CASE STUDY ON IRREDUCIBLE

INGUINAL HERNIA
BY NUR NADHIRAH BINTI ABDUL RAHIM
(2015895514)
DIPLOMA IN NURSING
OBJECTIVE

 Attain knowledge regarding the definition, etiology, signs and symptoms of hernia
 Understand the surgical correction of inguinal hernia and complications after surgery
 Identify patients needs , carry out interventions according to the needs and evaluate
patients response to care.
HERNIAS

 HERNIA OCCURS WHEN THE WALL OF

MUSCLE WEAKENS AND THE INTESTINE
PROTRUDES THROUGH THE MUSCLE
WALL OF A CAVITY.

Reference (No Author, No Title, No Date):

[Untitled illustration of Hernia]. Retrieved February, 2013
from https://www.health.harvard.edu/diseases-and-conditions/hernia-
COMPOSITION OF HERNIA

 CONSISTS OF 3 PARTS

1. THE SAC 3. CONTENTS OF THE SAC

 MOUTH  OMENTUM-OMENTOCELE
 NECK  INTESTINE-ENTEROCELE
 BODY AND FUNDUS  FLUID-ASCITES
 SOMETIMES PART OF
BLADDER OR OVARY

2. THE COVERING OF THE SAC

COMPOSITION OF HERNIA
CAUSES

 WEAKNESS OF ABDOMINAL MUSCULATURE

CONGENITAL ACQUIRED
• PATENT PROCESSES VAGINALIS • OBESITY
(males) • PREGNANCY
• PATENT CANAL OF NUCK • INCISION
(females) • INFECTION
• CONNECTIVE TISSUE-
smoking,aging,CTD,systemic
illness(marfan syndrome,ethers-
danlos)
CAUSES

 INCREASED ABDOMINAL PRESSURE

• CHRONIC CONSTIPATION
• CHRONIC COUGH
• STRAINING-WEIGHT LIFTING
• STRAINING DURING BOWEL MOVEMENT OR URINATION
• FLUID IN ABDOMINAL CAVITY
• ASCITES
• INTRA-ABDOMINAL MALIGNANCIES
• PREGNANCY
SITES OF HERNIAS

 UMBILICAL HERNIA- a portion of the bowel protrudes through the umbilicus

 ABDOMINAL HERNIA-occur in the midline of the abdomen between the umbilicus and the
xiphoid process
 INGUINAL HERNIA –occur in groin area
 FEMORAL HERNIA –the intestine pushes into the passageway carrying blood vessels and
nerves to the legs
 HIATAL HERNIA-portion of stomach protrudes into the mediastinal cavity through the
diaphragm.
SITES of hernias

Usually hernias are described by where the hole is in the abdominal wall.
1) Epigastric
2) Diastasis (not a true hernia)
3) Supra-umbilical hernia
4) Umbilical hernia
5) Incisional hernia
6) Scar (previous inguinal hernia op)
7) Recurrent inguinal hernia
8) Spigelian hernia (rare)
9) Inguinal hernia
10) Femoral hernia
11) Pubic bone
12) Inguinal ligament – groin skin crease
TYPES OF HERNIA

 REDUCIBLE= the content can be returned to abdomen.

 IRREDUCIBLE= the content cannot be returned to abdomen.
 REDUCTION-EN-
MASS=Reduction of a hernia or of a dislocation of any part by means of manipulation. But
if forcibly reduce this can occur.
 OBSTRUCTED= bowel in hernia has good blood supply but bowel is obstructed.
 INCARCERATED=irreducible,synonymously with obstructed hernia. Content of the hernia
sac are stuck to one another by adhesions or got block by faeces.
 STRANGULATED=no blood supply to the hernia → gangrene.
REDUCTION-EN-MASS
IRREDUCIBLE INGUINAL HERNIA

 HERNIAIRREDUCIBLE INGUINAL HERNIA occur in the groin and the content cannot be
returned to abdomen.
IRREDUCIBLE HERNIA

 DUE TO
 ADHESIONS
 NARROWING OF NECK
 INCARCERATION
 MASSIVE HERNIA INSIDE SCROTUM
INGUINAL HERNIA
INDIRECT DIRECT

• OCCURS • THROUGH THE DEEP • THROUGH THE POSTERIOR

INGUINAL RING WALL OF INGUINAL CANAL

• SHAPE • PYRIFORM SHAPE • GLOBULAR SHAPE

• AGE • ANY AGE GROUP • ELDERLY

• AETIOLOGY • PREFORMED SAC • WEAKNESS OF OF

POSTERIOR WALL OF
INGUINAL CANAL
• ON STANDING • DOES NOT POPS OUT • POPS OUT

• INTERNAL RING • SWELLING NOT SEEN • SWELLING IS SEEN

OCCLUSION TEST
SYMPTOMS

 BULGE/LUMP AT THE AFFECTED AREA

 pain or discomfort in the affected area (usually the lower abdomen), especially when
bending over, coughing, or lifting
 weakness, pressure, or a feeling of heaviness in the abdomen
 a burning, gurgling, or aching sensation at the site of the bulge
 Swelling increase in size
COMPLICATION

 Most inguinal hernias enlarge over time if they're not repaired surgically. Large hernias
can put pressure on surrounding tissues — in men they may extend into the scrotum,
causing pain and swelling.
 Incarcerated hernia. This complication of an inguinal hernia occurs when a loop of
intestine becomes trapped in the weak point in the abdominal wall. This may obstruct the
bowel, leading to severe pain, nausea, vomiting and the inability to have a bowel
movement or pass gas.
 Strangulation. When part of the intestine is trapped in the abdominal wall (incarcerated
hernia), blood flow to this portion of the intestine may be diminished. This condition is
called strangulation, and it may lead to the death of the affected bowel tissues. A
strangulated hernia is life-threatening and requires immediate surgery
investigation

 A health care provider can confirm that you have a hernia during a physical exam. The
growth may increase in size when you cough, bend, lift, or strain.
 X-ray abdomen/CT Scan in case of strangulated inguinal hernia
TREATMENT

 SURGICAL MANAGEMENT Inguinal hernia surgery refers to a surgical operation for the
correction of an inguinal hernia.

 SURGICAL
 HERNIORRHAPHY
 HERNIOPLASTY
Herniorrhaphy (tissue repair)

 Herniorrhaphy is the oldest type of hernia surgery and is still being used. It involves a
surgeon making a long incision directly over the hernia then using surgical tools to open
the cut enough to access it.
 Tissues or a displaced organ are then returned to their original location, and the hernia sac
is removed.
 The surgeon stitches the sides of the muscle opening or hole through which the hernia
protruded. Once the wound has been sterilized, it is stitched shut.
HERNIOPLASTY (MESH REPAIR)

 In hernioplasty, instead of stitching the muscle opening shut, the surgeon covers it with a
flat, sterile mesh, usually made of flexible plastics, such as polypropylene, or animal tissue.
 The surgeon makes small cuts around the hole in the shape of the mesh and then stitches
the patch into the healthy, intact surrounding tissues.
 Damaged or weak tissues surrounding the hernia will use the mesh, as a supportive,
strengthening scaffold as they regrow.
 Hernioplasty is better-known as tension-free hernia repair.
COMPLICATION OF SURGERY

 Post herniorrhaphy pain syndrome, or inguinodynia is pain or discomfort lasting greater

than 3 months after surgery of inguinal hernia.
 Hernia recurrence. Recurrence is the most common complication of inguinal hernia
repair, causing patients to undergo a second operation. Hernia recurrence occurs less
often when a hernioplasty is performed.
 Bleeding. Bleeding inside the incision of hernia repair.It can cause severe swelling and
bluish discoloration of the skin around the incision.It is unusual and occurs in less than 2
percent of patients
 Wound infection. The risk of wound infection is small—less than 2 percent,and is more likely
to occur in older adults and people who undergo more complex hernia repair.
 Injury to internal organs. Although extremely rare, injury to the intestine, bladder, kidneys,
nerves and blood vessels leading to the legs, internal female organs, and vas deferens.
COMPLICATION OF MESH REPAIR

 Complications are frequent (>10%). They include, but are not limited to:
 foreign-body sensation
 chronic pain
 ejaculation disorders
 mesh migration
 mesh folding
 Infection
 adhesion formation
 erosion into intraperitoneal organs In the long term, polypropylene meshes face degradation, due
to heat effects. This increases the risk of stiffness and chronic pain. Persistent inflammation and
increased cell turnover at the mesh-tissue interface raised the possibility of cancer transformation.
NURSING MANAGEMENT (GENERAL)

• Alteration in comfort • Teach about bed rest ,

pain related to • intermittent icepacks ,
disease condition • scrotal elevation to reduce scrotal edema or swelling.
• Alteration in comfort • Encourage ambulation as permitted
pain related to • Advise patient that difficulty in urination is common after surgery,
surgical intervention promote elimination to eliminate as necessary or catheterise the
patient.

• Preventing infection • Check dressing for drainage &incision for redness and swelling.
• Monitor for signs/symptoms of infection
• Administer antibiotics if appropriate
PATIENT EDUCATION

 Advise that pain and scrotal swelling may be present for 24-48 hours after repair of an
inguinal hernia.
 Apply ice intermittently
 Elevate scrotum,and use scrotal support
 Take medication prescribed to relieve discomfort
 Teach to monitor self for signs of infection.
 Report continued difficulty in voiding
 Avoid heavy lifting for 4-6 weeks.Athletics and extremesof exertion to be avoided for 8-12
weeks post operatively
CASE STUDY
  NAME:RAI JEETAH
 AGE: 21Y/O
DEMOGRAPIC DATA
 R/N:1811615
 K/P:06905891
 DOB:23/07/1996 (21.7 T)
 DOA:19/4/2018
 DOD:21/4/2018
 NATIONALITY :NEPALESE
 SEX :MALE
Presented To Emergency
Department
  PATIENT CAME TO EMERGENCY DEPARTMENT WITH
REFERRED LETTER FROM PRIVATE GENERAL
PRACTITIONER TRO STRANGULATED RIGHT INGUINAL
HERNIA.
GENERAL SURGERY HISTORY  PATIENT PRESENTED WITH RIGHT SECROTAL
SWELLING
 SUDDEN ONSET PAIN FOR THE PAST 2 DAYS
 NON RADIATING
 PAIN SCORE OF 2/10
 SWELLING INCREASE IN SIZE WHEN COUGH

HISTORY OF PRESENT ILLNESS  ABLE TO BO AND PU

 AT ED NOTED VBG WORSENING ACIDOSIS (7.34-
7.32), LACTATE ↑ INTREND (1.7-2.4)
PLAN FROM EMERGENCY  Hydrate 1 Liter and repeat VBG and lactate.
DEPARTMENT Review after hydrate.
 To admit to 4a surgical ward
 For operation,hernioplasty after seen by surgical
 Keep NBM with IVD 4 pint ( 2pint N/S,2 pint D5%)
 Medication to serve
 IV tramal 50 mg stat and BD
 T.PCM 1g QID
 IV Maxalon 10g BD.
  PAST MEDICAL HISTORY
• NKMI
GENERAL SURGERY HISTORY  PAST SURGICAL HISTORY
• TELECOSPIC LOCKING NAIL FOR RIGHT FEMUR
 ALLERGIES
• NO KNOWN OF DRUG OR FOOD ALLERGIES
 ALCOHOL AND TABACCO USE
• OCCASIONAL DRINKER
 FAMILY HISTORY
• NO KNOWN MEDICAL ILLNESS AMONG FAMILY
  SWELLING AT RIGHT SCROTAL UP TO MID-INGUINAL
REGION WITH MILD TENDERNESS ON PALPATION
GENERAL SURGERY HISTORY  COUGH IMPULSE POSITIVE
 RIGHT TESTES NOT PALPABLE
 LEFT TESTES PALPABLE
 BLOOD INVESTIGATION SHOW PATIENT WITH
LACTATE ACIDOSIS
 ABDOMINAL SOFT,NON TENDER,BOWEL SOUND
PHYSICAL EXAMINATION
PRESENT
  HE IS MODERATELY BUILT
 WT:64KG
 HT:156CM

GENERAL APPEARANCE  MAINTAINS ERECT POSTURE AND STEADY GAIT

 HYGIENE AND GROOMING:
 LOOKS CLEAN AND TIDY
 MAINTAIN HIS PERSONAL HYGIENE

 MOOD: CALM AND COOPERATIVE

FAMILY HISTORY

 NOT MARRIED YET.

 SOCIO ECONOMIC STATUS
 WORKING AS COOKER FOR THE PAST 4 YEARS IN
MALAYSIA.
  VITAL SIGN
BASELINE DATA  BLOOD PRESSURE:123/82 mmHg
 PULSE:73/min
 RESPIRATION:19/min
 TEMP:37°C
 SPO2-99% ↓RA
 GCS :15/15
 MFS: 20 WITH WHITE TAGING
 NO THROMBOPHLEBITIS SEEN AT LEFT DORSAL VEIN
INVESTIGATION
description value unit range description value unit range
WBC 8.27 10^3/uL 4.6-10.2 lactate 2.7 mEq/L 0.5-2.0
RBC 6.02 10^6/uL 4.0-6.1

HGB 16.8 g/dl 12.2-

18.1
HCT 50.4 % 37.7-
53.7
PLATELET 272 10^3/uL 130-400
CREATININE 66.2
umol/L
UREA 4.0 Mmol/L 3.2-8.2
POTASSIUM 4.0 Mmol/L 3.5-5.5
SODIUM 138 mmol/L 132-146
CHLORIDE 107 mmol/L 99-109
 NAME DOSE ROUTE FREQUENCY DURATION
MEDICATIONS
IV TRAMAL 50mg IV TDS 1 DAY
IV 10 mg IV TDS 1 DAYS
MAXALON
IV 1.5g IV STAT TO OT 1 DAYS
CEFUROXIME
T.PCM 1g ORAL QID 7 DAYS
T.ZINNAT 250 mg oral BD 5 DAYS
C.TRAMAL 50mg oral TDS 7 DAYS
NURSING CARE PLAN (PRE-OP)
NURSING OBJECTIVE INTERVERVENTIONS RATIONALE EVALUATIO
DIAGNOSIS N
1.Fear and Patient will free 1. Assess the • Different level of Patient
anxiety from fear anxiety. patient’s level anxiety will affect verbalise
related to of anxiety. the coping free from
hospitalization mechanism of anxiety and
the client cooperate
2. Introduced self • To lessen patient with the
and established anxiety and treatment.
rapport. develop trust.
3. Monitor • To identify
patient’s vital sign physical
responses
associated with
both medical
and emotional
conditions
NURSING CARE PLAN (PRE-OP)
NURSING OBJECTIVE INTERVERVENTIONS RATIONALE EVALUATIO
DIAGNOSIS N
1.Fear and Patient will free 4. Give patient ward • Awareness of Patient
anxiety from fear anxiety. orientation to the verbalise
related to familiarize patient environment free from
hospitalizatio with the environment promotes anxiety
n and new experiences comfort and and
or people as needed. may decrease cooperate
anxiety with the
experienced by treatment
the patient.
5. Encourage patient • To decrease
to verbalise feelings patient’s being
and express emotion. aloneor
overwhelmed
by stressful
situation.
NURSING CARE PLAN (PRE-OP)
NURSING OBJECTIVE INTERVERVENTIONS RATIONALE EVALUATION
DIAGNOSIS
1.Fear and Patient will free 6. Explain all activities, • With Patient
anxiety from fear anxiety. procedures, and issues preadmission verbalise free
related to that involve the patient; patient from anxiety
hospitalizatio use nonmedical terms education, and
n and calm, slow speech. patients cooperate
Do this in advance of experience with the
procedures when less anxiety treatment
possible, and validate and
patient’s emotional
understanding. distress and
have
increased
coping skills
because they
know what to
expect.
NURSING CARE PLAN (PRE-OP)
NURSING OBJECTIVE INTERVERVENTIONS RATIONALE EVALUATI
DIAGNOSIS ON
2.High risk for Patient will 1. Assess patient skin • Dry skin and Patient
fluid volume maintains normal turgor and oral mucous mucous fluid
deficit fluid volume. membranes for signs membranes may volume is
related to nil of dehydration. be result of poor maintain
by mouth dehydration. normal.
status. 2. Monitor vital sign • Hypotension,
tachycardia,
febrile can
indicate fluid
loss.
3. Monitor intake and • To provides
output chart. information
about overall
fluid balance.
NURSING CARE PLAN (PRE-OP)
NURSING OBJECTIVE INTERVERVENTIONS RATIONALE EVALUATI
DIAGNOSIS ON
2.High risk for Patient will 4. Assess colour and amount • A normal urine Patient
fluid volume maintains of urine. Report urine output output is fluid
deficit normal fluid less than 30 ml/hr for 2 considered volume is
related to nil volume. consecutive hours. normal not less maintain
by mouth than 30ml/hour. normal.
status. Concentrated
urine denotes
fluid deficit.
5. Administer iv fluids as • IV fluids are
ordered by the doctor. necessary to
maintain
hydration status.
NURSING CARE PLAN (POST-OP)
NURSING OBJECTIVE INTERVERVENTIONS RATIONALE EVALUATI
DIAGNOSIS ON
1.Alteration Patient will 1. Assess pain characteristics; • To planning pain Patient
in comfort verbalise quality,severity,location,onse management verbalise
pain related relieves of t,duration,precipitating or strategies. relieves of
to surgical pain. relieving factors pain.
intervention.
2. Monitor vital sign • To identify the
changes in the
vital sign when
pain is
increasing.
3. Provide rest periods to • To relieve muscle
promote relief, sleep, and tension and
relaxation. reduce pain.
4.Instruct patient to support • To reduce the
the scrotal with tight swelling at the
underware incision.
NURSING CARE PLAN (POST-OP)
NURSING OBJECTIVE INTERVERVENTIONS RATIONALE EVALUATI
DIAGNOSIS ON
1.Alteration Patient will 5. Educate patient about • To divert the Patient
in comfort verbalise diversion therapy such as mind from focus verbalise
pain related relieves of deep breathing exercise or about the pain. relieves of
to surgical pain. listening to music. pain.
intervention. 6. Administer analgesic such • To relieve
as capsule tramal and tablet patient pain.
paracetamol as ordered by
doctor.
NURSING CARE PLAN (POST-OP)
NURSING OBJECTIVE INTERVERVENTIONS RATIONALE EVALUATION
DIAGNOSIS
2. High risk for Patient will 1. Assess the incision site, • Establish Patient remain
infection remains free noted if there is soak baseline for free from
related to from infection. dressing or sign of timely infection with
surgical infection like redness or intervention. evidence of
infection. oozing. no sign and
2. Monitor vital sign To determine sign symptom of
of infection like infection.
patient will be
febrile
3. Demonstrate good Maintaining clean,
skin hygiene such as dry skin provide
wash thoroughly and barrier to a
pat dry carefully. infection.
NURSING CARE PLAN (POST-OP)
NURSING OBJECTIVE INTERVERVENTIONS RATIONALE EVALUATION
DIAGNOSIS
2. High risk for Patient will 4.Advise patient to wear To prevent from Patient remain
infection remains free underware with cotton skin irritation. free from
related to from infection. material. infection with
surgical 5. Provided and applied Wound dressing evidence of
infection. wound dressing carefully protect the wound no sign and
and surrounding symptom of
tissue. infection.

6. Emphasizes Improved nutrition

importance of and hydration will
adequate nutrition such improve skin
as protein and fluid condition.
intake.
7.Administer antibiotic as to prevent from
ordered by doctor. infection.
 19/4/18 • Patient from ED admitted to 4a. General
condition calm.
• Patient c/o right scrotum swelling for 2/7
with blood investigation lactate acidosis
• Ward orientation given to patient and
COURSE OF HOSPITAL STAY patient understood.
• Patient keep nil by mouth
• To run 2 pint N/S over 2 hours-in progress
• To repeat VBG and Lactate post
hydration.
• Ivd 4 pint/24hrs (2 pint N/S,2 pint D5%)
• To post case coming morning
• Preparation for ot done
20/4/18 • Undergone open right hernioplasty under
general anesthesia. He received IV
Cefuroxime 1.5 g intraoperatively.
• Received patient with dressing intact
and no active bleeding seen . Patient on
face mask 5L/min. on ivd N/S 1pint-in
progress.
 20/4/18 • Operative findings:
• Right irreducible indirect inguinal
hernia
• Contents of sac:omentum
• Laxed posterior wall,right posterior
COURSE OF HOSPITAL STAY wall repair.
• POST OPERATIVE ORDERS
• Allow orally as tolerated
• Off ivd
• Scrotal support
• Light duty 3/12
• T. pcm 1g QID
• C. TRAMAL 50mg tds
• WI DAY 3
• STO DAY 10.

20/4/18 Operation site intact. No bleeding seen.

patient tolerated orally well. Patient’s scrotal
support with tight underware. Analgesic iv
tramal 50mg TDS change to C.tramal 50 mg
TDS.Off Iv maxalon 10 mg TDS.
 21/4/18 • Patient tolerated orally well. Patient had
passed flatulence and bowel open
normally.Patient ambulated well to the
toilet.
• Discharge by evening. discharge plan:
COURSE OF HOSPITAL STAY • TCA SOPD x 2/52 (8/5/18@8am)
• MC for x2/52
• WI (23/4/18)
• STO D10 (30/4/18)
Discharde medication
• Cap.tramal 50 mg tds x5/7
• Tab. Zinnat 250 mg bd x5/7
• Tab. Pcm 1g qid x5/7

Condition at discharge
• Aferbrile, vitally stable,pain free, wound
intact and no bleeding seen.
NURSING REPORT
19/4/2018 @11.55 p.m S:New case admitted to ward, accompanied by hospital’s attandence.
Mode of admission via walking. Upon admission,condition of patient
calm. Breathing under room air.Branula at left hand with IVD in
progress.
B:Patient came to hospital with complaint of right scrotum swelling for 2
days. First hospitalization. No known medical illness. X-ray KUB Film
(from ED) attached.
A: Vital sign. Bp;138/71 mmHg, HR:96 bpm, RR:20/min,PAIN score:2,
Spo2-99% Temp:37 .vitally stable. Branula insitu over left dorsum-no
pain,no sweling,no redness
R:ward orientation given to patient. Given instruction that patient need
to Nil By Mouth. IVD bolus 2pint N/S over 2 hour –in progress. To
remind the housemen to repeat VBG an Lactate after past hydration.

19/4/2018 @1.45 a.m A:General condition patient calm. Sleeping on bed.

R:IVD N/S completed.VBG and Lactate post hydration taken by Dr.
Amsareka.Patient keep NBM with IVD5 pint over 24hours (3 pint
N/S,2pint D5%)-in progress
E- patient looks comfortable.Able to ambulate to the toilet.
20/4/201 S-General condition of patient is calm.Breathing under room air . Patient is nil by mouth
8 @7.30 with IVD in progress. Branula at left hand.
am B- patient diagnosed as strangulated right inguinal hernia
A-BP:112/60 mmHg,PR-82 bpm, RR:20/min. TEMP:37. Spo2:99% vitally stable. PAIN
SCORE;2. . Branula insitu over left dorsum-no pain,no sweling,no redness. Good skin
intact. Pink tongue.
R-IVD 4 pint over 24 hours (2 pint N/S, 2 pint D5%)- in progress. Preparation to OT-done.
Operation for right herniaplasty KIV bowel resection and Kiv stoma.
E-Patient rest in bed and no symptom of dehydration.
20/4/2018 Patient sent to ot for Operation for right herniaplasty KIV bowel resection and Kiv stoma.
@2pm Patient vitally stable. Prepared well for preoperative.

20/4/2018 S-Received patient from OT via stretcher. Patient calm and stable.Breathing under room
@ 6 pm air.
B-Post-Operating Day1;right hernioplasty. Popst-operating diagnosis;right irreducible
inguinal hernia.
A; BP:114/62 mmHg,HR:84bpm,RR:20/min,Temp:37,SPO2:99%, Pain Score:3. vitally stable.
Operation site intact. No active bleeding seen.
R- To encourage patient take start your diet slowly with clear fluids and return to a
normal diet if tolerated. To off IVD-done. Educate patient for scrotal support using tight
underware to reduce scrotal swelling. For wound inspection Day3 (23/4/18) and STO
Day 10 (30/4/18)
E- Patient understood for scrotal support and tolerated well to clear fluid.
21/4/18 @1.40 S-General condition of patient is calm. Breathing under room air. Branula at left
am hand. Patient is sleeping on bed.
B-Post-Operating Day1;right hernioplasty. Popst-operating diagnosis;right
irreducible inguinal hernia.
A-BP:120/66mmHg,HR:84bpm,RR:20/min,Temp:37,SPO2:99%, Pain Score:1.
vitally stable. Branula insitu over left dorsum-no pain,no sweling,no redness No
Operation site intact. No active bleeding seen. On scrotal support.
R- Patient have taken orally well. For wound inspection Day3 (23/4/18) and STO
Day 10 (30/4/18).
E-patient slept well and no sign of infection at wound site

21/4/18 @ S-General condition of patient is calm. Breathing under room air. Branula at left
7.30 am hand. Patient rest in bed.
B-Post-Operating Day1;right hernioplasty. Popst-operating diagnosis;right
irreducible inguinal hernia.
A-BP:114/60mmHg,HR:88bpm,RR:20/min,Temp:37,SPO2:99%, Pain Score:0. vitally
stable. Branula insitu over left dorsum-no pain,no sweling,no redness No
Operation site intact. No active bleeding seen. On scrotal support.
R- Seen by Dr.Ezzah.Patient allow Discharge once patient flatulence and able
to BO. For wound inspection Day3 (23/4/18) and STO Day 10 (30/4/18).
E- Patient ambulated well. No verbalise of pain.
21/4/18 @10 am Patient verbalise had went to toilet to BO and
able to flatulence. To wait for doctor to review for
discharge.
21/4/2018 @ 1 pm S-General condition of patient is calm. Breathing
under room air. Branula at left hand. Patient
sitting on chair
B-Post-Operating Day1;right hernioplasty. Popst-
operating diagnosis;right irreducible inguinal
hernia.
A-
BP:114/77mmHg,HR:82bpm,RR:20/min,Temp:37,SP
O2:99%, Pain Score:0. vitally stable. Branula insitu
over left dorsum-no pain,no sweling,no redness
No Operation site intact. No active bleeding
seen. On scrotal support.
R- Seen by Dr.Ezzah.Patient allow Discharge.
Health education for post operation and
discharge instruction given. TCA SOPD 2’52
(8/5/18 @ 8 am) For wound inspection Day3
(23/4/18) and STO Day 10 (30/4/18) discharge
with medication.
E- Patient ambulated well. No verbalise of pain.
Health Education

 WOUND CARE.
 DO NOT TOUCH WITH BARE HAND AT THE INCISION SITE THIS WILL CAUSE INFECTION
 When showering, remove outer dressing and leave suture intact.
 After showering, pat dry and reapply a bandaid or small gauze dressing over the incisions.
 It is important to keep your incision site clean and dry.
 Don't use oils, powders, or lotions on your incision.
 P
š atient need to maintain personal hygiene like change underware as often as possible and
patient can take bath to avoid for infection.
Health Education

 Pain or discomfort
 This should be manageable with pain medication. Take the medication as prescribed so that you
will be comfortable and will be able to move about more easily.
 Wearing well-fitting briefs may provide support and increase comfort in the event of genital
swelling .
 Rembember do not do heavy chores and avoid heavy lifting for 3 months.
 Once at home, if you are unable to pass urine for eight hours and are uncomfortable, go to the
emergency department
HEALTH EDUCATION

 WOUND CARE.
 DO NOT TOUCH WITH BARE HAND AT THE INCISION SITE THIS WILL CAUSE INFECTION
 When showering, remove outer dressing and leave suture intact.
 After showering, pat dry and reapply a bandaid or small gauze dressing over the incisions.
 It is important to keep your incision site clean and dry.
 Don't use oils, powders, or lotions on your incision.
 P
š atient need to maintain personal hygiene like change underware as often as possible and
patient can take bath to avoid for infection
  Instruct patient to do light duty and avoid heavy
lifting for 3 months and give light duty slip for his
employer to aware his health condition.
 Advise patient to maintain personal hygiene like
DISCHARGE INSTRUCTION change underware as often as possible and
patient can take bath to avoid for infection.
 Tell patient to wear tight underware for scrotal
support to reduce scrotal swelling.
 To educate the patient to take the medication at
right time,right dose,right route. Continue with oral
antibiotics and analgesics as ordered.
 Monitor for signs of infection like
redness,pain,swelling,heat at wound site and to
report to emergency if so.
 Encouraged to have vitamin C and protein rich
food for process of wound healing
 Remaind patient about his appointment as
schedule and give TCA card.
REFERENCES

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 Geevarghese, J. (2013, October 17). Case study on inguinal hernia. Retrieved May 20, 2018, from
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Care-Plan-Impaired-Skin-Integrity
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 Safarmas Follow. (2009, May 28). Surgical Options In The Management Of Hernia Repair. Retrieved May 1, 2018, from
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