Objective:

General objective:

To be able to further understand what is Indirect Inguinal Hernia are all about,
its nature effects and management.

Specific Objectives:

♥ To distinguish the causes, signs and symptoms, treatment and precaution of

Indirect Inguinal Hernia.

♥ To utilize all nursing care and interventions in biding to the nursing process.

♥ To integrate the appropriate health teaching for proper home management of

the health problems and promotion of self care.

♥ To be able to know the specific drugs used for therapeutic management of the
patient.

Patient’s profile

Name: Daniel Landingin

Birthday: Dec.11, 1946
Sex: male
Age: 63 years old
Address: Portic Bugallon, Pangasinan
Civil Status: Married
Religion: Roman Catholic
Date of Admission: Feb.9, 2010 @ 10:15 A.m.

Past and Present history:

The patient is first time to confine at Region 1 Medical Hospital on February 10,
2010.He was complaining of Bulging Mass at Inguinal Area Left. 2 years prior to
admission patient noted for bulging mass .no other sign and symptoms noted.

Upon the interview patient claimed that his job before is a bus conductor where
he lift heavy baggage for how many years then promoted as an inspector. Now that
his 63 years old he was already retired to his job. he also claimed that he have an
hypertension.
General Survey:
Skin: - edema
Musculoskeletal: - Arthritis
Respiratory: - Cough; - cold
Cardiovascular: - chest pain
Gastrointestinal: - LBM
Extremities: - Edema; - fracture
Neurological: E/N
Musculoskeletal: - Hematoma

Medical Diagnosis:

Indirect Inguinal Hernio L Reducible

Discussion

An inguinal hernia is a defect in the fascia that allows contents from the abdomen,
such as a piece of intestine, to push out under the skin. There are two basic types
of inguinal hernias, direct or indirect, depending on where the protrusion takes
place relative to the inguinal canal.

Uncomplicated inguinal hernias often do not cause any symptoms, but some patients
notice pressure in the groin area, which may increase over time. A bulging in the
groin may appear and disappear as the abdominal contents pass in and out of the
hernia opening. The bulge usually becomes more noticeable when standing or
straining, and disappears when lying down.

An inguinal hernia can become incarcerated, or closed off, if a piece of intestine or

fat becomes trapped in the hernia opening.

If a piece of intestine is incarcerated, the flow of materials inside the intestine

can become obstructed. In a strangulated hernia, the blood supply gets cut off and
part of the intestine may die. Surgeons often recommend repairing an inguinal
hernia before these complications have a chance to occur.

A strangulated hernia, or intestinal obstruction, can cause severe symptoms,

including: pain at the hernia site, nausea or vomiting, inability to pass gas or have a
bowel movement, fever and chills, and/or abdominal swelling.

Treatments

If you have an uncomplicated inguinal hernia, your doctor may try to temporarily
reduce it by pushing the protrusion back into your abdomen. In addition, your
doctor will most likely advise you to schedule surgery to repair the hernia before
complications develop.

If your doctor suspects a complicated hernia, such as a strangulation, he or she will

start IV antibiotics and schedule emergency surgery.

The two most common types of operations used to repair an inguinal hernia are:
traditional open repair, which requires a relatively large incision; laparoscopic
repair, which requires several tiny incisions; a third type of repair, called a Prolene
Hernia System, is similar to a traditional open repair except that it requires only
local anesthesia.

A laparoscopic repair is performed through several tiny “keyhole” incisions.

Surgical instruments are slipped through the other openings.

Laparoscopic hernia repair is generally less painful and requires a shorter recovery
period than a traditional open repair.

Procedure

In the days leading up to your procedure: Arrange for a ride to and from the
hospital and for help at home as you recover. The night before, eat a light meal and
do not eat or drink anything after midnight. Shower the evening before or the
morning of your procedure. If you regularly take medications, herbs, or dietary
supplements, ask your doctor about the need to temporarily discontinue them. Do
not start taking any new medications, herbs, or dietary supplements before
consulting your doctor.

Depending on the type of procedure you have, you may receive general, spinal, or
local anesthesia. If you receive general anesthesia, you will be unconscious
throughout the procedure. If you receive spinal or local anesthesia, you will remain
awake, but sedated, during the surgery.

Your surgeon will begin by making the type of incision necessary for the chosen
procedure: a single larger incision for an open repair, or several small openings for
a laparoscopic repair. The exact location of the laparoscopic incisions will vary.

In laparoscopic hernia repair, your surgeon will use an instrument called a trocar to
first create an opening near your navel. Carbon dioxide gas will be pumped through
this opening to separate the layers of your abdominal wall. This will allow the hernia
and surrounding structures to be viewed more easily. Your surgeon will then go on
to create the additional openings.

Next, your surgeon will insert the laparoscope through the opening at your navel.
Images from a camera at the end of this laparoscope will be projected onto a video
monitor. Your surgeon will then pass surgical instruments through the other
keyhole openings to perform the operation.

There are two types of laparoscopic repairs: The more common Preperitoneal
approach and the less common Transabdominal approach.

In either method, the intestinal protrusion is pushed back into the abdomen, and a
piece of mesh is sewn into place in the abdominal wall to reinforce the repair and
help prevent recurrent hernias.

Upon completion of the repair, the incisions are closed with sutures, or other
materials, and dressed with a bandage.
Risks and Benefits

The possible complications of inguinal hernia repair are the same for both open and
laparoscopic techniques. They include: side effects from anesthesia, wound
infection, excessive bleeding, damage to blood vessels, nerves, or organs in the
area, difficulty urinating, swelling of the scrotum, excess scar tissue formation,
and/or recurrent hernia.

Benefits of inguinal hernia repair include: resolution of inguinal discomfort,

elimination of hernia complication risk.

In an inguinal hernia repair, or any procedure, you and your doctor must carefully
weigh the risks and benefits to determine whether it’s the most appropriate
treatment choice for you.

After the Procedure

Most patients who have uncomplicated inguinal hernia repairs are sent home from
the hospital on the same day as their surgery.

Following your operation, you will usually be advised to: keep the incision or
incisions clean and dry, drink plenty of fluids and eat fiber-rich foods to avoid
constipation, move your bowels as soon as you feel the urge, get up and walk around
the day after your surgery, avoid lifting.

Be sure to call your doctor immediately if you notice: signs of infection, such as
fever and chills, redness, swelling, increased pain, excessive bleeding, or discharge
from the incision sites, difficulty urinating, nausea or vomiting, constipation, pain
that isn’t relieved by medication, cough, shortness of breath, or chest pain.

Pathophysiology:

Defects in the muscular wall may be congenital and caused by weakened tissue or
a wide space at the inguinal ligament, or may be caused by trauma. Intra-abdominal
pressure increases with obesity, heavy lifting, coughing and traumatic injuries from
blunt pressure. When two of these factors coexist with some tissue weakness, a
hernia may occur. Increased pressure without a weakness is not likely cause a
hernia. Weakness, in addition to being present from birth, is acquired as part of
the aging process. As client age, muscular tissues become infiltrated and are
replaced by adipose and connective tissue.
When the contents of the hernial sac can be replaced into the abdominal cavity by
manipulation, the hernia is said to be reducible. Irreducible and incarcerated are
terms that refer to a hernia in which the contents of the sac cannot be reduced or
replaced by manipulation. Hernias can penetrate through the defect in the
abdominal wall, through the diaphragm, or through some internal structure within
the abdominal cavity.
Medical Management:

Feb.9, 2010
10:15 A. m
DAT then NPO post midnight
CBC typing
Urinalysis
ECG
Chest X-ray
Serum Electrolyte
FBAS; BUN

Tx.
IVF D5LRS 1L @ 30-35 gtts/min
Cefuroxime 750 mg IVP ANST (-)
For hernioplasty L
Secure Consent
Notify OR

Post Op Order
9:25 to DAW S/P hernioplasty l under SAB
Flat on bed x 6
Oxygen at 4L PM
NPO
IVF @ 30 gtts/min
IVF to ff: D5 LRS 1L x 8
D5LRS x 8
Continue IVF Cefuroxime 750mg q 8
Nalbuphine HCL 5 mg IVP q 4 x 2 doses
Then PRN for severe pain
Keterolac 30 mg IV q 6 x 4 doses (-) ANST
Ranitidine 50 mg IV q 8 x 3 doses
Monitor Urine output q 1
Monitor V/S q 15 x 1 q 30 x 2

Laboratory Results:

Chest PA

No definite active lung infiltrate is seen

Heart is not enlarged
The aorta and vascularity are within normal
Both costrophrenic sulci are unremarkable
The diaphragm and visualized bones of the thorax are intact

Comment:
Unremarkable Chest Study
 University of Luzon
College of Nursing
Perez Blvd. Dagupan City

A Case Study

About

Indirect Inguinal Hernia

Submitted To:
Mr. Remon Ramos

Submitted by:
Meryl Vittoria F. Arias
MTW 7-3 shift