Adamson University

College of Nursing

CASE PRESENTATION
INGUINAL HERNIA

I. OBJECTIVES

At the end of the case presentation our audience and co-learners in the field of health will
be able to enhance their knowledge, skills and attitudes in properly initiating the actual duties
and responsibilities of a hospital nurse by participating in the reduction of the mortality,
morbidity, disability and further complications of Inguinal Hernia in order to be an effective
and proficient nurses in the future

II. INTRODUCTION

a. Definition of the case

Hernia is a defect in the abdominal wall that allows abdominal contents to

protrude out of the abdominal cavity. It may occur in the scrotal or inguinal area
or in the abdominal wall, or diaphragm.

b. Etiology

Trauma, surgery, and increased intra-abdominal pressure caused by such

conditions as pregnancy, obesity,weight-lifting, or tumors are risk factors for
hernia formation.

c. Incidence

About 27% of males and 3% of females develop a groin hernia at some

time in their life. In 2013 about 25 million people had a hernia. Inguinal, femoral
and abdominal hernias resulted in 32,500 deaths globally in 2013 and 50,500 in
1990. Approximately 80% of hernias occur in the groin. In 2013 In the USA, the
incidence rate of inguinal hernia is approximately 1 in 544 or 0.18% or 500,000
people.

d. General Signs and Symptoms

 Protruding bulge
 Pain
 Discomfort
 Weakness
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d. Theoretical Framework
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III. PATIENT’S DATA

 Name: Patient RM
 Address: San Jose Del Monte, Bulacan
 Religion: Catholic
 Age: 27
 Sex: Male
 Race: Asian
 Marital Status: Single
 Educational Attainment: High School Graduate
 Occupation: Carpenter
 Date of Admission: November 17, 2010;
 Time of Admission: 5:05PM

IV. NURSING HISTORY

a. Chief Complain
“Nahihirapan akong umihi at masakit ang ari ko, nagsuka na din ako kaya
dinala na ako sa hospital” as verbalized by the client

b. Present History
Patient RM was admitted at Bulacan Medical Center at 5:05 PM of November
17, 2010. He said that he had difficulty in urinating and he feel pain in his
groin every time he walks He said that this happened after he played basketball
last November 16, 2010 from 8 AM to 3 PM having only little time of rest.

c. Past History
For his childhood illnesses, he experienced asthma, mumps and chicken pox.
He also said that he was able to complete the immunizations when he is a child.
He has an allergy in cement powder, he feels itchy whenever it touches his skin.
It was his first time to be hospitalized. As for his asthma, he took herbal
medicines as given by his grandmother.
d. Personal And Social History

He is married with five children. He has a good family support in the home.
SOCIO ECONOMIC STATUS : He is a retired from job. He has middle class
socioeconomic status
.
e. Developmental History
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f. Physical Examination

Vital Signs Findings Analysis

Temperature 36.8 Celsius Normal
Respiratory Rate 24 cpm Normal
Pulse Rate 82 bpm Normal
Blood Pressure 138/32 Normal

Height Weight BMI

162 cm 68 kg 24

Parts to be Actual Findings

assessed

General Clean, no unusual odor

Appearance

Skin Presence of bruise noted (in the left knee).

Pallor noted.

Cool and clammy to touch.

Good skin turgor in both upper and lower extremities;

the skin returns to its previous state immediately after
being tented.

Hair Hair is black and is evenly distributed.

Silky and smooth hair.

No areas of hair loss noted.

Dandruff on scalp noted.

Thick hair strands

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Nails Trimmed dirty nails.

Smooth in texture.

Intact epidermal lining around the nails.

Capillary Refill Test less than 3 seconds.

Head Rounded (normocephalic and symmetrical with frontal,

parietal and occipital prominences).

Head size is appropriate to body size.

No nodules or masses upon palpation.

Eyes Eyebrows and eyelashes are evenly distributed.

Eyelids are intact.

Sclera appears white.

Pale conjunctiva.

No discharges and discoloration noted.

Blink reflex intact.

Able to read words at a distance of 18-20 inches.

(+) Pupils Equal Round and Reactive to Light

Accommodation (PERRLA).

Ears Ears are symmetrical in size and in line with the outer
canthus of the eyes.

Color of ears is the same with the facial skin.

No discharges and foul odor noted upon inspection.

Pinna and ear canal are clean.

Auricles are firm and recoil to previous state when

folded.

No nodules or masses noted upon palpation.

Able to hear whispered words and ticking of watch at a

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distance of 10cm.

Mouth Moistened and pink lips noted upon inspection.

Incomplete teeth noted, with tooth decay

Tongue is able to move freely and able to swallow

foods.

Tonsils are pink in color and smooth upon inspection.

No dentures upon inspection.

Gums are not inflamed.

Abdomen Abdominal skin is intact.

Distended abdomen noted.

Audible bowel sound upon auscultation.

Abdominal dullness upon percussion.

Presence of solid rounded mass noted upon palpation

(left inguinal region).

Abdominal pain (pain scale of 7/10) complained.

Genital Has discharges which appear white and watery and has

foul odor.
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V. ANATOMY AND PHYSIOLOGY

The gastrointestinal tract in humans begins at the mouth, continuing through the
esophagus, stomach, small and large intestines. Taken as a whole, the GI tract is about 9
meters in length. There are many supporting organs as well, such as the liver, which
helps by secreting enzymes that are necessary for the digestion of food.

Anatomy and Physiology of Gastrointestinal tract

Human Gastrointestinal Tract

The human GI tract can be divided into two halves, namely, the upper GI tract and the
lower GI tract.
Upper Gastrointestinal tract

The upper GI consists of the following organs:

The Mouth
It includes the teeth, tongue, and buccal mucous membranes containing the ends of the
salivary glands that continue with the soft palate, floor of the mouth, and underside of
the tongue. Mouth functions by chewing the food, constantly by the muscular action of
the tongue, cheeks, teeth through the lower jaw and upper jaw.

The Pharynx
The pharynx is enclosed in the neck and throat which functions as part of both the
digestive system and the respiratory system. It protects the food from entering the
trachea and lungs.

The Esophagus
A muscular tube-like structure that functions by carrying food to the stomach. Once the
chewed food reaches the esophagus from the mouth, the action of swallowing becomes
involuntary and is controlled by the esophagus.

The Stomach
This is where most of the digestion takes place. The stomach is a J-shaped bag-like
organ that stores the food temporarily, breaks it down, mixes and churns it with
enzymes and other digestive fluids and finally, passes it along to the small intestine.
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Lower Gastrointestinal tract

The lower GI consists of the following organs:

Small intestine
The small intestine is a coiled thin tube, about 6 meters in length, where most of the
absorption of nutrients takes place. Food is mixed with enzymes from the liver and the
pancreas in the small intestine. The surfaces of the small intestine functions by absorbing
the nutrients from the food into the bloodstream, which carries them to the rest of the body.

Large Intestine
The large intestine, also known as the Colon, is a thick tubular organ wrapped around the
small intestine. Its primary function is to process the waste products and absorb any
remaining nutrient and water back into the system. The remaining waste is then sent to the
rectum and discharged from the body as stool
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VI. PATHOPHYSIOLOGY

Modifiable Factor: Non-Modifiable Factor:

- Occupation (Carpenter) Sex (Male)
- Activity (Basketball)
- Previously diagnosed with
Inguinal Hernia

Excessive use of
abdominal muscles

Increased pressure in the compartment of the

abdomen develops

Intra-abdominal wall (containing membranes

or muscles) becomes weakened

Relaxation of Thinning of the

abdominal wall fascia
musculature
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Evolves into a hole

Part of the small intestine pushes through a

hole in the abdominal wall, slides through
the inguinal canal, and creates a loop

The loop part of the small intestine got

trapped in the hernia sac

Bulges through a weak area in the muscles

and appear on the right side of the scrotum

Compression of the scrotum

Cell damage
scrotum

Inflammatory response

Redness Blood vessel near the site of injury are Heat

dilated
scrotum
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Increased permeability of capillary WBC, enter tissue and

Interstitial Filtration
begin to engulf bacteria

Plasma leak from blood stream into

tissue Inflammation

Swelling of tissue of scrotum

Inflamed tissue reaches nociceptors

Stimulation of pain receptors

PAIN
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VII. LABORATORY EXAMINATION

LAB RESULT NORMAL CLINICAL CLINICAL NURSING
EXAM VALUES SIGNIFICANCE MANIFESTATION RESPONSIBILITIES
Complete Hemoglobin: 120g/L 120 – 170 g/L WBC is slightly This is to determine Increased WBC and
Blood Hematocrit : 0.37 0.37 – 0.54 elevated based on blood components and Neutrophil-check temp., s/s
Count RBC: 4.29 x10^12/L 4.1 – 5.1 x10x12/L the normal value of the response to of infection/ inflammation,
(CBC) MCV: 86.7fL 80 – 96 fl 4.3-10 g/l and inflammatory process assess for any treatment-
MCH: 28pg 27 – 31 pg Neutrophil is and infection. antibiotics. And increased
MCHC: 34g/dl 34 -36 g/dl slightly elevated platelet count assess for
WBC: 11.1 x10^9/L 4.5 – 11 x10x9/L based on the normal anemia and any ferrous
Neutrophil: 0.66 0.55 – 0.65 value 0.55-0.65 sulfate.
Lymphocytes: 0.26 0.25 – 0.35 which confirms the
Basophil: 0.00 0.00 – 0.01 presence of
Monocytes: 0.06 0.03 – 0.06 infection. Platelet
Eosinophil: 0.02 0.02 – 0.04 count is also
Platelet Count: 414 150 – 400 elevated base on the
x10^9/L x10^9/L normal value 150-
400x10^9/L which
confirms iron
deficiency anemia
Urinalysi Color: Yellow The transparency Urinalysis yields a large Collect specimen correctly,
s Transparency: Slightly Clear result slightly amount of information assess intake and output
Turbid 4.6 – 6.5 turbid and the pH about possible disorders
pH: 7.5 1.016 – 1.022 level is elevated of the kidney and lower
Specific Gravity: 1.020 Negative from the normal urinary tract, and
Glucose: Negative Negative that possibility may systematic disorders that
Protein: +1 Negative have infection in alter urine composition.
Bilurubin: Negative Negative urinary tract. The Urinalysis data include
Ketone: Negative Negative result is has +1 color, specific gravity,
Blood: Negative Normal Protein means she pH, and the presence of
Urobilinogen: Normal Negative has Protenuria, protein, RBC’s, WBC’s,
Nitrite: Negative None there is a presence bacteria, Leukocyte,
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Pus Cell: 0.1 /hpf of pus cells in the esterase, bilirubin,

urine which means glucose, ketones, casts
that there is also the and crystals
presence of
infection
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College of Nursing

VIII. DRUG STUDY

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IX. NURSING CARE PLAN

X. DISCHARGE PLANNING
XI. IMPLICATIONS
Nursing Research
There are new discoveries that were dogged out and have great helped to the
people. Nursing is evolving. Great discoveries are waiting to be discovered. Students
should not stop studying nursing, reading new discoveries should be encouraged so that
being an efficient nurse someday can be achieved. It takes time, patience and right
attitude to achieve one’s goals and we should be willing to sacrifice anything in order to
reach our dreams in becoming a health care giver. We should always bear in mind that we are
dealing with real lives, with real hearts and real feelings and real emotions
Nursing Education
This study deals with the importance of the concept in giving optimal care. It is
being emphasized the basic knowledge of Gestational Hypertension and the important
details in preventing the disease. This study further encourage the health team to enrich
themselves with adequate knowledge and attitude in preparation of giving care to patients
with Gestational Hypertension.
Nursing Practice
This study focuses on the skill that is necessary to provide optimum care.
Knowledge should be supported with skills and positive attitudes. Skills are designed to
be polished with constant practice and an open mind for corrections that would open
doors for improvements. That is Important in dealing with a fast-changing and updating
world like ours
XII. BIBLIOGRAPHY
Books
Priscilla Lemone & Karen Burke “Medical - Surgical Nursing: Critical Thinking in Client
Care”, 3rd Edition, pg. 677-679
Online Resources
http://www.columbia.edu/itc/hs/pubhealth/modules/reproductiveHealth/anatomy.html
https://byjus.com/biology/gastrointestinal-tract/
Adamson University
College of Nursing
https://teachmeanatomy.info/abdomen/areas/inguinal-canal/?utm_source=TrendMD&utm
_medium=cpc&utm_campaign=TeachMeAnatomy_TrendMD_0
https://teachmeanatomy.info/abdomen/areas/inguinal-triangle/
https://www.news-medical.net/health/Hernia-Pathophysiology.aspxc