inguinal hernia
TRANSCRIPT
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.
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
Nursing Care Plan(pre-operative)
Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation
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
Nursing Care Plan(pre-operative)
Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation
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
Nursing Care Plan(post-operative)
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
Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation
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
Nursing Care Plan(post-operative)
Nursing Care Plan(post-operative)
Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation
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