Nursing Care Plan for Inguinal Hernia

A hernia is a protrusion or projection of an organ or organ part through the wall of the cavity that normally contains it. An inguinal hernia occurs when either the omentum, the large or small intestine, or the bladder protrudes into the inguinal canal. In an indirect inguinal hernia, the sac protrudes through the internal inguinal ring into the inguinal canal and, in males, may descend into the scrotum. In a direct inguinal hernia, the hernial sac projects through a weakness in the abdominal wall in the area of the rectus abdominal muscle and inguinal ligament. Inguinal hernias make up approximately 80% of all hernias. Repair of this defect is the most frequently performed procedure by both pediatric and adult surgeons. Hernias are classified into three types: reducible, which can be easily manipulated back into place manually; irreducible or incarcerated, which cannot usually be reduced manually because adhesions form in the hernial sac; and strangulated, in which part of the herniated intestine becomes twisted or edematous, possibly resulting in intestinal obstruction and necrosis.

An inguinal hernia is the result of either a congenital weakening of the abdominal wall (when the processus vaginalis fails to atrophy and close) or weakened abdominal muscles because of pregnancy, excess weight, or previous abdominal surgeries. In addition, if intra-abdominal pressure builds up, such as related to heavy lifting or straining to defecate, a hernia may occur. Other causes include aging and trauma. [ ]

Nursing care plan assessment and physical examination An infant or a child may be relatively symptom-free until she or he cries, coughs, or strains to defecate, at which time the parents note painless swelling in the inguinal area. The adult patient may complain of pain or note bruising in the area after a period of exercise. More commonly, the patient complains of a slight bulge along the inguinal area, which is especially apparent when the patient coughs or strains. The swelling may subside on its own when the patient assumes a recumbent position or if slight manual pressure is applied externally to the area. Some patients describe a steady, aching pain, which worsens with tension and improves with hernia reduction.

On inspection, the patient has a visible swelling or bulge when asked to cough or bear down. If the hernia disappears when the patient lies down, the hernia is usually reducible. In addition, have the patient perform a Valsalva s maneuver to inspect the hernia s size. Before palpation, auscultate the patient s bowel; absent bowel sounds suggests incarceration or strangulation. You may be able to palpate a slight bulge or mass during this time and when the examiner slides the little finger 4 to 5 cm into the external canal that is located at the base of the scrotum. If you feel pressure against your fingertip when you have the patient cough, an indirect hernia may exist; if you feel pressure against the side of your finger, a direct hernia may exist. Palpate the scrotum to determine if either a hydrocele or

Allow as much time as is needed to answer questions and explain procedures. In a hernioplasty. If the hernia is incarcerated. especially for the newborn who is prone to fluid shifts. are anxious because their child requires general anesthesia for the procedure. As with any postoperative patient. when applied. manage nasogastric suction. If possible. and after the surgery. A truss is a thick pad with an attached belt that is placed over the hernia to keep it in place. A delay in seeking healthcare may result in strangulation of the intestines and require emergency surgery. In the adult population. Surgery then may occur within 24 to 48 hours. Parents. during. surgical intervention to correct the defect takes the patient away from home and the work setting and causes anxiety. it can be used successfully in elderly or debilitated adult patients who are poor surgical risks or who do not desire surgery. inspect for signs and symptoms of possible peritonitis. Manual pressure is applied to reduce the hernia. Often. Encourage the patient to defer bathing and showering and instead to use . and monitor the patient for the return of bowel sounds. the protrusion may be moved back into place and a truss for temporary relief can be applied. The nurse also instructs patients and parents on the care of the incision. Nursing care plan intervention and treatment plan If the patient has a reducible hernia. Collaboration with the surgical team is necessary to prepare the patient and family for surgery. Although a truss is palliative rather than curative. The nurse explains what to expect before. manual reduction may be attempted by putting the patient in Trendelenburg s position with ice applied to the affected side. the incision is simply covered with collodion (a viscous liquid that. Postoperatively. The surgeon replaces hernial *******s into the abdominal cavity and seals the opening in a herniorrhaphy procedure. especially those of a newborn. The patient should be able to tolerate small oral feedings before discharge and should be able to urinate spontaneously. Intravenous fluids are administered to prevent dehydration.cryptorchidism (undescended testes) is present. dries to form a thin transparent film) and should be kept clean and dry. the surgeon reinforces the weakened area with mesh or fascia. Nursing care plan primary nursing diagnosis: Pain related to swelling and pressure. and deep breathe every 2 hours. encourage the patient to use an incentive spirometer or assist the patient to turn. use preoperative teaching tools such as pamphlets and videotapes to reinforce the information. cough. monitor the patient for respiratory complications such as atelectasis or pneumonia.

side effects. continued incisional pain. high fever. Caution the patient against lifting and straining. and dosage recommendations of all analgesics. Explain how to monitor the incision for signs of infection. the patient must notify the primary healthcare provider immediately. wound drainage. * The patient's bowel function will return to normal. Assist the patient with the truss. Infants or young children who are wearing diapers should have frequent diaper changes. teach the signs of a strangulated or incarcerated hernia: severe pain. and mucus production. Explain the importance of completion of all antibiotics. Explain that he or she can resume normal activities 2 to 4 weeks after surgery. diarrhea. . Nursing care plan discharge and home health care guidelines Teach the patient signs and symptoms of infection: poor wound healing. nausea. Encourage the patient to bathe daily and to apply a thin film of powder or cornstarch to prevent skin irritation. * The patient will express feelings of comfort. Explain that if these symptoms occur. incisional swelling and redness. or the diapers should be turned down from the incision so as not to contaminate the incision with urine. If the patient does not have surgery. fever. vomiting. and bloody stools. preferably in the morning before the patient arises.sponge baths until he or she is seen by the surgeon at a follow-up visit. she or he should use it only after a hernia has been reduced. Teach the patient or parents about the possibility of some scrotal swelling or hematoma. both should subside over time. If the patient uses a truss. Explain the mechanism of action. cough. ****************************** Common Nursing diagnoses found on Nursing care plan for Inguinal Hernia * Activity intolerance * Acute pain * Ineffective tissue perfusion: Gastro Intestinal * Risk for infection * Risk for injury Nursing outcomes nursing care plans for Inguinal Hernia * The patient will perform activities of daily living within the confines of the disease process.

* Administer analgesics as necessary. fluids and analgesics for pain as ordered. * Tell the postoperative patient that he'll probably be able to return to work or school and resume all normal activities within 2 to 4 weeks. * Tell the patient that immediate surgery is needed if complications occur.* The patient will remain free from signs or symptoms of infection. * Closely monitor vital signs and provide routine preoperative preparation. * Place the patient in Trendelenburg's position to reduce pressure on the hernia site. After surgery. * Don't allow the patient to cough. involving a protracted hospital stay and. necessitating emergency surgery. * Explain that elective surgery is the treatment of choice and is safer than waiting until hernia complications develop. When surgery is scheduled * Administer I. * Warn against applying the truss over clothing. * Assess the skin daily and apply powder for protection because the truss may be irritating. elevating the scrotum on rolled towels also reduces swelling. instruct him to bathe daily and apply liberal amounts of cornstarch or baby powder to prevent skin irritation. apply it in the morning before the patient gets out of bed. * If the patient uses a truss. Patient teaching home health guide * Explain what an inguinal hernia is and how it's usually treated. a jock strap or suspensory bandage may be used to provide support. For best results. a colostomy. but do encourage deep breathing and frequent turning. * In males. . * Apply ice bags to the scrotum to reduce swelling and relieve pain. * The patient will avoid complications. * Provide routine postoperative care. * Control fever with acetaminophen or tepid sponge baths as ordered. * Watch for and immediately report signs of incarceration and strangulation. Point out that wearing a truss doesn't cure a hernia and may be uncomfortable. If necessary. * Warn the patient that a strangulated hernia can require extensive bowel resection. possibly. Nursing interventions nursing care plans for Inguinal Hernia * Apply a truss only after a hernia has been reduced.V. which reduces its effectiveness and may cause slippage.

* Inform the postoperative patient that the risk of recurrence depends on the success of the surgery. warmth. incision swelling and redness. his general health. * Teach the patient signs and symptoms of infection: poor wound healing. * Caution the patient against lifting and straining . tenderness. Instruct him to watch for signs of infection (oozing. fever. side effects. Explain the mechanism of action. and his lifestyle. * Explain the importance of completion of all antibiotics.* Explain that he or she can resume normal activities 2 to 4 weeks after surgery. Tell him to keep the incision clean and covered until the sutures are removed. redness) at the incision site. and mucus production. continued incision pain. * Before discharge. * Remind him to obtain his physician's permission before returning to work or completely resuming his normal activities. cough. wound drainage. and dosage recommendations of all analgesics.

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