Inguinal Hernia

Inguinal Hernia “Case Presentation”

INTRODUCTION

OBJECTIVES

• Acquire knowledge about “Inguinal Hernia”

• Obtain independent, dependent and collaborative nursing skills necessary in handling patient with Hernia.

• Gain appropriate attitude in handling patient with hernia.

• Help patient promote health and medical understanding of such condition through the application of the nursing skills

.

OVERVIEW

An inguinal hernia is a condition in which

intra-abdominal fat or part of the small intestine,

also called the small bowel, bulges through a

weak area in the lower abdominal muscles.

Patient’s Profile

PATIENTS HISTORY

• Present Health History

• Past Health History

• Family Health History

• Environmental

PHYSICAL ASSESSMENT& GENERAL APPEARANCE

HEAD TO TOE ASSESSMENT

Body Part Findings Interpretation

Genitals

With a bulging mass on the right inguinal area around 5 cm in diameter.

With enlarged right scotum

Abnormal

Upper Extremi-ties

Symmetrical with visible veins; Nails are transparent, smooth & convex with light pink nails beds & white translucent tips.

Normal

ANATOMY & PHYSIOLOGY

Types of Inguinal Hernia

Incarcerated Inguinal Hernia • Is a hernia that becomes stuck in

the groin or scrotum and cannot be massaged back into the abdomen

Strangulated Hernia • is a serious condition and requires

immediate medical attention.

PATIENT’S BASED PATHOPYSIOLOGY

• PATIENT'S BASSED PAtho.doc

Laboratory Results

• CBC.docx

SURGICAL MANAGEMENT

• Herniorrhapy with mesh

Is a surgical procedure for correcting hernia, It is a

procedure involves an incision in the groin pushing the

protruded intestine by sewing the muscle tissue &

inserting an absorbable mesh that decreases the tension

on the weakened abdominal wall, reducing the risk of

hernia reoccurrence.

http://en.wikipedia.org/wiki/Hernia

SURGICAL MANAGEMENT

Pre-Operative Nursing Care

• secure consent

• monitor vital sign

• skin preparation

• administering pre-op medications

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SURGICAL MANAGEMENT

Post-Operative Nursing Care

• monitor sign of infections

• monitor for hemorrhage

• monitor vital signs until stable

NURSING MANAGEMENT

• Place patient in Trendelenburg position with ice applied

to affected side.

• Avoid lifting heavy objects

• Application of a truss

• Encourage patient to use incentive spirometer

• Encourage breathing exercises.

Medical Management

Name of Drugs Mode of Action Classification Indications Contraindications Adverse Drug Reactions

Nursing Consideration

Tramadol Amaryll vial

Centrally acting analgesic not chemically related to opioids but binds to mu-opioid receptors and inhibits reuptake of norepinephrine and serotonin.

Analgesics (Opioid) / Supportive Care Therapy

Moderate to severe pain & post-op pain.

Hypersensitivity. Acute intoxication with alcohol, hypnotics, centrally acting analgesics, opioids, or psychotropic agents

Nausea, vomiting, diarrhea, constipation. Tiredness, drowsiness, dizziness, headache, Skin rashes, tachycardia, bradycardia, flushing, allergic reactions.

Assess for level of

pain relief and administer prn dose as needed.

Monitor vital signs and assess for orthostatic hypotension or signs of CNS depression.

Discontinue drug and notify physician if S&S of hypersensitivity occur.

Assess bowel and bladder function; report urinary frequency or retention.

Use seizure precautions for patients who have a history of seizures or who are concurrently using drugs that lower the seizure threshold.

Monitor ambulation and take appropriate safety precautions.

Medical Management

Name of Drugs Mode of Action Classification Indications Contraindication Adverse Drug Reactions

Nursing Consideration

Monowel (Cefoxitin)

Inhibits bacterial cell wall synthesis, thus promoting osmotic instability which eventually leads to bacterial cell death.

Cephalosporins 2nd - generation

Peritonitis & other intra-abdominal & intrapelvic infections, septicemia, endocarditis, gynecological, resp tract, bone & joint, skin & soft tissue infections, UTI including uncomplicated gonorrhea.

Allergy to penicillins and cephalosporins and people with allergic drug background.

Phlebitis, inflammation at the site of inj, GI reactions eg nausea & vomiting

Assess patient’s previous sensitivity reaction to penicillin or other cephalosporins. Cross-sensitivity between penicillins and cephalosporins is common. Do skin testing. Watch out for allergic reaction and anaphylaxis: rash, urticaria, pruritus, chills, fever or joint pain.

For IV use, reconstitute 1g with 10ml of sterile water for injection of diluents.

For IV injection administer slowly for 3 to 5 minutes through tubing of a flowing compatible IV solution.

Discard unused medication after 24 hour if stored at room temperature of 1 week if stored at a refrigerator.

Assess bowel movement daily; diarrhea may indicate psuedomembranous colitis.

Medical Management

Name of Drug Mode of Action Classification Indications Contraindications Adverse Drug

Reactions Nursing

Consideration

Paracetamol

Decreases fever by inhibiting the effects of pyrogens on the hypothalamic heat regulating centers and by a hypothalamic action leading to sweating and vasodilatation.

Antipyretics/ Analgesics

Relief of mild-to-moderate pain; treatment of fever

Hypersensitivity to the drugs

Hematologic: hemolytic anemia, neutropenia, leukopenia, pancytopenia Hepatic: jaundice Metabolic: hypoglycemia Skin: rash, urticaria

Assess patient’s fever or pain: type of pain, location, intensity, duration, temperature, diaphoresis Do skin testing. Watch out for allergic reaction: rash, urticaria; if these occur, drug may have to be discontinued. Assess hepatotoxicity: dark urine, clay-colored stools, yellowing of skin and sclera; itching, abdominal pain, fever, diarrhea if patient is on long-term therapy. Warn patient that high doses or unsupervised long-term use can cause liver damage. Excessive alcohol use may increase the risk of liver damage.

Nursing Care Plan(pre-operative)

Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

Subjective: ”Masakit dito sa may singit ko” as verbalized by the patient. Objective: ć enlarged R

scrotum 5cm

ć right groin pain noted ć heavy

dragging pain ć pain scale of 8/10

ć facial grimace

ć guarding

behavior c limited ROM moaning at times

Pain related to swelling and pressure on intestinal tissues secondary to disease condition as manifested by complaint of pain, facial grimace & guarding behavior

At the end of the shift, the patient’s pain will be lessen

Vital signs monitored

and recorded Established rapport

with the patient

Performed a

comprehensive assessment of the pain to include the location, characteristic and intensity of pain and precipitating factors

Provided comport measures such as:

a. Providing quiet

environment b. Placing client in

reversed T-position

c. Encouraged use of

diversional activities and relaxation techniques such as focused breathing and imaging

Encouraged verbalization of pain

Administered analgesic, as indicated, to maximum dosage, as needed

To obtained baseline

data and fluctuations in VS may show pain

To established trust and cooperation with the client and to enhance compliance

To obtained information about pain and patient’s condition

To promote non-

pharmacological pain management

a. To reduce tension

b. To decrease pressure and swelling of intestines by taking advantage of the gravity

c. To divert attention away from pain

To enhance emotional

comfort

To pharmacologically decrease pain

Goal partially met: pain lessened, ć latest pain scale of 7/10



Subjective: ”Mainit ang pakiramdam ko” as verbalized by the patient. Objective: febrile ć temp of

38.2° C skin warm to

touch

ć flushed skin diaphoretic ć increased WBC 11.3 x /L ć body malaise

c enlarged R

scrotum 5cm in circumference

c complaint of

groin pain

Altered body temperature: Hyperthermia r/t inflammatory process secondary to disease condition as manifested by increase temp of 38.2C

At the end of the shift the patient body temp will be at normal range

vital signs monitored

and recorded Provided tepid

sponged bath Provided cold

compress at the forehead

IVF properly regulated Provided surface

cooling e.g. by the use of fans

Provided loose and

cotton clothing Encouraged frequent

rest periods administered anti -

pyretics as ordered

to obtain baseline data to lower the body

temp thru conduction to lower temp thru

conduction to maintained fluid

balance and to prevent DHN

to promote heat loss to promote heat loss to reduced metabolic

demand to pharmacologically

decrease temperature

Goal met: patient’s temp is within normal range, c latest temp of 37.5° C



Subjective: ”Pauti-uti lang ang pagdumi ko.” as verbalized by the patient. Objective: ć pellet-like

yellow brown hard stool

ć hypoactive

bowel sounds ć abdominal

tenderness ć abdominal

cramps ć enlarged R

scrotum 5cm in circumference

Constipation related to decreased motility of gastrointestinal tract secondary to disease condition as evidenced by pellet-like yellow brown hard stool and hypoactive bowel sounds

At the end of the shift patient will regain normal pattern of bowel functioning

performed assessment

of the abdomen

turned patient side to side

IVF properly monitored

and regulated

to obtain information

about the condition of the client

to stimulate peristalsis to promote fluid

balance

Goal was not met: Still no bowel movement

Nursing Care Plan(post-operative)

Assessment Nursing Diagnosis Planning Intervention Rationale

Subjective: ”Mapula at nangangati ang tahi ko” as verbalized by the patient. Objective: c incised wound

on RLQ with soiled dressing

ć redness on the

suture line

ć itchiness on the suture line

slightly febrile c

temp of 37.9°C

Risk for infection r/t break in the primary defense of the body secondary to surgical procedure done as evidenced by broken skin

At the end of the shift, patient/family will show lifestyle changes to prevent infection.

Noted risk factors for

occurrence of infection

Observed localized signs of infection at suture line

Monitored vital signs

particularly temperature Tepid sponge bath

rendered and provided cold compress at forehead

Wound dressing changed aseptically

Turned patient side to side

Instructed proper hand

hygiene and emphasized importance

Encouraged deep

breathing and coughing exercise

To assess causative or

contributing factors

To assess for signs of infection at the wound site

To serve as a baseline

data for nursing care and to watch for the development of infection e.g. fever

To decreased body

temperature thru conduction

To prevent infection at wound site

To prevent pneumonia Universal precaution

to prevent transmission of bacteria

To prevent pneumonia


Assessment Nursing Diagnosis Planning Intervention Rationale

Health teachings provided emphasizing the importance of:

a. Proper wound care such as the use of antiseptic

b. Regular proper personal hygiene such as perineal care and regular change of underwear

c. Adherence to

treatment regimen e.g. completion of antibiotic

d. Advised to eat foods

rich in Vit. C and protein such as fruits, juices, legumes, and organ meats

Prescribed antibiotic

medication given

To prevent

contamination and further development of infection

To help in immediate

wound healing To pharmacologically

preventing infection


Subjective: ”Masakit ang tahi ko” as verbalized by the patient. Objective: ć post-op pain at

RLQ, sharp and shooting ć pain scale of 6/10

c incised wound

at RLQ

ć facial grimace

ć guarding behavior

c limited range of

motion moaning at times

Pain related to disruption of skin and tissue 2° to surgical procedure done as evidenced by facial grimace and guarding behavior

At the end of the shift, patient’s pain will be lessen

Assessed characteristic

of pain, location and description

Vital signs monitored and recorded

Encouraged position of

comfort Provided comfort

measures such as: a. Providing quiet

environment b. Encouraged deep

breathing c. Guided imagery

Encouraged diversional activities such as reading news paper or talking to the relatives

Assisted client splinting

technique of wound Encouraged frequent

rest periods Provided prescribed

analgesic

To obtain baseline

data for pain Fluctuation in vital

signs may indicate presence of pain

To lessen pain To promote non-

pharmacological pain management.

a. To reduce tension b. To assist in muscle and

generalized relaxation c. To divert attention

away from pain

To distract attention and reduce tension

To help reduce pain by

providing pressure at the wound

To lessen pain To pharmacologically

decrease the pain

Goal met, pain lessened: latest pain scale of 4/10




Subjective: ”Hindi pa sya nakakagalaw ng ayos” as verbalized by the patient’s daughter. Objective: c incised wound

on RLQ ć limited range of

motion c body weakness c body malaise c complaint of

pain, c pa in scale of 6/10

Activity intolerance related to generalized weakness and presence of pain secondary to surgical procedure done as evidenced by limited ROM

At the end of the shift patient will demonstrate improvement in activity.

Monitored vital signs.

Assessed patient’s level

of activity. Encouraged adequate

rest periods in between activities of daily living.

Diverted attention by

talking to the pt, and providing reading materials

Turned patient side to side.

Instructed and

emphasized importance of early ambulation.

Provided medication for pain

to obtain baseline data

to serve as a baseline

data rest between activities

provides time for energy conservation and recovery

To distract attention away from the pain

To serve as a form of

activity to patient and to prevent pneumonia.

To promote activity To pharmacologically

decrease pain

Goal met seen patient activity was improved, seen patient walking

Documents

Inguinal Hernia