguinal canal. In men, the testes descended through the canal shortly before birth. The uterus ligament is located in the canal in women. When there is a hernia in this passage, it results in a protruding bulge that may be painful on movement.Symptoms of Inguinal HerniaThese types of hernias are most noticeable by their physical appearance. They cause bulges along the pubic area that can increase in size when you stand up or cough. This type of hernia may be painful or sensitive to the touch.Other symptoms may include: pain when coughing, exercising, and bending over burning sensations sharp pain heavy sensation in the groin swelling scrotum in men

Causes and Risk Factors of Inguinal HerniaThere is no one cause of this type of hernia. However, weak spots within the abdominal and groin muscles are thought to be a major cause. Extra pressure on this area of the body can eventually cause hernias.Risk factors can increase your chances of this condition. Examples of factors include: Heredity personal history of hernias being male premature birth being overweight or obese pregnancy cystic fibrosis chronic cough frequent constipation frequently standing for long periods of time

Types of Inguinal HerniasThere are two types of inguinal hernia: indirect and direct. Anindirect inguinal herniais the most common type. It often occurs in premature births, when the inguinal canal is not fully developed. However, this type of hernia can occur at any time during your life. This condition is most common in males.Adirect inguinal herniamost often occurs in adults. It is most often attributed to weakening muscles during adulthood. According to the National Digestive Diseases Information Clearinghouse (NDDIC), this type of hernia is exclusive to malesInguinal hernias may also be classified as incarcerated or strangulated. Incarcerated inguinal herniasare stuck in the groin muscles.Strangulated versions are more serious medical conditions that restrict blood flow to the small intestine. Strangulated hernias are life-threatening and require emergency medical care.Diagnosis of an Inguinal HerniaThese hernias may be easily pushed back into the abdomen when lying down. However, if they are unable to be pushed back into the abdomen, you may have a strangulated inguinal hernia. Your doctor can make this determination during a physical exam. During the exam, you may be asked to cough while standing so the hernia can be checked when it is at its largest.Treating Inguinal HerniasSurgery is the primary treatment for inguinal hernias and a very common operation and highly successful procedure. Your doctor will recommend either herniorrhaphy (open repair) or laparoscopy.Open repairinvolves making an incision into the groin and returning the abdominal tissues into the abdomen and repairing the abdominal wall defect.Laparoscopyuses several small incisions rather than a single incision. This surgery may be preferable if you want a shorter recovery time.Prevention and Outlook of Inguinal HerniasEarly treatment can help cure inguinal hernias. However, there is always the slight risk of complications, such as infection after surgery, scars, and the recurrence of the hernias. Call your doctor if you experience new symptoms or if side effects occur after treatment. Although you cannot prevent genetic defects that may cause the hernias, you can possibly lessen their severity by: maintaining a healthy weight eating a high-fiber diet not smoking avoiding heavy liftingVIII. Nursing Care PlanNursing Diagnosis

Activity intolerance Acute pain Ineffective tissue perfusion: Gastro Intestinal Risk for infection Risk for injury

Nursing outcomes nursing care plans for Inguinal Hernia

The patient will perform activities of daily living within the confines of the disease process. The patient will express feelings of comfort. The patient's bowel function will return to normal. The patient will remain free from signs or symptoms of infection. The patient will avoid complications.

Nursing interventionsNursing Care Plan For Inguinal Hernia

Apply a truss only after a hernia has been reduced. For best results, apply it in the morning before the patient gets out of bed. Assess the skin daily and apply powder for protection because the truss may be irritating. Watch for and immediately report signs of incarceration and strangulation. Closely monitor vital signs and provide routine preoperative preparation. If necessary, When surgery is scheduled Administer I.V. fluids and analgesics for pain as ordered. Control fever with acetaminophen or tepid sponge baths as ordered. Place the patient in Trendelenburg's position to reduce pressure on the hernia site.

After surgery,

Provide routine postoperative care. Don't allow the patient to cough, but do encourage deep breathing and frequent turning. Apply ice bags to the scrotum to reduce swelling and relieve pain; elevating the scrotum on rolled towels also reduces swelling. Administer analgesics as necessary. In males, a jock strap or suspensory bandage may be used to provide support.

Patient teaching home health guideNursing Care Plan For Inguinal Hernia

Explain what an inguinal hernia is and how it's usually treated. Explain that elective surgery is the treatment of choice and is safer than waiting until hernia complications develop, necessitating emergency surgery. Warn the patient that a strangulated hernia can require extensive bowel resection, involving a protracted hospital stay and, possibly, a colostomy. Tell the patient that immediate surgery is needed if complications occur. If the patient uses a truss, instruct him to bathe daily and apply liberal amounts of cornstarch or baby powder to prevent skin irritation. Warn against applying the truss over clothing, which reduces its effectiveness and may cause slippage. Point out that wearing a truss doesn't cure a hernia and may be uncomfortable. Tell the postoperative patient that he'll probably be able to return to work or school and resume all normal activities within 2 to 4 weeks. Explain that he or she can resume normal activities 2 to 4 weeks after surgery. Remind him to obtain his physician's permission before returning to work or completely resuming his normal activities. Before discharge, Instruct him to watch for signs of infection (oozing, tenderness, warmth, redness) at the incision site. Tell him to keep the incision clean and covered until the sutures are removed. Inform the postoperative patient that the risk of recurrence depends on the success of the surgery, his general health, and his lifestyle. Teach the patient signs and symptoms of infection: poor wound healing, wound drainage, continued incision pain, incision swelling and redness, cough, fever, and mucus production. Explain the importance of completion of all antibiotics. Explain the mechanism of action, side effects, and dosage recommendations of all analgesics. Caution the patient against lifting and straining.