INDIRECT INGUINAL LEFT

HERNIA
HERNIA
 A protrusion of an organ through a weak area in the muscles or
tissue that surround and contain it. Most commonly, the word
hernia is used to refer to an abdominal hernia. An inguinal
hernia occurs when a loop of intestine enters the inguinal canal
in the groin area, between the pubis and the top of the leg. The
intestine goes through the lower layers of the weakened
abdominal wall and creates a lump.
 Causes of Inguinal Hernia
-Heavy lifting
-Straining during bowel movements and urinating
-Constipation
-Excessive coughing or sneezing
-Vigorous exercise or sex can be contributory factors
-Family history of hernia
-Obesity
 Signs and Symptoms of Inguinal Hernia
Tenderness or sharp pain in the groin often
aggravated by lifting or bending. A tender
lump in the groin or scrotum it usually
disappears when you lie down and
enlarges when you cough, sneeze or
strain.
 CONTENTS
I. Objectives of the Study
II. Patient’s Profile
 Personal Data
 History of Present Illness
 Past Medical History
 Familial History
 Social/Lifestyle History
 Physical Examination
III. Anatomy and Physiology
IV. Pathophysiology
V. Diagnostic Test/Special Procedure
 Laboratory Test
 Special Procedures
VI. Course in the Ward
VII. Treatment
 Drug Study
VIII. Nursing Care Plan
IX. Health Education/Patient’s Education
 Objectives of the study

General Objectives:

The purpose of this study is to

prevent further complications
brought by inguinal hernia.
 SPECIFIC OBJECTIVES:

• To inform and update the knowledge of patient about

inguinal hernia self-care and prevention of complications
during hospitalization.

• To plan management strategies to a inguinal hernia patient.

 
• To use the nursing process as a framework for care in
patients with hernia.

• To improve status of the patient

• To correct defect and prevent strangulation.

• To include adequate nutritional intake.

PATIENT’S PROFILE
 PERSONAL DATA

Name : Mr. Z
Age : 24 years old
DOB : November 4, 1985
Place of Birth : Quezon City
Sex : Male
Religion : R. Catholic
Occupation : none
Nationality : Filipino
Weight: 120 lbs
Height : 5 ft 9 inch
 History of present illness
 
Date of Admission : July 4, 2010
Time of Admission : 9:45a.m
Chief Complaint : Inguinal mass to left
Admitting Diagnosis : Indirect Inguinal Left Hernia
 
Vital Signs:
Temp: 36.5C
BP: 120/70 mmHg
Pulse Rate: 81 bpm
RR : 20 cycle/min
PAST MEDICAL HISTORY
 
 
(-) Allergy
 
(+) Asthma- Last attack during childhood
 
 
 
FAMILY HISTORY
 
(+) Hypertension – Parent’s Side
 

SOCIAL/LIFESTYLE
 
-Non smoker
 
-Alcoholic Beverage Drinker
 
-His diet consist of nutritional intake
according to his satisfaction
 
-Helping his brother making hallow blocks and
collecting heavy steel
 
-Heavy lifting comes usually to his work
 
 Physical Examination

•General Survey:
Conscious and Coherent

•Vital Signs:
Temp=36.8º c
PR: 98 bpm
RR: 20 cycles/min
BP: 100/70 mmHg
•Integumentary –Black Contour

-Skin:
Warm, Moist skin
-Hair:
Hair evenly distributed
Smooth texture
Absence of dandruff
Absence of infestation
Thick hair
-Nails:
Oval in shape with slight thickness
At end part of nail, smooth texture
Normal Capillary refill (1-2 secs.)
•Head and Neck
-Head:
Normocephalic Symmetric
-Eyes:
Normal visual acuity
Both eyes coordinated movement with parallel alignment
Symmetric evenly distributed Eyebrow/Eyelashes
Eyelids color matches the skin with coordinated movement
Pink partial conjunctiva
-Ears:
Symmetric , Smooth auricle with light brown color, Small in
shape
No discharge, No wounds, Presence of cerumen
-Nose:
Located at the midline of the face and
there is no swelling or lesions noted
-Mouth:
Pale lips, smooth and not scaly.
Absence of tooth decay
Pinkish and reddish gums.
Pink pharynx
Normal flow of saliva
Tongue is pinkish in color, both
palate is still and normal position
-Neck:
Client was able to turn his neck from left to right motion
Head position is equal on both sides
-Thorax and lungs:
Spine vertically aligned
No tenderness or masses
Breathing is normal
-Abdomen:
Unblemished skin and uniform in color
Dullness at the lower right quadrant
-Musculoskeletal:
Irregular movements
Weak in appearance
-Lower Extremities:
Symmetrical on both sides of the body with
no contractures
Muscles are firm with smooth coordinated
movements
No deformities, no tenderness, or swelling
with joints moving smoothly
-Neurologic:
Full consciousness, response to verbal
stimuli, organized speech noted
-Genitourinary System:
Client refuse
 Diagnosis
An inguinal hernia occurs when a loop of intestine enters the inguinal
canal in the groin area, between the pubis and the top of the leg. The
intestine goes through the lower layers of the weakened abdominal wall
and creates a lump. Indirect inguinal hernia- a hernias are much more
common in males than females because of the way males develop in the
womb. In a male fetus, the spermatic cord and both testicles, starting from
an intra-abdominal location. Normally descend through the inguinal canal
into the scrotum, the sac that holds the testicles.

Sometimes the entrance of the inguinal canal at the inguinal ring does not
close as it should just after birth, leaving a weakness in the abdominal wall.
Fat or part of the small intestine slides through the weakness into the
inguinal canal, causing a hernia. In females, an indirect inguinal hernia is
caused by the female organs or the small intestine sliding into the groin
through a weakness in the abdominal wall.
• Causes:
Any condition that increases the pressure in
the intra-abdominal cavity may contribute to
the formation of a hernia, including the
following:
-Heavy lifting
-Straining during bowel movements
and urinating
-Constipation
-Excessive coughing or sneezing
-Vigorous exercise or sex can be
contributory factors
-Family history of hernia
-Obesity
Anatomy and Physiology
•An indirect inguinal hernia
follows the tract through the
inguinal canal. This results
from a persistent process
vaginalis. The inguinal canal
begins in the intra-abdominal
cavity at the internal inguinal
ring, located approximately
midway between the pubic
symphysis and the anterior
iliac spine.
 The canal courses down along the
inguinal ligament to the external ring,
located medial to the inferior
epigastric arteries, subcutaneously and
slightly above the pubic tubercle.
Contents of this hernia then follow the
tract of the testicle down into the
scrotal sac.
 Types of Hernia - Location

Hernias may occur

commonly in such areas as
the lower abdomen or
groin areas (Inguinal
Hernia), at the region
around the navel
(Umbilical Hernia), or even
through a prior surgical
incision (Incisional Hernia).
Anatomic locations for
Hernias can re-occur in an
various hernias area of a previous hernia
repair (Recurrent Hernia).
 But Hernias can and do occur anywhere on the
abdominal wall, and are given other various
names such Femoral, Epigastric, Spigelian or
Sports Hernia. The basic problem remains the
same, the muscle container of the abdominal
wall no longer holds the contents safely and
securely in place.
As pressure inside the abdomen pushes the
abdominal contents through this defect, a bulge
is created, and pain, burning or aching are
experienced. These symptoms gradually increase
in intensity with time as the hernia gradually
enlarges, stretching surrounding tissue and
irritating local nerve pain fibers
PATHOPHYSIOLOGY
 Increased pressure in the
compartment of the abdomen is
develop

Intra-abdominal wall (containing membranes or

muscle) of inguinal canal into the scrotum becomes
weakened

Causing the inguinal ring not to close

Evolves into a hole

or defect Feeling of weakness or
pressure In the groin

Pain or Discomfort

Fat or part of the

small intestine slide
trough the inguinal Swollen or enlarged of
canal scrotum
 DIAGNOSTIC TEST
&
SPECIAL PROCEDURE
 URINALYSIS
Physical Reference Values Microscopic Reference Values
Examination Examination

Color Yellow Yellow RBC: 0-1/hpf 0-1 / hpf

Transparency Slightly Hazy Clear WBC: 0-1/hpf 0-3 / hpf

Reaction 6.5 4.8 – 7.8 Bacteria: occasional Few

Specific Gravity 1.015 1.015- 10.25 Epithelial Cells: Few

occasional

Chemical Examination:
•Sugar: Negative
•Albumin: Negative
 CBC- Complete Blood
Count
Examination Result Normal Value
Hemoglobin 14.1 13.5- 18.5 g/dL
Hematocrit 41.8 40-54%
Red Blood cells 5.08 4.0- 6.0 : 10ˆ6 /υL
Mean Corpuscular Hemoglobin 27.8 26- 34 pg
Mean Corpuscular Volume 82.3 80- 100 fL
Mean Corpuscular Hemoglobin 33.7 31- 37 g/dL
WBC 9.06 4.5- 11.0 : 10ˆ3/υL
Neutrophils 57.0 50- 70%
Lympocyte 33.2 20-40%
Monocyte 6.5 0- 7%
Eosinophils 2.9 0.0- 5.0%
Basophils 0.4 0.0- 1.0%
Platelet Count 223 150- 400ˆ6/υL

•Remarks: Platelet Adequate

 Fecalysis Report

Gross Examination Result Microscopic Result

Examination

Color Dark Brown RBC None

Consistency Formed Pus Cells None

Mucus None

Ova or Parasites None Seen

None Seen
Cysts of
Trophozoite
 Radiology/X-Ray Section

-INTERPRETATION-

*Chest ( PA OR AP) Adult

 Lungs are clear. Hila and Pulmonary

vessels are within normal limit
 Heart is normal in size and configuration
 Diaphragm and Sulci are intact
 The visualized bony and soft tissue
structures are normal
 COURSE IN THE WARD

 On admission, nursing diagnostics

done and therapeutics started on,
7/05/10.
 Patient underwent herniorrhaphy ,
left, Post- operative condition was
stable.
 He was discharged, improved and
stable.
 Treatment for Inguinal Hernia

 Treatment is important to avoid a

potentially serious condition called a
strangulated hernia. This is when the
bulging through the muscle wall
obstructs the flow of blood to the
intestine or stops the flow of intestinal
contents, leading to tissue death.
An inguinal hernia can often be reduced
(pushed back into place). If this
doesn't work, then surgery is required
under a general anesthetic. The segment
of bowel is put back in the abdominal
cavity and the muscle is closed. A piece
of plastic mesh is sometimes used to
reinforce the weakened muscle area. A
dry dressing protects the incision area
for a few days.
DRUG STUDY
 Cloxacillin-500mg 1cap 4x/day for 7days
C: Penicillin
I: Infections due to staph resistant
to benzyl penicillin including infections
of the skin and soft tissue, bones and
joints, resp. tract and urinary tract;
otitis media
A: Take empty stomach 1hr. Before or
2hrs. After meals
Ci: Hypersensitivity to penicillins
SE: History of significant allergies or
asthma
AR: G.I. disturbances and skin rashes
• Mefenamic Acid-500mg 1cap 3x/day

C: Non-steroidal Anti-inflammatory drug

I: For Acute and chronic relieving pain
A: Take immediately after meals
Ci: Ulceration ir inflammation of GIT
SE: Pregnancy; Renal and hepatic
impairment. Patients suffering from
dehydration. May exacerbate asthma

AR: GI disturbances, drowsiness, skin

rash

DI: Coumarin Anticoagulants

• Cefuroxime-750mg IV q8º

C: Cephalosporin (Anti-biotic)
I: Infections of urinary and lower
resp. tract. Peri-operative prevention
: Inhibits cell-wall synthesis,
promoting osmotic instability usually
bacteria.
A: Should be taken with food
AR: G.I. disturbances and skin rashes
Ci: Hypersensitivity to penicillin
• Ranitidine-50mg I.V q8º

C: Antacids, Antireflux agent,

Antiulcerants
I: Management of peptic ulcer disease,
persistent dyspepsia, patient at risk of
acid aspiration during gen. anesthesia or
child birth.
D: Active duodenal ulcer
A: Before and after meals
SE: Rule out gastric malignancy prior to
therapy.
AR: Constipation, Diarrhea,
Nausea/Vomitting, abdominal pain.rash
• Diclofenac-35mg. I.M 2x/day

C:Anti-Inflammatory
I:Relief of mild to moderate pain of
dysmenorrhea
: Inhibits Prostaglandin

A: Should be taken with food (Take

immediately after meals. Swallow whole, do not
chew/crush.)

SE: Abnormal pain dyspepsia heartburn

diarrhea hepatotoxicity
AR: Active G.I. bleeding/ ulcer disease
Nursing Care Plan
 Long Term goal: The patient will verbalize recognition of Intrapersonal/family dynamics and reactions that affect the pain problem.
Short Term goal: The patient will verbalize and demonstrate relief and/or control of pain/discomfort.

Assessment Nursing Diagnosis Scientific Rationale Intervention Rationale Expected Outcome

S>>Patient 1. Note sex and 1. Suggests there

verbalized, -Acute pain -Unpleasant age of patient. may be differences
between women and The patient will
“Nahihirapan ako related to his sensory and
present condition emotional men as to how they verbalized
magkikilos dahil perceive and/or
kumikirot pag of indirect experience relief/absence
respond to pain.
tumatayo ako” inguinal left arising from of pain
hernia actual or 2. Evaluate pain 2. May exaggerated
O>> V/S: potential tissue behavior because client’s
Temp: 36.5ºc damaged or perception of pain is
BP:120/70mmHg described in not believed or
because client
PR : 81 bpm terms of such believes caregivers
RR : 20cycle/min. damage are discounting
reports of pain
-(+)discomfort
-8/10 pain scale 3. Assist client to 3. To assist in
-Facial learn muscle and
Grimacing diaphragmatic generalized
breathing. relaxation.
-(+)Tenderness
-(+)Swelling 4. Monitor vital 4. Usually altered in
signs acute pain

5. Provide comfort 5. To provide

measures nonpharmacological
pain management.
SHORT TERM GOAL: PATIENT WILL PARTICIPATE WILLINGLY IN DESIRED ACTIVITIES
LONG TERM GOAL: PATIENT WILL USE IDENTIFIED TECHNIQUES TO ENHANCE WOUND HEALING

Assessment Nursing Diagnosis Scientific Rationale Intervention Rationale Expected Outcome

S>>Patient 1. Establish rapport 1. To gain trust to

verbalized, “Hindi -Risk for -Because of the patient - The patient
ko naman alam infection broken skin, will be able to
kung pano linisan 2. Monitor Vital 2. To determine any
related to surgical traumatized identify
ang opera ko” Signs abnormalities
incision tissue
secondary to on the injured reducing
3. Encourage the 3. To reduce
O>> V/S:
Herniorrhaphy site relative to change existing factors infections
Temp: 36.5ºc
BP:120/70mmHg has occurred. dressings of the
This could lead to patient as needed
PR : 81 bpm
RR : 20cycle/min. the invasion of
4. Encourage the 4. To prevent any
pathogenic patient or relative to pathogenic
microorganism cleanse infections
-Worries about therefore with solution the
his condition increasing the sites of wound of
risk of infection the patient daily
-(+)Oozing and may result to
5. Instruct the 5. To promote
-(+)Redness further patient the wellness
-(+)Tenderness complications if techniques to
-Poor wound not prevented protect integrity
healing of skin, care of
-(+)Swelling lesions and
prevention of
-Poor wound spread of
healing infection.
Health Education/Patient’s
Education
Patient teaching home health guide
 

 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 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