Case Study of Indirect Inguinal Hernia (r)

Bulacan State University College of Nursing

City of Malolos, Bulacan

A Case study of Indirect Inguinal Hernia

Presented by:

Group 2A BSN 3DNerissa Federis

Marjelene FloresJaecelyn Junio

Joanna Marie LlanoHannah Gail M. Lorenzo

Jeffrey C. Lumba

Presented to:

Sir Marcial Espiritu, RN, MSN

Table of Contents:I. Introduction……………………………………………………………………………………………………………………….Page2

II. Objectives……………………………………………………………………………………………………………………….Page6

III. Nursing Assessment…………..……………………………………………………………………………………………….Page8

IV. Anatomy and Physiology ……………………………………………………………….…………………………………….Page19

V. Pathophysiology ……………………………………………………………………………………………………………….Page21

VI. Patient and His Care………………………………………………………………………………………………………….Page37

VII. Nursing Problem Prioritization…………………………………………………………………………………………….Page47

VIII. Nursing Care Plan………………………………………………………………………………………………………….Page49

IX. Health Teaching………………………………………………………………………………………………….………….Page52

X. Discharge Planning ………………………………………………………………………………………………………….Page70

XI. Conclusion……………………………………………………………………………………………………………….….Page71

XII. Bibliography……………………………………………………………………………………………………………….Page71

I.INTRODUCTION

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This is the case study of baby S.A.M, a 4 year old client from Tambubong, Baliuag, Bulacan, he was admitted at Baliuag District Hospital last May 14, 2013 at 1:15 p.m with a chief complaint of Indirect Inguinal Hernia and Undescended Testes.

A hernia occurs when the contents of a body cavity bulge out of the area where they are normally contained. These contents, usually portions of intestine or abdominal fatty tissue, are enclosed in the thin membrane that naturally lines the inside of the cavity. Hernias by themselves may be asymptomatic (produce no symptoms) or cause slight to severe pain. Nearly all have a potential risk of having their blood supply cut off (becoming strangulated). When the content of the hernia bulges out, the opening it bulges out through can apply enough pressure that blood vessels in the hernia are constricted and therefore the blood supply is cut off. If the blood supply is cut off at the hernia opening in the abdominal wall, it becomes a medical and surgical emergency as the tissue needs oxygen which is transported by the blood supply. Different types of abdominal-wall hernias include the following:

Inguinal (groin) hernia: Making up 75% of all abdominal-wall hernias and occurring up to 25 times more often in men than women, these hernias are divided into two different types, direct and indirect. Both occur in the groin area where the skin of the thigh joins the torso (the inguinal crease), but they have slightly different origins. Both of these types of hernias can similarly appear as a bulge in the inguinal area. Distinguishing between the direct and indirect hernia, however, is important as a clinical diagnosis.

o Indirect inguinal hernia: An indirect hernia follows the pathway that the testicles made during fetal development, descending from the abdomen into the scrotum. This pathway normally closes before birth but may remain a possible site for a hernia in later life. Sometimes the hernia sac may protrude into the scrotum. An indirect inguinal hernia may occur at any age.

o Direct inguinal hernia: The direct inguinal hernia occurs slightly to the inside of the site of the indirect hernia, in an area where the abdominal wall is naturally slightly thinner. It rarely will protrude into the scrotum. Unlike the indirect hernia, which can occur at any age, the direct hernia tends to occur in the middle-aged and elderly because their abdominal walls weaken as they age.

Femoral hernia: The femoral canal is the path through which the femoral artery, vein, and nerve leave the abdominal cavity to enter the thigh. Although normally a tight space, sometimes it becomes large enough to allow abdominal contents (usually intestine) to protrude into the canal. A femoral hernia causes a bulge just below the inguinal crease in roughly the mid-thigh area. Usually occurring in women, femoral hernias are particularly at risk of becoming irreducible (not able to be pushed back into place) and strangulated. Not all hernias that are irreducible are strangulated (have their blood supply cut off ), but all hernias that are irreducible need to be evaluated by a health-care provider.

Umbilical hernia: These common hernias (10%-30%) are often noted at birth as a protrusion at the bellybutton (the umbilicus). This is caused when an opening in the abdominal wall, which normally closes before birth, doesn't close completely. If small (less than half an inch), this type of hernia usually closes gradually by age 2. Larger hernias and those that do not close by themselves usually require surgery at age 2-4 years. Even if the area is closed at birth, umbilical hernias can

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appear later in life because this spot may remain a weaker place in the abdominal wall. Umbilical hernias can appear later in life or in women who are pregnant or who have given birth (due to the added stress on the area).

Incisional hernia: Abdominal surgery causes a flaw in the abdominal wall. This flaw can create an area of weakness in which a hernia may develop. This occurs after 2%-10% of all abdominal surgeries, although some people are more at risk. Even after surgical repair, incisional hernias may return.

Spigelian hernia: This rare hernia occurs along the edge of the rectus abdominus muscle through the spigelian fascia, which is several inches to the side of the middle of the abdomen.

Obturator hernia: This extremely rare abdominal hernia develops mostly in women. This hernia protrudes from the pelvic cavity through an opening in the pelvic bone (obturator foramen). This will not show any bulge but can act like a bowel obstruction and cause nausea and vomiting. Because of the lack of visible bulging, this hernia is very difficult to diagnose.

Epigastric hernia: Occurring between the navel and the lower part of the rib cage in the midline of the abdomen, epigastric hernias are composed usually of fatty tissue and rarely contain intestine. Formed in an area of relative weakness of the abdominal wall, these hernias are often painless and unable to be pushed back into the abdomen when first discovered.

Hernia Causes:Although abdominal hernias can be present at birth, others develop later in life. Some involve pathways formed during fetal development, existing openings in the abdominal cavity, or areas of abdominal-wall weakness.Any condition that increases the pressure of the abdominal cavity may contribute to the formation or worsening of a hernia. Examples include: obesity,heavy lifting,coughing,straining during a bowel movement or urination,chronic lung disease and fluid in the abdominal cavity. A family history of hernias can make you more likely to develop a hernia. The signs and symptoms of a hernia can range from noticing a painless lump to the severely painful, tender, swollen protrusion of tissue that you are

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unable to push back into the abdomen (an incarcerated strangulated hernia).Reducible Hernia: It may appear as a new lump in the groin or other abdominal area. It may ache but is not tender when touched. Sometimes pain precedes the discovery of the lump. The lump increases in size when standing or when abdominal pressure is increased (such as coughing). It may be reduced (pushed back into the abdomen) unless very large. Irreducible hernia: It may be an occasionally painful enlargement of a previously reducible hernia that cannot be returned into the abdominal cavity on its own or when you push it. Some may be chronic (occur over a long term) without pain. An irreducible hernia is also known as an incarcerated hernia. t can lead to strangulation (blood supply being cut off to tissue in the hernia). Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting. Strangulated hernia: This is an irreducible hernia in which the entrapped intestine has its blood supply cut off. Pain is always present, followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting). The affected person may appear ill with or without fever. This condition is a surgical emergency. Hernia Diagnosis:If you have an obvious hernia, the doctor may not require any other tests (if you are healthy otherwise). If you have symptoms of a hernia (dull ache in groin or other body area with lifting or straining but without an obvious lump), the doctor may feel the area while increasing abdominal pressure (having you stand or cough). This action may make the hernia able to be felt. If you have an inguinal hernia, the doctor will feel for the potential pathway and look for a hernia by inverting the skin of the scrotum with his or her finger.

Our client have a Indirect Inguinal Hernia (Reducible Hernia).The diagnostic procedure done with our client is Physical Examination.The other laboratory examinations like Hematology, Urinalysis, and X-ray. The patient’s medication were Morphine sulfate,Ketamine,Paracetamol, Mefenamic acid.

During gestation, a boy's testicles develop inside his abdomen, and then, sometime before birth, they push through a tunnel in the tissue between the groin and the abdomen (called the inguinal canal) and descend into the scrotal sac.In girls, the ovaries descend through the tunnel and into the pelvis. At that point, the passage through the abdominal wall should close up.In about 5 percent of babies (mostly boys, and especially those who were premature), the opening remains large enough to allow a loop of the intestine to poke down into the tunnel. Inguinal hernias do not improve on their own. You'll notice a firm, oblong lump about the size of your thumb either in your baby's groin area or the scrotum. You may not notice the lump for weeks or even months after your child is born.It may bulge out when he's active or crying, then disappear back into the abdomen when your baby is relaxed. Hernias occur more often in children who have one or more of the following risk factors: a parent or sibling who had a hernia as an infant, cystic fibrosis, developmental dysplasia in the hip, undescended testes, abnormalities of the urethra. About 25% of males and 2% of females develop inguinal hernias; this is the most common hernia in males and females.Data from developing countries is limited hence the exact prevalence and incidence is not known. Gender and anatomic distribution of Hernias is believed to be similar to developed countries. Generally most of the hernias occur in the groin in adults.Approximately 75% of all hernias occur in the groin; two thirds of these hernias are indirect and one third direct.Indirect inguinal hernias are the most common hernias in both men and women; a right-sided predominance exists.Incisional and ventral hernias account for 10% of all hernias. Only 3% of hernias are femoral hernias.Between 10% and 30% of children have an abdominal wall hernia; most hernias of this type close spontaneously by age 1 year. The incidence of incarcerated or strangulated hernias in children is 10-20%; 50% of these occur in infants younger than 6 months. Sex: Approximately 90% of all inguinal hernia occur in males. Femoral hernias (although rare) occur almost exclusively in women because of the differences in the

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http://www.emedicinehealth.com/script/main/art.asp?articlekey=59281

pelvic anatomy. The female-to-male ratio of Obturator hernias is 6:1. Age:Indirect hernias usually present during the first year of life, but they may not appear until middle or old age. Direct hernias occur in older patients as a result of relaxation of abdominal wall musculature and thinning of the fascia. Umbilical hernias usually occur in infants and reach their maximal size by the first month of life. Most hernias of this type close spontaneously by the first year of life, with only a 2-10% incidence in children older than 1 year. HerniaIncidence http://www.medindia.net/surgicalprocedures/hernia-incidence.htm#ixzz2TahgRVDl

We chose this case because we are aiming to gain more knowledge and explain all the necessary information about Indirect Inguinal Hernia. In addition, our group will learn the needed action for this type of disease in hospital setting aside from the knowledge acquired in Nursing Education. And this study also aims to be a reference for future studies and researches of other nursing students.

II. OBJECTIVESCLIENTS OBJECTIVES

GENERAL

To render the necessary nursing intervention for the patient having Indirect Inguinal Hernia.

SPECIFIC

Knowledge

To evaluate an assessment for the client having Indirect Inguinal Hernia. To develop awareness for the client’s mother understand her son’s disease. To able to understand the importance of complying with the client’s medication.

Skills

To conduct an assessment for the client having Indirect Inguinal Hernia. For the client’s mother to be able to manage her son in times of sickness triggers. To be able to practice self care activities appropriately.

Attitude

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http://www.medindia.net/surgicalprocedures/hernia-incidence.htm#ixzz2TahgRVDl

To be able to improve discipline in order to manage himself greatly. To be able to comply with treatments to promote recovery. To be able to build trust with the hospital personnel.

STUDENTS OBJECTIVES

GENERAL

For us, nursing students to obtain a broad understanding about Indirect Inguinal Hernia through completing the necessary action and data for this case study.

SPECIFIC

Knowledge

To increase knowledge about Indirect Inguinal Hernia. To learn the probable cause, sign and symptoms of Indirect Inguinal Hernia. To improve knowledge about how to do the ideal nursing intervention for clients with Indirect Inguinal Hernia.

Skills

To do the necessary nursing intervention in hospital for client with Indirect Inguinal Hernia. To give the known medication for client with Indirect Inguinal Hernia. To do the necessary nursing intervention in hospital for client with Indirect Inguinal Hernia.

Attitude

To observe and understand the behavior of client having Indirect Inguinal Hernia. To develop our nursing responsibilities. To give the proper care and build a genuine nurse-patient relationship conducive to good health.

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III. Nursing Assessment A.BIOGRAPHIC DATA Name: Baby S.A.M Age: 4 teas old Sex: Male Civil Status: Single Position in the family: Only child Address: Tambubong, Baliuag, Bulacan Birth date: May 27, 2008 Occupation: none Nationality: Filipino Religion: Roman Catholic Educational Attainment: Date of Admission: May 14, 2013Time: 1:15pm Initial diagnosis: Indirect Inguinal Hernia Right: undescended testis Right for Herniotomy Final diagnosis: Indirect Inguinal Hernia Right: undescended testis Right for Herniotomy

B. REASON FOR VISIT/CHIEF COMPLAINT

“Simula nung 5 months old palang siya, may luslos na sya sa kanang singit niya, tapos ngayong 4 years old lang siya pwedeng ipaopera sabi ng Doctor.” As verbalized by the client’s mother.

C. HISTORY OF PRESENT ILLNESS

Patient’s condition started since he was a 4 months old baby as he cry actively it bulge out, then disappear back into the abdomen when he stoped crying. The client was admitted in the hospital on May 14, 2013at 1:15pm.

D. HISTORY OF PAST ILLNESS

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The patient mother stated that baby S.A.M develop an Asthma but disappeared when the baby reached 2 years old. According also to his mother he experienced coughs and colds. She does not have any regular medical and dental check-ups. He has a complete vaccine.

E. Family Health Illness History (GENOGRAM)

According to the client’s mother, the client’s grandfather at her side, died due to cancer a long time ago. At the client’s father side, his grandfather is with hypertension and Diabetes Mellitus. With regards to his mother’s siblings, one already died due to vehicular accident.

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BA62

(+) hpn, DM

NA60

GM65

(+)Cancer

SM63

AAM

23

MM

24

BM

25

PA26

TA

29

JM

33

LM

27

DA

34

VACCINES AGE NUMBER OF DOSE DOSE ROUTE SITE

BCG Any time at birth

School entrance

1 0.05ml

0.01ml

ID

ID

Right deltoid

DPT 1 ½ months 3 0.5ml IM Upper outer portion of the thigh

OPV 1 ½ months 3 2 gtts Oral Mouth

Hepa B At birth 3 0.5ml IM Outer portion of the thigh

Measles 9 months 0.5ml Subq. Outer part of the arm

(Kozeir 8th edition, p. 434 volume 1)

F. Functional Health Pattern

1. HEALTH PERCEPTION/HEALTH MANAGEMENT PATTERN

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Legend:

Female

Male

Client

(+) IIH- Indirect Inguinal Hernia(+) hpn- Hypertension(+) DM- Diabetes Mellitus

Prior to Hospitalization During Hospitalization

According to the client’s mother, the client is playful and doesn’t complain of any pain regarding his son’s hernia.

After the surgery, the client stated that his circumcised penis hurts but the incision from herniotomy doesn’t hurt that much. He stated that he wants to play and go out to the hospital already.

2. NUTRITIONAL METABOLIC PATTERN

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According to the Client’s mother, Before the client was hospitalized He used to drink Bottled milk about 350mL thrice a day, In morning then after siesta then before he goes to sleep. He used to eat a lot. And drinks at least 5 glasses of water a day.

After the surgery, The client was ordered with DAT once fully awake. He is with an IVF of D5 0.3 NaCl 500 cc at 40-42 gtts/min.

72 HOUR DIETARY RECALL

Date Noted Time of the Day Foods TakenMay 15,2013(Tuesday)

Breakfast andLunch(noon time)

Dinner(evening)

1 small bowl of Tinola with two small pcs of chicken1 bottle (350mL) of Milk

1 small Bowl of Lugaw with 1 small pc of chicken1 bottle (350mL) of water

May15, 2013 (Wednesday)

Breakfast(morning)

Lunch(noon)

Dinner(evening)

NPO

NPO

1 small bowl of Lugaw1 bottle (350mL) of water

June 29, 2012(Friday)

Breakfast(morning)

Lunch

3 pcs of pandesal1 cup of coffee(150ml)1 small bowl of

Prior Hospitalization During Hospitalization

According to the client’s mother, the client used to defecate at least once a day and urinates for at least 3-4 times a day.

According to the client’s mother, the client defecates once a day. His urine is just the same before he was hospitalized.

3. ELIMINATION PATTERN

4. ACTIVITY/EXERCISE PATTERN

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Character Color Odor Frequency DiscomfortStool solid brown foul

odor1 time No

DiscomfortUrine Regular

urinationwater-colored urine

no foul odor

3-4 times a day

No discomfort

Perspiration : The client’s perspires much because he always used to play with his cousins.

Character Color Odor Frequency

Discomfort

Stool Solid stool Brown No odor

1time Having discomfort due to pain in the circumcised penis.

Urine Regular urination

water-colored urine

no foul odor

2-3 times a day

Having discomfort due to pain from circumcision.

Perspiration : The client’s perspire because of the pain experiencing

5. SLEEP/REST PATTERN

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Fully dependent with his mother

Feeding =4 toileting =2 grooming =2 Bathing =2 dressing =2 bed mobility =4LEGEND:0- Full Self Care1- requires use of equipment or device2- requires assistance or supervision from other person3- requires assistance or supervision from other person/ device4 dependent and does not participate

Fully Dependent with his mother

Feeding =4 toileting = 2 grooming = 2 Bathing =2 dressing = 2 bed mobility = 2

LEGEND:0- Full Self Care1- requires use of equipment or device2- requires assistance or supervision from other person3- requires assistance or supervision from other person/ device4 dependent and does not participate


The client, as stated by her mother, was always sleeping at exactly 8PM and wakes up at 6AM during school days. To be exact, he sleeps for about 10 hours. But sometimes, he used to be awake before lunch. And then he used to take a nap for at least 2 hours in the afternoon.

The client sleeps at 9PM to 6AM, to be exact, he sleeps at 9 hours. He can’t sleep in the afternoon because he is not comfortable in the hospital and stated the, “mainit kasi po dito.”

6. COGNITIVE PERCEPTUAL PATTERN

7. ROLE RELATIONSHIP PATTERN

8.COPING STRESS TOLERANCE

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The client has no problem in vision, hearing and sensory perception.

The client has no problem in vision, hearing and sensory perception.


The client is an only child but used to play with his cousins. When his mother is at school, his auntie takes good care of him.

His father leaves at work to take care of him together with his mother.


After doing school works, He used to play with his cousins to relieve stress. The client talks to his mother to relieve stress of staying in the hospital without TV.

9. VALUES BELIEF PATTERN

G. Growth and Development

THEORY PSYCHOSOCIAL COGNITIVE PSYCHOSEXUAL MORAL

STAGE Preschool (3 to 5 years)

Initiative vs. Guilt

Exploration

Pre operational stage

2 to 7 Years

Phallic stage

3-6 years old

genitalia

Pre-conventional morality

Stage 1: Obedience or

punishment orientation

DEFINITION Children need to begin

asserting control and power

Children begin to think

symbolically and learn to use

The third stage of

psychosexual development is

This is the stage that all young

children start at (and a few

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The client is a Roman Catholic and goes to church to attend mass every Sunday.

The client believed that praying to God will make him recover from his surgery easily.

http://psychology.about.com/od/psychosocialtheories/a/initiative-versus-guilt.htm

over the environment. Success

in this stage leads to a sense of

purpose. Children who try to

exert too much power

experience disapproval,

resulting in a sense of guilt.

words and pictures to

represent objects. They also

tend to be very egocentric, and

see things only from their

point of view.

Developemental changes

Children at this stage tend to

be egocentric and struggle to

see things from the perspective

of others.

While they are getting better

with language and thinking,

they still tend to think about

things in very conrete terms

the phallic stage, spanning the

ages of three to six years,

wherein the child's genitalia

are his or her

primary erogenous zone. It is

in this third infantile

development stage that

children become aware of their

bodies, the bodies of other

children, and the bodies of

their parents; they gratify

physical curiosity by

undressing and exploring each

other and their genitals, and so

learn the physical (sexual)

differences between "male"

and "female" and

adults remain in). Rules are

seen as being fixed and

absolute. Obeying the rules is

important because it means

avoiding punishment.

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http://en.wikipedia.org/wiki/Human_anatomy

http://en.wikipedia.org/wiki/Erogenous_zone

http://en.wikipedia.org/wiki/Phallic_stage

the gender differences between

"boy" and "girl".

FINDINGS PASS PASS PASS PASS

REMARKS Positive. The client , shows

that he has the power to

question what is happening to

him.

Positive. The client is in pre

operational stage ask a lot of

things to his mom and explain

it by using some gestures or

pictures.

Positive. The client has more

on his feelings on his mother.

Positive. He obeys when in

command.

IV. Anatomy and Physiology

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http://en.wikipedia.org/wiki/Gender

The inguinal canal is a passage in the anterior (toward the front of the body) abdominal wall which in men conveys the spermatic cord and in women the round ligament. The inguinal canal is larger and more prominent in men. Each person has two, on the left and right sides of the abdomen.

The small intestine (or small bowel) is the part of the gastrointestinal tract following the stomach and followed by the large intestine and is where much of the digestion and absorption of food takes place.

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The superficial inguinal ring (subcutaneous inguinal ring or external inguinal ring) is an anatomical structure in the anterior wall of the human abdomen. It is a triangular opening that forms the exit of the inguinal canal, which houses the ilioinguinal nerve, the genital branch of the genitor femoral nerve, and the spermatic cord (in men) or the round ligament (in women)

The deep inguinal ring (internal or deep abdominal ring, abdominal inguinal ring, internal inguinal ring) is the entrance to the inguinal canal.

The spermatic cord is the name given to the cord-like structure in males formed by the vas deferens and surrounding tissue that run from the abdomen down to each testicle

The testicle is the male gonad in animals testes are components of both the reproductive system and the endocrine system. The primary functions of the testes are to produce sperm (spermatogenesis) and to produce androgens, primarily testosterone.

V. Pathophysiology

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MODIFIABLE RISK FACTORS NON MODIFIABLE RISK FACTORS

Nutrition Weak abdominal wall Age Gender Hereditary

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Inguinal ring will not closed

Pain or discomfort to the affected organs

Scrotum enlarged or swollen

Fatty substance or part of the small intestine slides through the inguinal canal

Causing malfunction of the inguinal ring

Intra abdominal wall (membranes and muscles) of the inguinal canal into the scrotum becomes weakened

Evolves to a hole or defect

A. PHYSICAL ASSESSMENT

VITAL SIGNS: PR=131 bpm TEMPERATURE=37.6 degree RR=26 cpmHeight = 3’5” Weight = 35.2 lbs BMI : 14.7 UnderweightPAIN SCALE: 3/5 according to Wong Baker Face Pain ScaleMay 15, 2013

PARTS TO BE ASSESSED TECHNIQUE NORMAL FINDINGS ACTUAL FINDINGS REMARKS

General appearance

1. Body built in relation to client’s age, lifestyle & health

Inspection Proportionate and varies with lifestyle

He has a proportionate (mesomorph) body built which

Normal

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INDIRECT INGUINAL HERNIATION


is appropriate with his lifestyle

2. Client’s posture & gait, standing, sitting & walking

InspectionRelax, erect posture,

coordinated body movementsn/a n/a

3. Client’s overall hygiene & grooming

Inspection Neat He is neat and clean. Normal

4. Body & breath odor InspectionNo body odor or minor body

odor relative no body odor Normal

5. Signs of distress in posture or facial expression

Inspection No distress notedThere are sign of restlessness, the patient is irritated and cries

at time

deviation from normal due to pain felt by the patient

6. Obvious signs of health or illness

Inspection Healthy appearance Weak in appearanceDeviation from normal due to

pain felt by the patient

7. Client’s attitude Inspection Cooperative Cooperative once kept calm Normal

8. Client’s affect/mood; appropriateness of the clients response

Inspection Appropriate to the situation Appropriate to the situation Normal

9. Quantity of speech, quality & organization

InspectionUnderstandable, moderate

pace; exhibits thought association

Understandable and in a moderate pace; exhibits

thought association answer to question appropriately

Normal

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10. Relevance & organization of thoughts

InspectionLogical sequence; makes

sense; has sense of reality.Has a sense of reality Normal

SKIN

1. Skin moisture Inspectionmoisture in skin fold and

axillaeMoist skin folds Normal

2. Skin Texture Inspection smooth smooth Normal

3. Skin turgor Inspection and palpation Springs back Springs back Normal

Hair and Nails

1. Fingernails plate shape to determine its curvature & angle

InspectionConvex curvature, angle of

nail plate about 160 degrees.Convex and has less than 180

degreeNormal

2. Fingernail & toenail bed color

Inspection

Highly vascular and pink in light skinned clients; dark- skinned clients may have

brown or black pigmentation in longitudinal streaks.

Pinkish in color Normal

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3. Tissues surroundings nails Inspection Intact epidermis.He has an intact epidermis

with no hangnailsNormal

4. Fingernail & toenail texture Palpation Smooth texture. Smooth nail texture Normal

5. Blanch test of capillary refill

PalpationPrompt return of pink or usual

color (generally less than 4 seconds.)

The color return to the original color in 2 seconds

Normal

1. Evenness of growth over the scalp

Inspection Evenly distributed hair. His hair is well distributed Normal

2. Hair thickness & thinness Palpation Thick/thin hair. He has a thick hair Normal

3. Presence of infections or infestations

Inspection Not present. Not present. Normal

4. Texture & oiliness over the scalp

Palpation Silky, resilient hair. Silky, resilient hair. Normal

SKULL

1. Size, shape & symmetry Palpation Rounded (normocephalic and symmetrical, with frontal,

parietal, and occipital prominences); smooth skull

Head is symmetrically round. Normal

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contour.

2. Nodules or masses & depressions

PalpationSmooth, uniform consistency; absence of nodules or masses.

No mass or nodules noted; Normal

FACE

1. Facial features Inspection

Symmetric or slightly asymmetric facial features; palpebral fissures equal in size; symmetric nasolabial

folds.

Symmetric or slightly asymmetric facial features; palpebral fissures equal in size; symmetric nasolabial

folds.

Normal

2. Symmetry of the facial movements

InspectionSymmetrical facial

movements.Facial movements are

symmetricalNormal

EYEBROWS & EYELASHES

1. Evenness of distribution & direction of curl

Inspection

Hair evenly distributed; skin intact. Eyebrows

asymmetrically aligned equal movement. Eyelashes curl

slightly outward.

Eyebrows and eyelashes are both evenly distributed,

symmetrical aligned. Eyelashes curl slightly

outward.

Normal

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CORNEA

1.Clarity & color Inspection Transparent, shiny and smooth; details of the iris are visible. In older people, a thin grayish white ring around the

Details of iris are visible. Transparent, shiny and

smooth.

Normal

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margin, called arcussenilis, may be evident.

IRIS

1. Shape & color Inspection Flat and roundFlat and round and uniform in

color.Normal

PUPILS

1. Color, shape & symmetry of size

InspectionBlack in color; equal in size;

normally 3-7 mm in diameter; round, smooth border.

Firm and equal pupils Normal

EYELIDS

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1. Surface characteristics & ability to blink

Inspection and Palpation

Skin intact, no discharge, no discoloration. Lids close

symmetrically approximately 15-20 involuntary blinks per minute; bilateral blinking.

When lids open, no open, no visible sclera above corneas, and upper and lower borders

of cornea are slightly covered.

Eyelids skin are intact, no noted discharge, and no noted

discoloration. Lids close symmetrically. Client

exhibited 18 involuntary blinks per minute.

Normal

CONJUNCTIVA

1. Bulbar conjunctivas color, texture & presence of lesions

InspectionTransparent; capillaries

sometimes evident.

Transparent, capillaries evident, no discharge was

noted.Normal

2. Palpebral conjunctivas color, texture & presence of lesions

InspectionShiny, smooth, pink or red in

color.Shiny, smooth and pale in

colorDeviation from normal due to

starvation

SCLERA

1. Color & clarity InspectionSclera appears white

(yellowish in dark- skinned clients).

Sclera appears white Normal

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EAR’S AURICLE

1. Color & symmetry of size &position

Inspection

Color same as facial skin, symmetrical, auricle aligned with outer canthus of eye, about 10cm from vertical.

Color is same with facial skin, symmetrical with each other,

auricle aligned with outer canthus of eye, about 10 cm

vertical

Normal

2. Texture & elasticity & areas of tenderness

PalpationMobile, firm and not tender,

pinna recoils after it is folded.

Both pinna recoils after being folded. Mobile, firm and not

tender.Normal

EXTERNAL EAR CANAL

1. Cerumen, skin lesions, pus & blood

Inspection

Distal third contains hair follicles and glands. Dry

cerumen in various shades of brown

No noted pus, blood and odor. Minimal cerumen noted. Distal third contains hair

follicles.

Normal

HEARING ACUITY TEST

1. Client’s response to normal voice tones

Inspection Normal voice tones audibleClient responds to normal

voice tonesNormal

NOSE

1. Shape, size or color & Inspection Symmetric and straight No discharge and/or flaring Normal

30


flaring or discharge from the nares

No discharge or flaring

Uniform color

noted. Symmetrical on both sides. Also uniform in color.

2. Presence of redness, swelling, growths & discharge or nares using the flashlight Inspection

Mucosa pink

Clear, watery discharge

No lesions.

Mucosa are intact and pinkish; minimal moist noted inside;

no swelling or nodules found. Normal

3. Position of nasal septum InspectionNasal septum intact and in

midline, intactNasal septum is intact and in

midlineNormal

4. Test patency of both nasal septum

InspectionAir moves freely as the client

breathes through the naresAir moves freely as the client breathes through each nares

Normal

5. Tenderness, masses & displacement of bone & cartilage

Palpation Not tender; no lesionsNo tenderness, no lesions noted. No displacement of

bone & cartilage.Normal

LIPS

1. Symmetry of contour color & texture

Inspection and Palpation

Uniform pink color

Soft, moist, smooth texture

Symmetry of contour

Ability to purse lips

Uniform pale to pink color

Soft, moist, smooth texture

Symmetry of contour

Ability to purse lips

Deviation from normal due to starvation

31

TEETH

1. Inspect for color, number & condition & presence of

denturesInspection

20 baby teeth

Smooth, white, shiny tooth enamel

20 baby teeth, 4 front teeth are with cavities

Deviation from normal due to teeth cavities

GUMS

1. Color & condition Inspection

Pink gums (bluish or dark patches in dark-skinned

clients)

Moist, firm texture to gums

Slightly pale gums, moist, firm texture

Deviation from normal due to starvation

TONGUE/FLOOR OF THE MOUTH

1. Color & texture of the mouth floor & frenulum

Inspection and PalpationSmooth tongue base with

prominent veinsSmooth tongue base with

prominent veinsNormal

2. Position, color & texture, movement & base of the

tongueInspection and Palpation

Central in position

Pink in color (some brown pigmentation on tongue borders in darj-skinned

Centered; pink in color, slightly rough, has thin white coating, smooth, no lesions;

moves freely.

Normal

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clients); moist; slightly rough; thin white coating

Smooth, lateral margins, no lesions

Raised papillae (taste buds)

Moves freely, no tenderness

ABDOMEN

1. Skin integrity Inspection

Unblemished skin, uniform in color, silver white striae

(stretch marks) or surgical scars.

Uniform in color with surgical incision

Deviation from normal due to surgical procedure done

2. Abdominal contour InspectionFlat, rounded (convex) or

scaphoid(concave)Convex in shape.

Normal

3. Bowel Sounds Auscultation Audible bowel sounds Audible bowel sounds Normal

Summary of Physical Assessment:

General Appearance: Sign of Distress in Posture and Facial Expression - There are sign of restlessness, the patient is irritated and cries at time

33

Obvious Signs of health or illness- Weak in appearance

Conjunctiva: Palberal conjunctivas color texture and presence of lesions- Shiny, smooth and pale in color

Lips: Symmetry of contour color and texture- Uniform pale to pink color, soft , ,oist snooth texture, symmetry of contour

Gums: Color and condition- pale, firm texture.

Abdomen: Skin Integrity - Uniform in color with surgical incision

COMPLETE BLOOD COUNT – April 25,2013T – 42.2 degree

TEST ACTUAL FINDINGS NORMAL FINDINGSWBC 8.8 x 109 3.5 – 10 x109

RBC 4.2 x 1012 3.80 – 5.0 x 1012

HGB 124 g/L 110 - 165HCT 0.354 L/L 0.350 – 500PLT 208 x 109/L 150 – 390PCT 0-166 x 10-2/L 0.100 – 0.600

34

WBC FLAGS DIFF:% LYM 41.4% 17.0 – 48.0 %% MON 17.5% 4.0 – 10.0 %% GRA 4.1 % 43.0 – 76.0 %

Chrisger L. SantosMedtech Lic # 46436

HEMATOLOGY – April 17, 2013

TEST ACTUAL FINDINGS NORMAL FINDINGSHGB 147 g/LHCT 0.40 g/LWBC 11.5 x x 109/LPLATELET COUNT 208 x 109/LSEGMENTERS 53.0LYMPHOCYTES 47.0


URINALYSIS

April 17, 2013

TEST FINDINGSColor Light YellowCharacteristic Slightly CloudyReaction AlkalineSPGP 1.015Albumin Negative

35

Sugar NegativeWBC 0 - 2RBC 0 – 1Epithelial Cells fewBacteria few

April 25 , 2013

TEST FINDINGSColor YellowCharacteristic CloudyReaction AcidicSPGP 1.030Albumin NegativeSugar NegativeWBC 2 - 3RBC 0 – 3Epithelial Cells fewBacteria few


RADIOLOGIC EXAMChest

FINDINGS: Both lung fields are essentially clear. Sinuses and diaphragm are intact. Heart is within normal limits.

36

Lux Evelyn C. Trinidad MD, MPARadiologist

VI. THE PATIENT AND HIS CARE

A. Medical Management

a. IVF, Nebulization, NGT, TPN, Oxygenation therapy

37

MEDICAL MANAGEMENT

TREATMENT

DATE ORDERED/ DATE PERFORMED/ DATE

CHANGE OR D/C

GENERAL DESCRIPTION INDICATIONS/ PURPOSES CLIENT’S RESPONSE TO THE TREATMENT

NURSING RESPONSIBILITIES

Intravenous fluid-D5 0.3 NaCl 500cc

(0.3% Dextrose in Sodium Chloride)

Date ordered:

Date performed:

Date change:

Hypotonic Solution

40-42 gtts/min

Used to provide free water and treat cellular dehydration.

Has lower concentration than the body fluids.

Signs and symptoms of dehydration were not noted such as dry skin.

Prior: Review physicians

orderDuring: Watch closely for signs

and symptoms of fluid overload.

Monitor I & OAfter: Maintain patent IV line,

watch for irritation in the insertion site.

Monitor I & O continuously.

Prior:

38

Intravenous fluid-D5LR 1L

(5% Dextrose in Lactated Ringer’s Solution)

Date ordered:

Date performed:

Date change:

Hypertonic Solution

Fast drip

It used to supply water and electrolytes (e.g. Calcium, potassium, sodium and chloride.)

Treatment for persons needing extra calories who cannot tolerate fluid overload.

Signs and symptoms of dehydration were not noted such as dry skin.

Review physicians order

During: Watch closely for signs

and symptoms of fluid overload.

Monitor I & OAfter:

Maintain patent IV line, watch for irritation in the insertion site

Monitor I & O continuously

b. Drugs

Generic/ BrandName/ Classification

DATE(ordered, given, changed,

discontinue)

Route of Administration,

Dosage, Frequency

Mechanism Action Client’s Response Nursing Responsibilities

39

Generic Name:Ibuprofen

Brand Name:Dolan

Classification:analgesic; antipyretic

Given orally,250mg/5mLSusp ½ tsp for 8hrs.

Blocks the prostaglandins, substances our body releases in response to illness and injury. Prostaglandins cause pain and swelling (inflammation); they are released in the brain and can also cause fever.

---- Prior: Take the patients vital signs

During Advised the patient to take it with

meals or milk if GI intolerance occurs.

Advise the patient to report any signs of N&V, diarrhea or constipation.

Monitor input and output continuously.

After: Monitor input & output

continuously. Assess for possible side effects.

Generic Name:Atropine Sulfate

Brand Name:Artopen

Classification:Cholinergic blocking drug

5 mLIV push

To suppress salivation, perspiration, and respiratory tract secretions; to reduce incidence of laryngospasm, reflex bradycardia arrhythmia, and hypotension during general anesthesia.

---- Prior: Monitor vital signs.HR is a sensitive

indicator of patient’s response to atropine.

During: The nurse should be alert in to

40

Generic Name:Paracetamol

Brand Name:Aeknil

Classification:Analgesic,Antipyretic

Generic Name:Midazolam Hydrochoride

Brand Name:Dormicun

Classifications:Benzodiazepine

300mgIV push

5mg/mLIV push

Reduces the synthesis of prostaglandins which are responsible for the mediation of pain and fever.

Short-term

sedation

• Postoperative amnesia

-----

-----

changes in quality, rate, and rhythm of HR and respiration and to changes in BP and temperature.

Monitor input & output.

After: Monitor input & output

continuously. Assess for possible side effects

Prior: make sure that the patient to have

no allergies in acetaminophenDuring:

Monitor pulse and respiration

After: Assess for patients comfort

Prior: Monitor pulse and respiration

During: Monitor BP, pulse and respiration

continuously during IV administration.

Oxygen and resuscitative equipment should be available in case of respiratory depression.

After:

41

Generic Name:Cephalexin Monohydrate

Brand Name:Ceporex

Classifications:Antibiotic, Cephalosporin (first generation)

Generic Name:Ketamine hydrochloride

Brand Name:Ketazol

Classifications:Anaesthetic

Given orally,susp 250 mg/5mLSusp ½ tsp q8h

5mLIV push

Inhibits synthesis of

bacterial cell wall, causing

cell death.

Anaesthesia for operations

of short duration and in

case of painful diagnostic

interventions. Induction of

anesth prior to the

administration of IV

anesth.

-----

------

Assess for patients comfort

Prior: Monitor vital signs

During: Advised the patient to take it with

meals for GI upset. Advised the patient to report any

adverse effect such as rash,yellow discoloration of the skin.

Monitor input & output.

After: Advised the patient to consume 2-

3L/day of fluids to prevent dehydration.

Monitor input & output continuously.

Prior: Monitor vital signs Explain to the patient that this can

cause dizziness, drowsiness; nausea, and vomiting.

During: Monitor BP, pulse and respiration

continuously during IV

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Generic Name:Bupivacaine HCL

Brand Name:Sensorcaine

Classification:Amide type local anaesthetic

Spinal Anaesthesia5mL

Block the generation and

the conduction of nerve

impulses, presumably by

increasing the threshold

for electrical excitation in

the nerve, by slowing the

propagation of the nerve

impulse, and by reducing

the rate of rise of the

action potential.

----

administration

After: Assess for patients

comfort Monitor input &

output

Prior: Inform the patient that they may

experience temporary loss of sensation and motor activity, usually in the lower half of the body, following proper administration of spinal anesthesia.

During: Maintain a patent airway. Monitor cardiovascular and

respiratory vital signs and the patient's state of consciousness.

After: Assess for patients comfort

c. Diet

43

Type of diet Date started General description

Indications/purpose Specific foods taken

Clients response to the diet

Nursing responsibilities

Soft diet

DAT

Foods that are easily digested

Diet as tolerated

All the foods that the client

can ingest.

Foods which are easily digested and pass quickly through your digestive system. These help to reduce the amount of time food stays in the intestines and make bowel motions soft and easy.

To regain his strength.

LugawWater

BreadsRice

CerealsFresh vegetables

fruits

The client understands why he needs to take a soft diet.

The client understands why he needs to eat nutritious food.

Prior:Weigh the child before feeding to make sure that the child receives the right amount of food.

After:Record the fluid intake and output intake. Prior:Tell the purpose of DAT to the patient.

During:Monitor and check the food intake.

Make sure food the is nutritious and beneficial to his present situation.

44

d.Activity/Exercises

Type of Exercises Date Started General Description Indication/purpose Clients Response to the Activity

Nursing Responsibilities

Ambulation The act of travelling by foot; is a healthy form of exercise.

It can help prepare and condition the body for the additional stress that surgery will cause.

Improve muscle tone and strength in his abdomen.

Prior:

Explain to him why he needs to perform exercises.

During:

Assits patient while performing the exercises.

45

B. Surgical Management

Surgical management

Date performed General description Indication and purpose Client response Nursing responsibilities

HerniorrhaphyAn operation for hernia that involves opening the hernia sac,returning the contents to their normal place,oblitering the hernia sac,closing the opening with strong sutures.

Performed to close or mend the weakened abdominal wall.

The patient is in pain.

Prior:

Explain to the procedure to the client.

Take the vital signs.

During:

Maintain a patent airway. Monitor cardiovascular and

46

respiratory vital signs and the patient's state of consciousness.

After:

Assess for patients comfort.

VII. Nursing Problem Prioritization

DATE IDENTIFIED CUES PROBLEM/ NURSING

DIAGNOSIS

JUSTIFICATION

May 17, 2013 Subjective:

“medyo mainit siya” as verbalized by the mother of the client.

Objectives:

> Febrile(37.6 ºC)> warm to touch>irritable>pale>weak in appearance

Altered body temperature related to inflammatory process

-We include this in prioritization because the patient is already warm to touch and he is restless.

47

>restlessMay 17, 2013 Subjective:

“medyo masakit po” as verbalized by the client.

Objective:> facial grimace> wong baker scale 3/5> guarding behavior

Acute pain related to surgical incision on right inguinal area

-We include this in prioritization because the patient’s wong baker scale is already 3/5.

May 17, 2013 Subjective: “di pa siya masyado makakilos” as verbalized by the mother of the patient.

Objective:>irritable>restless>cries at time

Decreased mobilization related to discomforts on operation site

-We include this in prioritization because the patient can’t move normally and not doing his usual activities.

May 17, 2013 Subjective: “di pa siya masyado makakilos” as verbalized by the mother of the patient.

Objective:>irritable>restless>cries at time

Activity intolerance related to discomforts on operation site

-We include this in prioritization because the patient can’t move normally and most of the time he is depending on his mother.

48

VIII. Nursing Care Plan

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

49

Subjective: “medyo mainit siya” as verbalized by the mother of the client.

Objective:>Febrile(37.6 ºC)>warm to touch>irritable>pale>weak in appearance>restless>cries at time>V/S as follows:BP: 90/50 mmHgRR: 26 cpmCR: 131 bpm

Altered body temperature related to inflammatory process

Short term goal:

After 1-2 hours of nursing intervention

the patient’s body temperature will decreased from 37.6 ºC to 37 ºC

Promote surface cooling by means of rendering tepid sponge bath

Promote bed rest

Encourage the mother to remove wet clothing of the patient

Discuss to the mother the importance of adequate fluid intake of the patient

Helps reduce high temperature

to reduce tension

to provide comfort

After 1-2 hours of nursing intervention

the patient’s body temperature decreased from 37.6 ºC to 37 ºC


50

Subjective: “medyo masakit po” as verbalized by the client.

Objective:> facial grimace> wong baker scale 3/5> guarding behavior> irritable> restless> cries at time>V/S as follows:BP: 90/50 mmHgRR: 26 cpmCR: 131 bpm

Acute pain related to surgical incision on right inguinal

Short term goal:

After 2-4 hours of nursing intervention the client will be able to:

Report pain is relieved from 3/5 to 1/5

Provide comfort measures , quiet environment, and calm activities

Instruct in and encourage use of relaxation techniques

Keep the area clean and dry, carefully dress wounds, support incision, prevent infection

To promote nonpharmacological pain management

To distract attention and reduce tension

To assist natural body’s repair

After 2-4 hours of nursing intervention the client was able to:

Report pain is relieved from 3/5 to 1/5


51

Subjective: “di pa siya masyado makakilos” as verbalized by the mother of the patient.

Objective:>irritable>restless>cries at time>V/S as follows:BP: 90/50 mmHgRR: 26 cpmCR: 131 bpm

Decreased mobilization related to discomforts on operation site

Short term goal:

After 3-5 hours of nursing intervention the client will be able to:

to move willingly on his own

demonstrate techniques and behaviors that enable safe moving or doing activities

Provide comfort measures , quiet environment, and calm activities

Make yourself available all the time

Support and assist the client in doing such activities

Keep the area clean and dry, carefully dress wounds, support incision, prevent infection

To promote nonpharmacological pain management

To help patient do his activities

To help patient do his activities

To assist natural body’s repair

After 3-5 hours of nursing intervention the client was able to:

to move willingly on his own

demonstrate techniques and behaviors that enable safe moving or doing activities

IX. Health Teaching

52

LEARNING

OBJECTIVES

LEARNING CONTENTS STRATEGIES TIME ALLOTMENT RESOURCES EVALUATION

After 30-45 minutes of

health teaching, the

client’s mother will be

able to:

a .know what is Indirect

Inguinal Hernia

b. know the causes, and

risk factor of Indirect

Inguinal Hernia

c .know the sign, test

and symptoms of

Indirect Inguinal Hernia

d. know the possible

treatment to Indirect

Inguinal Hernia

A hernia occurs when the contents of a body cavity bulge out of the area where they are normally contained. These contents, usually portions of intestine or abdominal fatty tissue, are enclosed in the thin membrane that naturally lines the inside of the cavity. Hernias by themselves may be asymptomatic (produce no symptoms) or cause slight to severe pain. Nearly all have a potential risk of having their blood supply cut off (becoming strangulated). When the content of the hernia bulges out, the opening it bulges out through can apply

Interactive discussion

Lecture discussion

Pamphlet giving

30-45 minutes Manila Paper-₱ 5.00

Bond Paper-₱5.00

Transportation-50.00

Total:₱60.00

Manpower:

BSN 3-D, Group 2A

Materials:

Pamphlets and visual

aids


health teaching ,the

client’s mother was able

to:

a .Gain knowledge

about Indirect Inguinal

Hernia

b. Understand the

causes, and risk factor

of Indirect Inguinal

Hernia

c .Understand the sign,

test and symptoms of

Indirect Inguinal Hernia

d. Gain knowledge

about possible treatment

53

enough pressure that blood vessels in the hernia are constricted and therefore the blood supply is cut off. If the blood supply is cut off at the hernia opening in the abdominal wall, it becomes a medical and surgical emergency as the tissue needs oxygen which is transported by the blood supply. Different types of abdominal-wall hernias include the following:

• Inguinal (groin) hernia: Making up 75% of all abdominal-wall hernias and occurring up to 25 times more often in men than women, these hernias are divided into two different types, direct and indirect. Both occur in the groin

to Indirect Inguinal

Hernia

54

area where the skin of the thigh joins the torso (the inguinal crease), but they have slightly different origins. Both of these types of hernias can similarly appear as a bulge in the inguinal area. Distinguishing between the direct and indirect hernia, however, is important as a clinical diagnosis.

o Indirect inguinal hernia: An indirect hernia follows the pathway that the testicles made during fetal development, descending from the abdomen into the scrotum. This pathway normally closes before birth but may remain a possible site for a hernia in later life. Sometimes the hernia

55

sac may protrude into the scrotum. An indirect inguinal hernia may occur at any age.

o Direct inguinal hernia: The direct inguinal hernia occurs slightly to the inside of the site of the indirect hernia, in an area where the abdominal wall is naturally slightly thinner. It rarely will protrude into the scrotum. Unlike the indirect hernia, which can occur at any age, the direct hernia tends to occur in the middle-aged and elderly because their abdominal walls weaken as they age.

• Femoral hernia: The femoral canal is the path through which the femoral artery, vein, and

56

nerve leave the abdominal cavity to enter the thigh. Although normally a tight space, sometimes it becomes large enough to allow abdominal contents (usually intestine) to protrude into the canal. A femoral hernia causes a bulge just below the inguinal crease in roughly the mid-thigh area. Usually occurring in women, femoral hernias are particularly at risk of becoming irreducible (not able to be pushed back into place) and strangulated. Not all hernias that are irreducible are strangulated (have their blood supply cut off ), but all hernias that are

57

irreducible need to be evaluated by a health-care provider.

• Umbilical hernia: These common hernias (10%-30%) are often noted at birth as a protrusion at the bellybutton (the umbilicus). This is caused when an opening in the abdominal wall, which normally closes before birth, doesn't close completely. If small (less than half an inch), this type of hernia usually closes gradually by age 2. Larger hernias and those that do not close by themselves usually require surgery at age 2-4 years. Even if the area is closed at birth, umbilical

58

hernias can appear later in life because this spot may remain a weaker place in the abdominal wall. Umbilical hernias can appear later in life or in women who are pregnant or who have given birth (due to the added stress on the area).

• Incisional hernia: Abdominal surgery causes a flaw in the abdominal wall. This flaw can create an area of weakness in which a hernia may develop. This occurs after 2%-10% of all abdominal surgeries, although some people are more at risk. Even after surgical repair, incisional hernias may return.

59

• Spigelian hernia: This rare hernia occurs along the edge of the rectus abdominus muscle through the spigelian fascia, which is several inches to the side of the middle of the abdomen.

• Obturator hernia: This extremely rare abdominal hernia develops mostly in women. This hernia protrudes from the pelvic cavity through an opening in the pelvic bone (obturator foramen). This will not show any bulge but can act like a bowel obstruction and cause nausea and vomiting. Because of the lack of visible bulging, this hernia is very

60

difficult to diagnose.

• Epigastric hernia: Occurring between the navel and the lower part of the rib cage in the midline of the abdomen, epigastric hernias are composed usually of fatty tissue and rarely contain intestine. Formed in an area of relative weakness of the abdominal wall, these hernias are often painless and unable to be pushed back into the abdomen when first discovered.

Hernia Causes:Although abdominal hernias can be present at birth, others develop later in life. Some involve pathways

61

formed during fetal development, existing openings in the abdominal cavity, or areas of abdominal-wall weakness.Any condition that increases the pressure of the abdominal cavity may contribute to the formation or worsening of a hernia. Examples include: obesity,heavy lifting,coughing,straining during a bowel movement or urination,chronic lung disease and fluid in the abdominal cavity. A family history of hernias can make you more likely to develop a hernia.

The signs and symptoms of a hernia can range

62

from noticing a painless lump to the severely painful, tender, swollen protrusion of tissue that you are unable to push back into the abdomen (an incarcerated strangulated hernia).Reducible Hernia: It may appear as a new lump in the groin or other abdominal area. It may ache but is not tender when touched. Sometimes pain precedes the discovery of the lump. The lump increases in size when standing or when abdominal pressure is increased (such as coughing). It may be reduced (pushed back into the abdomen) unless very large. Irreducible hernia: It

63

may be an occasionally painful enlargement of a previously reducible hernia that cannot be returned into the abdominal cavity on its own or when you push it. Some may be chronic (occur over a long term) without pain. An irreducible hernia is also known as an incarcerated hernia. t can lead to strangulation (blood supply being cut off to tissue in the hernia). Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting. Strangulated hernia: This is an irreducible hernia in which the entrapped intestine has its blood supply cut off. Pain is always present, followed quickly by

64

tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting). The affected person may appear ill with or without fever. This condition is a surgical emergency.

Hernia Diagnosis:If you have an obvious hernia, the doctor may not require any other tests (if you are healthy otherwise). If you have symptoms of a hernia (dull ache in groin or other body area with lifting or straining but without an obvious lump), the doctor may feel the area while increasing abdominal pressure (having you stand or cough). This action may make the hernia able to be felt. If you

65

have an inguinal hernia, the doctor will feel for the potential pathway and look for a hernia by inverting the skin of the scrotum with his or her finger.

LEARNING

OBJECTIVES



student nurse-client

interaction, the patient’s

mother will be able to:

- State the uses of pain

management.

Definition of no pharmacological pain management.- Non-pharmacological or natural therapies are things you can do or think about that help decrease your pain. These therapies do not involve taking


Lecture discussion

Return Demonstration

Pamphlet giving


Bond Paper-₱5.00


Total:₱60.00

Manpower:

BSN 3-D, Group 2A




mother was be able to:

- State the uses of pain

management.

66

- Utilize different non-

pharmacological pain

management.

- Manifest a relief in

pain.

medicines, but work along with your medicines. People have used "natural" ways to help with pain and healing from the very beginning of time.* The different nonpharmacological pain management.- Breathing exercises, Music therapy, Massage, Distraction, Heat and Cold, Laughter * How to do deep breathing exercises.

Materials:


aids

- Utilize different non-

pharmacological pain

management.

- Manifest a relief in

pain.

LEARNING

OBJECTIVES





mother will be able to:

- State the uses of Tepid

sponge bath to relieve

fever.

A tepid sponge bath can reduce fever and stress when performed correctly. Most generally, this type of care is offered in a hospital setting to lower an elevated temperature


Lecture discussion

Pamphlet giving


Bond Paper-₱5.00


Total:₱60.00

Manpower:

BSN 3-D, Group 2A




mother was be able to:

- State the uses of Tepid

sponge bath to relieve

fever.

67

- make client manifest

signs of relief from

hyperthermia

but can be completed easily at home. "Textbook of Basic Nursing" advises that the bath must be administered for at least 30 minutes to be effective. Constant monitoring of the patient's body temperature is essential, so that it does not drop below normal.

Preparation

Explain to the patient what you will be doing. The bath is ineffective if the patient is nervous or frightened. Record the temperature before beginning the bath. Gather the needed supplies: bath basin, several washcloths, towels and a bath sheet. Fill the bath basin with tepid water, 80 to 90

Materials:


aids

- make client manifest

signs of relief from

hyperthermia

68

degrees Fahrenheit. You may need to refill the basin several times throughout the bath, to prevent the water from becoming too cool.

Soak four washcloths in the tepid water and wring out the excess. Place one washcloth under each of the patient's arms and one on each side of his groin. The blood vessels are close to the skin in these areas, and this will help to cool the patient more effectively. At first, the patient will be chilled by this; allow several minutes for his body to adjust to the temperature of the water.

69

Bathing

Sponge each of the patient's limbs for five minutes. Keeping the lower half of the patient covered, begin sponging his arms and chest. Work your way to the legs, keeping the patient covered with a towel in the areas you are not bathing. Sponge the back and buttocks for ten minutes. This time is essential to lowering the temperature effectively. Continue to monitor the patient's temperature at intervals throughout the bath procedure. Replace the tepid water if chilled. If at any time the patient becomes chilled and begins

70

shivering, stop the bath.

Discontinue the bath once the temperature has reached a normal level. Cover the patient with the bath sheet.

X. Discharge Planning

Medicationo Advise the client’s caregiver that Medications should be taken regularly as prescribed, on exact dosage, time, & frequencyo Report any side effects or adverse effect of the medication

Exercise/Environmento Tell the client’s caregiver that it is much better to provide the client with a well ventilated room.

Treatmentso Inform client’s caregiver to fully participate in continuous treatment.o Compliance to the medication.

71

Health Teachingo Teach all about the post op care of herniorrhaphy; how to care of the operation site.

Out Patiento Follow scheduled check-up by the Doctoro Advise the client’s caregiver to report any unusual condition of the operation site.

Dieto High-fiber diet to prevent straining (pushing) during bowel movements. o Advise to drink more liquids after surgery.

Spiritualo Always believe, pray, trust and have faith to God.

XI. Conclusion

Within the span of 2 day of rendering care to our client SAM We are able to identify potential problems of our client and all our Nursing Care Plan met its goals. With the help of health teachings and other interventions, parents of S. we are able to learn how to recognize signs and symptoms and other risk factors of the condition of their son. We are also able to know the necessary interventions to our client after the surgery. They also learned how to do simple interventions for the client’s problems. They had also recognized the importance of compliance to treatment regimen in order to manage the condition of their son.

And at the end of this paper, we the Group 2 of BSN 3D were glad that we acquire the necessary knowledge and important nursing interventions on our chosen case, Hernia. We are honored to do this study and are also hoping that this study will be used as one of a source for the future student nurses in their case studies.

72

XII. Bibliography

http://en.wikipedia.org/wiki/Inguinal_hernia

http://prezi.com/ncllii1j-14b/indirect-inguinal-hernia/

http://www.scribd.com/doc/25970590/Case-Hernia

http://www.scribd.com/doc/49841652/Final-Case-Study-Hernia-1

http://www.ehow.com/way_5747279_tepid-sponge-bath-procedures.html

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http://www.ehow.com/way_5747279_tepid-sponge-bath-procedures.html

http://www.scribd.com/doc/49841652/Final-Case-Study-Hernia-1

http://www.scribd.com/doc/25970590/Case-Hernia

http://prezi.com/ncllii1j-14b/indirect-inguinal-hernia/

http://en.wikipedia.org/wiki/Inguinal_hernia

Documents

Case Study of Indirect Inguinal Hernia (r)