final icp hernia

8/3/2019 Final ICP Hernia

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Introduction

Inguinal hernias, more commonly referred to as groin hernias, occur when your

intestines are pushed through a weakness or tear in an area of the abdominal wall

known anatomically as the inguinal canal, thus creating a bulge.

Inguinal hernias are by far the most common type of hernia. Since inguinal

hernias are typically a result of the testis descending from the abdomen into the

scrotum, these types of hernias are found in men more than women at a rate of about

10 to 1.

Inguinal hernias are typically located in the area between your abdomen and

thigh and can occur on one side or both sides (bilateral) of the body. Often present is apainless bulge in the groin area. Inguinal hernias are typically more visible when

straining or coughing and may disappear when lying down. The presence of discomfort

or pain in this area and the inability to push the bulge back into the abdomen often

means the hernia may have become incarcerated or strangulated, and you should seek

medical attention as soon as possible.

Diagnosis of an inguinal hernia depends, in part, on your medical history and

also the doctors' findings upon examination of the groin. Although some serious

advances have been made in the medical field in recent years, no tests are needed to

diagnose a hernia.

Inguinal hernias can be acquired as the result of sudden or repetitive strain,

pressure or injury which weakens the abdominal wall. However, inguinal hernias can

also be congenital, or present since birth.

Typically accompanied by a bulge in the groin area, inguinal hernias

progressively increase in size and grow more and more uncomfortable as time goes on.

In some cases, there is no visible bulge present, but rather mild pain in the groin area

characterized by aching or burning sensations. This pain can be felt in the groin region,

but may also be present in the leg, back and even pubic areas as a result of referred

pain which may only lessen with rest but will not completely go away.

http://www.herniaonline.com/images/inguinalcanal.gif

http://www.herniaonline.com/glossary/index.html#bilateral

http://www.herniaonline.com/glossary/index.html#incarcerated

http://www.herniaonline.com/glossary/index.html#strangulated

http://www.herniaonline.com/symptoms/index.html#referred


http://www.herniaonline.com/images/inguinalcanal.gif

http://www.herniaonline.com/glossary/index.html#bilateral

http://www.herniaonline.com/glossary/index.html#incarcerated

http://www.herniaonline.com/glossary/index.html#strangulated





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Clients Profile

A. Demographic Data

Patient is a 33 years old male and he is married. He is a roman catholic.

He was admitted on February 24, 2011. He was diagnosed Hernia inguinal,reducible left.

B. Vital Signs

His vital signs were Temp 36.6°C, BP 110/70 mmHg, Pulse Rate 90 bpm,

Heart Rate 20 cpm. Her weight is 47 kg and her height is 157 cm.

C. Health Pattern

1. Health Perception and Health Management Patter.

The reason why he decided to admit him because he is wondering why

there is a mass that is growing in her left inguinal area. Prior to admission

patient x experience this weakening of his legs upon prolong standing and he

noted that he observed a mass growing on his left inguinal area. Patient x

was operated through herniorraphy last February 25, 2011. He is not having

her exercise every day. He used to smoke before but now he stop about 1

year ago but he drink occasionally. He has no allergies to foods and

medications.

2. Nutrition and Metabolic Pattern

Patient X’s diet was diet as tolerated with good appetite. He is not taking

any supplemental medications and he usually drinks water about 4 glasses in

a day. He maintains his weight with no problem of nausea and vomiting. Her

mouth is pinkish in color as well as his mucosa and gums. Her teeth are

complete. The uvula is in midline, tonsils were not inflamed. Trachea is in

midline and thyroids are not palpable. He has a post-operative wound at her

left inguinal area with no discharges noted. His intravenous fluid is D5LR at

1000 ml.

3. Elimination Pattern

The color of his stool is yellowish in color with no discomfort. In general

abdomen is superficial vein with symmetrical in configuration. Bowel sound

are normoactive, upon percussion there is fluid wave and upon percussion

also there is muscle guarding.

4. Activity-Exercise Pattern

He is not having her exercise but he is doing some house hold choirs. For

his cardiovascular status the precodrdial area was flat the heart sound were

distinct, peripheral pulses are symmetrical. His capillary refill 2 seconds will

go back to its normal color with pinking in color. For his respiratory status his

breathing pattern is regular with symmetrical lung expansion, tactile fermitus



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is symmetrical upon percussion its resonant, breathing sounds are vescular.

He has no cough. His activity of daily living or mobility status is upon feeding,

dressing, grooming, meal preparation he is total independence but he is

assisted with a person when he is takes a bath, cleaning, laundry, bed

mobility, ambulation and range of motion. he has a decrease in range of

motion due to his operation on her inguinal area, his spine is in midline and

gait is smooth.

5. Cognitive- Perceptual Pattern

Patient X is conscious and oriented. He is calm. His head is

normocephalic, facial movement is symmetrical, fontanels are close, with fine

hair and clean scalp. His eye lids are symmetrical, pink conjunctiva, scleras

are anicentric, and pupils are equal in size 3 mm brisk reaction to light with

uniform accommodation to light. Visual acuity is grossly normal and

peripheral vision is intact. External pinnae are normoset with no discharges,

tympanic membrane are intact with normal hearing. For the nose muscosa

are pinkish both are patent with normal smell. His primary language is bisaya.

He is a high school graduate.

6. Sleep Pattern

Patient X usually sleeps at 9:00 pm and he wakes up at 6:00 am. He sleepsafter he is done watching television.

7. Self- perception and Self-concept Pattern

Patient stated he feels weak and is worried about condition. His non-

verbal behaviours indicate willingness and urge to be well and recover but he

seems worried about his condition.

8. Role- relationship Pattern

Patient X is married. The person that will help him most is his family. He

has no financial support system.

9. Sexuality- Reproductive Pattern

Patient X has a problem with his reproductive organ due to enlargement of

the scrotum.

10.Coping- Stress Tolerance Pattern

Patient X manages stress by watching TV and talking family

11. Value and Belief Pattern

Patient X believed that going to church is important because in

that way we show our love to Jesus.



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Anatomy and Physiology

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. The inguinal canal is

situated just above the medial half of the inguinal ligament. In both sexes the canal also

transmits the ilioinguinal nerve. Approximately 3.75cm (1.57 inches). In males : the

spermatic cord and its coverings + the ilioinguinal nerve. in females the round ligament

of the uterus the ilioinguinal nerve.

The classic description of the contents of spermatic cord in the male are: 3

arteries: artery to vas, testicular artery, cremasteric artery 3 fascial layers: external

spermatic,internal spermatic,cremastic 3 other vessels: pampiniform plexus, vas

deferens, lymphatics 1 nerve: genital branch of the genitofemoral nerve The ilioinguinal

nerve passes through the superficial ring to descend into the scrotum, but does not

formally run through the canal.

During development gonads (ovaries or testes) descend from their starting point

on the posterior abdominal wall (para-aortically) and near the kidneys down the

abdomen and through the inguinal canal to reach the scrotum. The testis then descends

through the abdominal wall into the scrotum, behind the processus vaginalis (which later

obliterates).

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

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


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



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


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

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









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

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



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Thus lymphatic spread from a testicular tumour is to the para-aortic nodes first,and not the inguinal nodes. Abdominal contents (potentially including intestine) can be

abnormally displaced from the abdominal cavity. Where these contents exit through the

inguinal canal the condition is known as an indirect inguinal hernia. This can also cause

infertility. This condition is far more common in men than in women, owing to the

inguinal canal's small size in women.

A hernia that exits the abdominal cavity directly through the deep layers of the

abdominal wall, thereby bypassing the inguinal canal, is known as a direct inguinal

hernia.

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

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


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





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Pathophysiology

The testes migrates from the abdomen

Scrotum

Inguinal canal is enlarge

Transmitted the testicle and accommodate the structures of the spermatic cord

Raised intra abdominal pressure

In men, indirect hernias follow the same route as the descending testes, which

migrate from the abdomen into the scrotum during the development of the urinary and

reproductive organs. The larger size of their inguinal canal, which transmitted the

testicle and accommodates the structures of the spermatic cord, might be one reason

why men are 25 times more likely to have an inguinal hernia than women. Althoughseveral mechanisms such as strength of the posterior wall of the inguinal canal and

shutter mechanisms compensating for raised intra-abdominal pressure prevent hernia

formation in normal individuals, the exact importance of each factor is still under debate.

http://www.answers.com/topic/testicle

http://www.answers.com/topic/abdomen

http://www.answers.com/topic/development-of-the-urinary-and-reproductive-organs


http://www.answers.com/topic/inguinal-canal

http://www.answers.com/topic/spermatic-cord

http://www.answers.com/topic/testicle

http://www.answers.com/topic/abdomen



http://www.answers.com/topic/inguinal-canal

http://www.answers.com/topic/spermatic-cord



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Diagnostic Procedure and Laboratory Result

Blood Chemistry 2-22-2011

Test Result Reference

Glucose 112.2 mg/dL 59.9 - 110.1

Hematology 2-22-2011

Test Result Reference

Eosinophils 3.4 1.0 - 3.0



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Nursing Care Plan

ASSESSMENT DATA(Subjective & Objective

Cues)

NURSING DIAGNOSIS(Problem & Etiology)

GOALS &OBJECTIVES

NURSING INTERVENTIONS &RATIONALE

EVALUATION

Subjective Cues:

“Maam sakit pa ako operakung mag tindug ko ug dugaymga 7/10”, as verbalized

Objective Cues:

• Facial grimace

• Sleep disturbance

• Restless

• Irritable

Acute pain related to postoperative wound

At the end of 3 hourspatient will be able to:

-Report of relieved of pain from 7/10 to 5/10.

• Note of surgicalprocedures, as this caninfluence the amount of postoperative painexperienced.

• Used pain rating scaleappropriate to have abaseline of level of pain.

• Instructed to use splintingtechnique while coughing.

• Encouraged to do deepbreathing upon onset of pain.

• Instructed to use nonpharmacologicalmanagement.

• Encouraged to userelaxation technique suchas listening to music,reading books or newspaper or talking withthe watcher.

At the end of 3 hours of nursing care patientwas able to verbalizedpain from 7/10 to 5/10.

GOALS MET



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Cues)


GOALS & OBJECTIVESNURSING

INTERVENTIONS &RATIONALE

EVALUATION

Subjective cues:

“Nagburot siguro ni akongsingit maam kay basin gibarang ko”, as verbalized.

Objective cues:

• Inaccurate to followinstructions.

• Exaggeratebehaviours

Deficient knowledge relatedto informationmisinterpretation.

At the end of 8 hour of nursing care patient will beable to:

-Verbalize understanding of behaviour.

• Ascertain level of knowledge.

• Used short simplesentence whenexplaining to theclient.

• Used gestures and

facial expressionsthat help convey themeaning of information.

• Discuss one topic ata time, avoid givingtoo much informationin one session.

• Give shortexplanation about hiscondition.

At the end of 8 hour of nursing care patient wasable to verbalizedunderstanding about hiscondition.

GOALS MET



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Cues)


GOALS & OBJECTIVESNURSING

INTERVENTIONS &RATIONALE

EVALUATION

Risk for infection related topost-operative wounddressing.

At the end of 8 hours of nursing care patient will beable to:

-Be free from infection

• Observed localizedsigns of infection atsurgical wound.

• Assess anddocument type of discharges, amountand color.

• Changed wounddressings asindicated usingproper technique for changing.

• Encouraged earlyambulation, deepbreathing andcoughing exercisefor mobilization of secretion andprevent aspiration

At the end of 8 hours of nursing care patient was isfree from in infection

GOALS MET



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Drug Study

DRUG ORDER(generic name, brandname, classification,

dosage, route,frequency)

MECHANISM OFACTION

INDICATIONS CONTRAINDICATIONSADVERSE EFFECT

OF THE DRUGNURSING

RESPONSIBILITIES

Generic name:

Ciprofloxacin

Brand name:

Ciloxan

Classifications:

Antibacterial

Dosage:

500 mg

Route:

PO

Frequency:

BID

Bactericidal; interferes

with DNA replication in

susceptible bacteria

preventing cell

reproduction.

Treatment of uncomplicated UTIscaused by E.coli

Contraindicated withallergy to ciprofloxacin,norfloxacin or other

fluoroquinolones,

Headache, dizziness,insomnia, fatigue,depression,

hypotension, dry eye,eye pain, dry mouth.

• Monitor vitalsigns

• Adequatehydration isadvised.

• Advice client totake adequaterest

• Avoid driving



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MECHANISM OFACTION


OF THE DRUGNURSING

RESPONSIBILITIES

Generic name:

Ranitidine

Brand name:

Zantac

Classifications:

Histamine 2Antagonist

Dosage:

150 mg

Route:

PO

Frequency:

TID

Competitively inhibitsthe action of histamineat the H2 receptor of the parietal cells of thestomach, inhibits

basal gastric secretionand gastric acidsecretion that isstimulated by food,insulin, histamine,cholinergic agonists,gastric, andpentagastric.

• For activeduodenal ulcer

• Maintenancetherapy for

duodenal ulcer at reduceddosage

Contraindicated withallergy to ranitidine.

Use cautiously withrenal or hepatic function

Headache, malaise,dizziness,somnolence,tachycardia, rash,leukonpinea.

• Monitor vitalsigns.

• Raise side railsto prevent falls.

• Observed for

unusualities.



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MECHANISM OFACTION


OF THE DRUGNURSING

RESPONSIBILITIES

Generic name:

Tramadol

Brand name:

Ultram

Classifications:

Analgesic

Dosage:

50 mg

Route:

IVTT

Frequency:

QID

Binds to mu-opiodreceptors and inhibitsthe reuptake of norepinepherin and

serotonin; causesmany side effectssimilar to the opioids—dizziness,somnolence, nausea,constipation- but doesnot have therespiratory depressanteffects.

• Relief for moderatesevere pain.

• Relief for moderate tosevere chronicpain in adultswho needaround-the-clock treatmentfor extendedperiods.

Contraindicated withallergy to tramdol or opiods or acuteintoxication with

alcohol.

Sedation, dizziness or vertigo, headache,dizziness, dreaming,sweating

• Monitor vitalsigns

• Adequate rest is

advised.

• Keep back dry.



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Discharge Plan

Medications

Compliance to the medication regimen:

• Coprofloxacin OD PO for 1 week

Economy

• Encouraged active participation of the patient significant others in theprogram including self-monitoring of vital signs and diet for increasecompliance.

• To promote more understanding about the need for monitoring thecondition of the patient and proper food should be taken.

Treatment

• Explain the importance of adherence to therapeutic regimen at home asprescribed by the doctor.

• To instruct significant other to return patient for follow-up schedules andexaminations.

Health teachings

•

Give the significant others verbal and written instructions abouthome medications.

• Review specifics of drug regimen, diet, exercise/activity plan.

• Maintain peaceful environment to promote comfort and fastestrecovery.

Out-patient

•

Follow up visits to physician were encourage to significant others for further evaluation with regards to the condition of the patient.

• To ensure complete recovery and prevent further complications.

Diet

• Inform that the one prescribed by the physician for underlying conditionshould be followed and should not be omitted.

• Explain the importance of dietary supplements.

• Maintain hydration.

Spiritual

• Advice patient and significant others to ask god’s guidance andsupervision all through her life and entrust everything to him. Prayer is thebest weapon to all difficulties no matter what it is. God is always there allthe time.



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Related Learning Experience

Four weeks of Clinical Exposure at Capitol Northern Mindanao Medical Center

(Annex 2 Floor 1), was a great and unforgettable experience. I’ve learned a lot with

regards to caring for my patient and dealing with people. I had a lot of amazing

experienced on nursing procedures, on how to give PO medicines, having an NGT

feeding, IV follow-up and termination, bed making, sponge bath, getting vital

signs,measuring I and O, offering and removing bed pans, positioning and draping,

shampoo in bed, wound dressing, Oxygen administration, and a lot more.

Prior than that I had also experienced some problems; in our patient, some of

them would not cooperate and very toxic. But, I had overcome everything through my

determination and team work. I had learned that working as a team would made our

duty a lot essier and well-managed. And having a peaceful and united group could

produce a better quality of work.

Above all, we had the two most important persons in our rotation. Our Clinical

Instructor and our PCI. Our PCI who always helped, understands and supported us. To

our clinical instructor Mr. Dizon, who extends her patience for us , who always helped,

understands, supported and shared her knowledge and experiences being a nurse.

It was endeed a nice, enjoyable, meaningfull and one of a kind experience to us

being in this rotation.

final icp hernia

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