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
 With a bulg ing mass on the rig ht
ing uinal area around 5 cm in  Abno rmal
 Genitals
diameter.
 With enlarged right scotum
 Symmetrical w ith visible veins; Nails
 Upper Extremi- are transparent, smooth & convex  Normal
tie s w ith light pink nails beds & w hite
translucent tips.
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.
SURGICAL MANAGEMENT

Pre-Operative Nursing Care

• secure consent

• monitor vital sign

• skin preparation
• administering pre-op medications
hernia\vid\a.flv
hernia\vid\b.flv
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
Adverse Drug Nursing
Name of Drug s Mode of Action Classification Indications Contraindications
Re actions Consideration

Tramado l Cen trally actin g An alg esics Moderate to Hypersen sitivity. Nausea, vomitin g ,  Assess for level of
an alg esic n ot (Opioid ) / severe pain & Acute in toxication diarrh ea , pain relief an d
 Amaryll vial ch emically Sup portive Care post-o p pain . with alcoh ol, con stipation . admin ister prn do se
related to Th erapy h ypn otics, Tiredn ess, as n eeded.
op ioids but cen trally acting drow sin ess,  Mon itor vital sig n s
bin ds to mu - an alg esics, opioid s, dizzin e ss, an d assess for
op ioid receptors or psych otropic h eadach e, Skin orth ostatic
an d in h ib its ag en ts rash es, h ypo ten sion or sig n s
reuptake of tach ycardia, of CNS depression .
n orepin eph rin e bradycardia,  Discon tin ue drug
an d seroton in . flush in g , allerg ic an d n otify physician
reaction s. if S&S of
h ypersen sitivity
occu r.
 Assess bow e l an d
blad der fun ction ;
report urin ary
frequen cy or
reten tion .
 Use seizure
precau tion s for
patien ts w h o h ave a
h isto ry of seizures or
w h o are
con curren tly usin g
drug s th at low er th e
seizure th resh old.
 Mon itor ambulation
an d take appropriate
safety precaution s.
 Medical Management
Adverse Drug Nursing
Name o f Drug s Mode of Action Classification Indications Contraindication
Re actions Consideration

Mono w e l In h ib its b a cte rial Ceph alosp orin s Periton itis & oth er Allerg y to Ph lebitis, Assess patien t’s previous
ce ll w a ll 2 nd - g e n eratio n in tra-abdo m in al & pen icillin s an d in flammation at sen sitivity re action to
(Cefoxitin) in trap elvic ceph alosp orin s th e site of in j, GI p en icillin o r oth er
syn th e sis, th u s
in fection s, an d people w ith reactio n s eg ceph alosporin s. Cross-
prom oting sen sitivity betw een
septicemia , allerg ic drug n ausea &
osm otic en docard itis, backg ro un d. vo mitin g p en icillin s an d
in sta b ility w h ich g yn ecolog ical, ceph alosporin s is commo n .
e ve n tua lly le a ds resp tract, bon e &
to b a cte rial ce ll join t, skin & soft Do skin testing . Watch o ut
d e a th . tissue in fectio n s, for allerg ic reaction an d
UTI in clu din g an aph ylaxis: rash , urticaria,
un complicated p ru ritus, ch ills, fever or join t
g on orrh ea. p ain .

Fo r IV u se, recon stitu te 1g

w ith 10ml of sterile w ate r fo r
in jectio n of dilu en ts.

Fo r IV in je ction a dmin ister

slow ly for 3 to 5 min utes
th roug h tubin g of a flow in g
co mpatible IV solution .

Discard un used medicatio n

after 24 h o ur if sto red at
roo m tempera ture of 1 w eek
if stored at a refrig e rator.

Assess bow el movem en t

d aily; diarrh e a may in d icate
p suedom emb ran ou s colitis .
 Medical Management
Adverse Drug Nursing
Name of Drug Mode of Action Classification Indications Co ntraindicatio ns
Re actions Co nsideratio n

Parace tamo l Decreases fever An tip yretics/ Relief o f mild -to - Hypersen sitivity to Hemato log ic: Assess patien t’s fever or
by in h ibitin g th e An alg esics moderate pain ; th e drug s h emolytic pain : typ e of pa in ,
effects of treatmen t of fever an emia , location , in ten sity,
pyrog en s on th e neutropenia, duration , temperature,
h ypoth alamic leukopenia, diaph oresis
h eat reg ulatin g pancytopenia
cen ters an d by a Do skin testing . Watch
h ypoth alamic Hepatic: jau n dice out for allerg ic reaction :
action leadin g to rash , urticaria ; if th ese
sweatin g an d Metabolic: occur, dru g may h ave to
va sodilatatio n . hypog lycemia be discon tin ued.

Skin: rash , Assess h epatoto xicity:

urticaria dark u rin e, clay-colore d
stools, yellow in g of skin
an d sclera; itch in g ,
ab domin a l pain , fever,
diarrh ea if patien t is on
lon g -term th erapy.

Warn p atien t th at h ig h
doses or un supervised
lon g -term u se can cause
liver damag e. Excessive
alco h ol use may in crease
th e risk of liver d amag e.
 Nursing Care Plan
(pre-operative)
Assessment Nursing Diag no sis Planning Interventio n Ratio nale Evaluation

Subjective: Pain related to At th e en d o f th e sh ift,  Vita l sig n s mo nitored  To o btain ed b aselin e Go al p artially met:
sw ellin g an d p ressure th e p atien t’s p ain w ill an d reco rd ed d ata and flu ctu atio n s p ain lessen ed , ć latest p ain
”Masakit dito sa may o n intestin al tissue s be lessen in VS m ay sho w p ain scale o f 7 / 10
sing it ko ” as secon d ary to d isease  Estab lish ed rapp ort  To estab lish ed tru st
ve rb alized b y th e co n ditio n as w ith th e p atient and coo p eratio n w ith
p atie n t. man ife sted by th e clien t and to
co mp laint o f p ain , enh an ce co mp lian ce
Objective: facial grimace &  Perform ed a  To o btain ed
g u ard in g beh avio r co mp reh en sive info rmatio n abo ut p ain
 ć en larg ed R assessm en t o f th e p ain an d patient’s con d itio n
scro tum 5cm to in clu d e th e lo catio n,
ch aracteristic an d
 ć righ t gro in p ain inten sity of pain an d
p recipitatin g facto rs
 n o ted ć h e avy  Provid ed co mp ort  To p ro m ote n o n -
d rag g ing p ain ć m easu res su ch as: p h arm acolo g ical p ain
p ain scale o f man ag emen t
8/ 10 a. Provid in g q uiet a. To red uce tensio n
en viro n ment
 ć facial grimace b. Placin g client in b. To d ecrease pressu re
reversed T-p osition and sw elling o f
 ć g u ard in g intestin es b y takin g
b eh avior advan tag e of th e
g ravity
 c limited ROM c. En co uraged use o f c. To d ivert attentio n
d iversion al a ctivities aw ay fro m pain
 mo an ing at times an d relaxa tio n
te ch niq u es such a s
fo cu sed breath ing a n d
imag ing

 En co uraged  To enh an ce emotion a l

verb alizatio n o f p ain co mfort

 Ad m in istered  To p h arm aco lo gically

an alg esic, as ind icate d, d ecrease p ain
to ma ximu m d osag e,
as n eed ed
 Nursing Care Plan
(pre-operative)
Assessment Nursing Diag no sis Planning Interventio n Ratio nale Evaluatio n

Subjective: Altered b o dy At th e en d o f th e sh ift  vital sig n s mo n ito red  to o btain b aselin e d ata Go al met: p atien t’s temp
tem p erature: th e p atient b ody temp an d reco rd ed is w ith in normal ran g e, c
”Main it an g Hyp erth erm ia r/ t w ill b e at n o rmal latest temp o f 37.5 ° C
p akiramd am ko ” as in flamm ato ry process ran g e  Provid ed tep id  to lo w er th e b od y
verb alized b y th e seco n d ary to d isease sp o n g ed b ath temp th ru co n d uctio n
p atien t. co n d itio n as
man ifested by in crease  Provid ed co ld  to lo w er temp th ru
Objective: tem p o f 38.2C co mp ress at th e co n d u ctio n
fo reh ead
 feb rile ć temp o f
38.2° C  IVF p rop erly reg u lated  to main tain ed flu id
b alan ce an d to preven t
 skin w arm to DHN
to uch
 Provid ed surface  to pro mo te h eat lo ss
 ć flush ed skin co o lin g e.g . b y th e u se
o f fan s
 d iap h oretic
 Provid ed lo o se an d  to pro mo te h eat lo ss
 ć in creased co tto n cloth in g
WBC 11.3 x /L
 Enco urag ed freq u en t  to red uced m etabo lic
 ć bo dy malaise rest p erio ds d eman d

 c enlarg ed R  ad min istered an ti -  to ph armaco lo gically

scro tum 5cm in p yretics as ord ered d ecrease temp eratu re
circu mferen ce

 c co mp lain t o f
g ro in p ain
 Nursing Care Plan
(pre-operative)
Assessme nt Nursing Diag no sis Planning Interventio n Ratio nale Evaluatio n

Subjective : Co n stip atio n re la te d to At th e e n d o f th e sh ift  p erfo rm ed assessmen t  to o bta in in fo rm atio n Go a l w as n ot met: Still n o
d ecrea sed mo tility o f p atien t w ill reg ain o f th e ab d om e n ab o u t th e co n d itio n o f b o w e l mo ve me nt
”Pauti-u ti la n g an g g astro in te stin al tract n o rm al p a ttern o f th e clien t
p ag d u m i ko .” as seco n d ary to d isea se b o w e l fu n ctio n in g
verb alized b y th e co n d itio n a s  tu rn e d p atie n t sid e to  to stim u late p erista lsis
p atie n t. e vid en ced by p e llet- sid e
like ye llo w bro w n h ard
Obje ctive : sto o l an d h yp o a ctive  IVF p rop erly mo n itored  to pro mo te flu id
b o w el so u n d s a n d reg u lated b alan ce
 ć p ellet-like
yello w bro w n
h a rd stoo l

 ć h ypo active
b o w e l so u n ds

 ć ab do m in al
ten d e rn ess

 ć abd o m in al
cra mps

 ć en larg ed R
scro tum 5cm in
circu mferen ce
 Nursing Care Plan
(post-operative)
Assessment Nursing Diag no sis Planning Inte rve ntio n Ratio nale

Subjective :
”Map u la at
n a n g an g a ti an g ta h i
ko ” a s verb a lize d b y
th e p atie n t.
Obje ctive :
 c incised wound
on RLQ with soiled
dressing
 ć re d n ess o n th e
su tu re lin e
 ć itch in e ss o n th e
su tu re lin e
Risk for in fe ctio n r/ t
b re a k in th e p rima ry
d e fen se o f th e bo dy
se co n d ary to surg ica l
p ro ce d u re d o n e a s
e vid e n ce d b y b ro ke n
skin
At th e e n d o f th e sh ift,
p a tie n t/ fa m ily w ill
sh o w life style
ch a n g es to p reve n t
in fe ctio n .
 No te d risk fa cto rs for
o ccu rre n ce o f in fectio n
 O b serve d lo calize d sig n s
o f in fe ctio n at sutu re
lin e
 Mo n ito re d vita l sig n s
p articu la rly te mp eratu re
 Te p id sp o n g e b ath
ren d ere d a n d p ro vid e d
co ld co mp ress a t
fo re h e a d
 To asse ss ca u sative o r
co n trib u tin g factors
 To asse ss fo r sig n s o f
in fe ctio n a t th e w o u n d
site
 To se rve a s a b a se lin e
d a ta for n u rsin g ca re
a n d to w atch fo r th e
d e ve lo p m e n t o f
in fe ctio n e .g . fe ve r
 To d e cre a sed b o d y
te m p eratu re th ru
co n d u ctio n

 slightly febrile c  Wo u n d dre ssin g  To p reve n t in fe ctio n at

temp of 37.9°C ch a n g e d ase p tica lly w o u n d site

 Tu rn ed p a tie n t sid e to  To p reve n t p n e u mo n ia

sid e

 In stru cte d prop e r h a n d  Un iversa l p re ca u tio n

h yg ie n e a n d to p re ve n t
e m p h asize d im p orta n ce tran sm issio n o f
b a cte ria

 En co u ra g e d d e e p  To p reve n t p n e u mo n ia
b re a th in g a n d co u g h in g
e xe rcise
 Nursing Care Plan
(post-operative)
Asse ssment Nursing Diag no sis Planning Inte rve ntio n Ratio nale
He a lth te a ch in g s p ro vid e d
e m p h asizin g th e imp o rta n ce
o f:

a. Prop e r w o u n d ca re  To p reve n t
su ch as th e use o f co n ta m in a tio n a n d
a n tise p tic fu rth e r d e ve lop m e n t
o f in fe ctio n
b. Re g u la r prop e r
p e rso n a l h yg ie n e
su ch as p e rin e al
ca re a n d re g u la r
ch a n g e o f
u n d e rw e a r

c. Ad h e re n ce to
trea tm e n t re g ime n
e .g . co m p le tio n o f
a n tib io tic

d. Ad vise d to e at foo ds  To h e lp in im m e d ia t e
rich in Vit . C a n d w o u n d h e a lin g
p rote in su ch as
fru its, ju ice s,
le g u m e s, a n d o rg a n
m e a ts

 Pre scrib e d a n tib iotic  To p h arm a co lo g ica lly

m e d ica tio n g ive n p re ve ntin g in fe ctio n
 Nursing Care Plan
(post-operative)
Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

Subjective: Pain rela ted to At th e en d of th e sh ift,  Assessed ch aracteristic  To obtain b aselin e Goal met, pain lessen ed:
d isru ption o f skin and p atient’s p ain w ill be o f pain , locatio n and data for pain latest pain scale o f 4/ 10
”Masakit an g tah i ko ” tissu e 2° to surgical lessen d escription
as verb alized b y th e p rocedure do n e as
patient. evidenced by facial  Vital signs mon itored
g rimace and and re co rded  Fluctu ation in vital
Objective: g uardin g beh avior sign s may indicate
presen ce o f pain
 ć po st-op pain at  Enco uraged p ositio n of
RLQ , sh arp a nd co mfort  To lessen p ain
sho oting ć pain
scale of 6/ 10  Provided co mfo rt  To pro mote non -
measu res su ch as: ph armaco log ical p ain
 c in cised w o und man agement.
at RLQ a. Providing qu iet a. To red uce tensio n
environ men t
 ć facial grimace b. Enco uraged d eep b. To assist in mu scle an d
b reath ing gen eralized rela xa tion
 ć gu ard ing c. Guided imagery c. To divert attentio n
b eh avior aw ay fro m pain

 c limited ran ge o f  Enco uraged d iversio nal  To d istract attention

mo tio n activities such as an d red uce tension
reading n ew s p aper or
 mo an in g at times ta lking to th e relatives

 Assisted client sp lintin g  To h elp reduce pain by

te ch n iq ue of wo und provid in g pressu re at
th e w ound

 Enco uraged frequent  To lessen p ain

rest periods
 Provided p rescribed  To ph armacolog ically
analgesic decrea se th e pain

Assessment
Subje ctive:
”Hin d i p a sya
n akakag alaw n g
a yo s” a s verb alize d
b y th e p a tien t’s
d au g h te r.
Obje ctive :
 c incised wound
on RLQ
 ć limite d ra n g e o f
mo tio n
 c bo dy w ea kne ss
 c bo dy m a laise
 c co m p lain t o f
p ain , c p a in
sca le o f 6/ 10
Nursing Care Plan
(post-operative)
Nursing Diag no sis Planning Interventio n
Activity into le ran ce At th e en d o f th e sh ift  Mo n itored vital sig n s.
relate d to g en eralized p a tien t w ill
w e akn ess an d d e mo n strate  Asse ssed p atie n t’s leve l
p re se n ce o f p ain im p rovem en t in o f activity.
seco n d ary to surg ical activity.
p roced u re do n e as  En co urag e d a d eq u ate
evid en ce d by limite d rest p erio ds in b e tw een
RO M activities o f d aily livin g .
 Diverted attentio n by
talkin g to th e pt, an d
p rovid in g read in g
ma teria ls
 Turn ed p a tien t sid e to
sid e.
 In structed an d
e mp h asize d imp ortan ce
o f ea rly am b u latio n .
 Provid e d m ed icatio n fo r
p ain
Ratio nale Evaluatio n
 to o btain b aselin e d ata Go al met seen p atien t
activity w a s imp ro ved ,
 to se rve as a b a seline see n p atien t w alkin g
d a ta
 rest b etw e en activities
p rovid es tim e fo r
en erg y co n servatio n
an d re co very
 To d istra ct attentio n
aw ay fro m th e p ain
 To se rve as a fo rm o f
activity to p atie n t an d
to preve n t
p n eu m o n ia .
 To p ro mote activity
 To p h arm aco lo g ically
d e cre ase p ain