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

I.

Demographic Data

Name: Patient f
Age: 24
Sex: Male
Birthday: 9-11-1990
Birthplace: San Jose City
Address: San Jose City N.E
Civil Status: Single
Religion: Catholic
Nationality: Filipino
Highest Educational Attainment: College Graduate
Occupation: Programmer
Date Admitted: 3-9-15
Time Admitted: 12:33pm
Chief Complaints: Hernia
Admitting Diagnosis: Indirect Inguinal Hernia Left Incarcerated
II.

Past Medical History

None

III.

Family Illness History

The mother side- asthma

IV.

Diagnostics:

Hematology
HGB-139
RBC- 4.46

HCT-0.40
MCV- 90

WBC- 10.54
MCH-31.6

Differential Count
Neutrophil- 0.72
Lymphocyte-0.17
Eosinophil- 0.01

Monocyte- 0.05
APC- 300 X 10

C. List of All Drugs

Co Amoxiclav one tab TID per orem
Mefenamic Acid 500mg one tab TID per orem
V.

Physical Assessment
A. Psychological Status
The patient is a 24 year old male, Single and was born in San Jose City.

B. Mental & Emotional Status

The Patient is conscious, coherent and can responds to external and verbal stimuli. The
patient is cooperative during the nurse-patient interaction.
C. Environment Status
The patient is on the 2nd admission day. The Patient is in the Male Surgical Ward with
his aunt.
D. Sensory Status
The patient is able to read & write.
E. Motor Status
The 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 Status
The patient is on full diet, he ate rice soup for breakfast and one serving of vegetable for
lunch.
G. Elimination Status
The patient hasnt defecate since admission. The Patient has voided 3 times the shift.
H. Fluids & Electrolytes Status
The IVF of the patient was D5LRS 1 liter was ongoing.
VI.

Drug Guide

Name of the Drug

Mefenamic Acid

Classification
NSAID

Co-amoxiclav

Anti biotics

VII.

Inguinal Hernia Overview

Action
competitive inhibitor of COX-1 and
COX-2, which are responsible for
the first committed step in
prostaglandin biosynthesis.
bactericidal and works by inhibiting
the synthesis of bacterial cell walls.

Indication
For relief of mild to
moderate pain in patient
Acute bacterial sinusitis,
acute otitis media, acute
exacerbations of chronic
bronchitis, community
acquired pneumonia,
cystitis, pyelonephritis,
SSTI, bone and joint
infections.

An inguinal hernia is 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 Hernia
These 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 Hernia

There 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 Hernias

There are two types of inguinal hernia: indirect and direct. An indirect inguinal hernia is 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.

A direct inguinal hernia most 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 males

Inguinal hernias may also be classified as incarcerated or strangulated. Incarcerated inguinal

hernias are 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 Hernia

These 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 Hernias

Surgery 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 repair involves making an incision into the groin and returning the abdominal tissues into
the abdomen and repairing the abdominal wall defect.Laparoscopy uses 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 Hernias

Early 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 lifting

VIII.

Nursing Care Plan

Nursing 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 interventions Nursing 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 guide Nursing 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.