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I. Introduction Inguinal hernia is a condition in which intra-abdominal fat pushes through a weak spot in a groin muscle.

Indirect inguinal hernia is a type of hernia that is considered to be congenital lesion. The signs and symptoms are characterized by bulge, burning, pressure in the groin, pain, and discomfort when lifting or straining. It usually affects male and present during the first year of life, excessive straining and lifting of heavy objects, obesity, past history and familial history of hernia. According from the National Epidemiology center from 2000 to 2010 Philippine health statistics, hernia incidence are likely to occur in older people 70 years and older with an average of 4.4 %.

II. Identifying data Name: Mr. ABC Patient ID: 107142 Age: 51 Gender: Male Nationality: Filipino Status: Married Address: Olongapo, City Religion: Roman Catholic Educational Status: High School Graduate Occupation: Farmer Date of Admission: 03/05/13 Time of Admission: 9:39 am Name of Hospital: James L. Gordon Memorial Hospital Diagnosis: Indirect Inguinal Right Hernia

III. Patients History

A. Chief Complaint

Scrotal Bulging
B. History of Present Illness

Scrotal bulging noted since childhood, exacerbated by exertion, relieved by rest.


C. History of Past Illness

Patient has intermittent pain in the groin area for the past 3 years especially during strenuous work that is relieved by mefenamic acid and rest.
D. Family Health History

Father Hypertension.
E. History of Medical Specialty

Cyst excision at upper midsternal line.

F. Personal and Social History

The client lives with his family in Camarines Sur. He used to chew nganga everyday since he was 36 years old; he drinks alcohol beverages once a month. He works on a farm and heavy lifting comes usually to his work. Their water resource is from a manual water pump.
F. Nutritional History

The client diet is consist of nutritional intake according to his satisfaction usually vegetables and fish.

V. Physical Assessment Date of assessment: March 6, 2012 Time of assessment: 5:00 pm A. General Appearance: Patient is lying flat on bed wearing patient gown afebrile with relax appearance. Cooperative and oriented with ongoing D5LR 1L at 700 ml inserted at the right cephalic vein regulated at 31 to 32 drops per minute. Infusing well. Weight: 59.5 kg Height: 159 cm BMI = 23.52 normal weight B. Vital signs: T: 36.5 c P: 72 bpm R: 20 cpm BP: 130/80 mmHg
BODY PART Skin TECHNIQUES Inspection BMI Categories: Underweight = <18.5 Normal weight = 18.524.9 Overweight = 2529.9 Obesity = BMI of 31 or greater

NORMAL FINDINGS The skin has minimum perspiration. -Free from lesions/rashe s

ACTUAL FINDINGS The skin has minimum perspiration. -Free from lesions/rashe s equal bilaterally, warm to touch No presence of tenderness Smooth, a certain amount of roughness can be normal.

INTERPRETATI ON Normal

Normal Normal

Palpation equal bilaterally, warm to touch No presence of tenderness Smooth, a certain amount of roughness can be normal.

Normal Normal Normal Normal

Hair

Inspection

It should return to its original contour immediately. Hair varies from dark black to pale blonde. The body is covered by vellus hair and the terminal hair is evenly distributed. Hair may feel thin, straight, course, thick or curly.

It returns to original contour immediately Hair is black in color and evenly distributed The body is covered by vellus hair and the terminal hair is evenly distributed. Hair strands are thin, straight and shiny. Pinkish in color Normal Normal

Normal

Palpation

Normal

Nails

Inspection

Pink cast in light-skinned individuals, and brown in dark-skinned individuals. Smooth and slightly rounded or flat. Nail thickness should be uniform throughout Prompt return of pink or usual color should be 1-2 sec

Palpation

Normal Slightly rounded and thick

Abnormal Capillary refill time of 4 seconds

Head Size Symmetr y Inspection -Round, proportional to the size of the body -No areas of -Round, proportional to the size of the body -no areas of Normal

Palpation

Normal

tenderness -Clean, free from masses, lumps, lice, nits, dandruff and lesions

tenderness -Clean, free from masses, lumps, lice, nits, lesions but positive from dandruff Normal

Hair Black Color Evenness of growth, thickness and thinness Scalp Inspection Inspection Thick and evenly distributed Black Normal Thick and evenly distributed Normal Palpation Smooth texture, no oiliness No areas of tenderness Face Skin color Facial movemen t Eyes Inspection Inspection Light to dark brown Symmetric facial features & movement -lids open and close symmetricall y and has frequently blinking reflex up to 20 times per minute Symmetrical in size, extension, hair texture and movement Dark brown Symmetric facial features & movement -lids open and close symmetricall y and has frequently blinking reflex up to 17 times per minute Symmetrical in size, extension, hair texture and movement Normal Normal Smooth scalp, no oiliness No areas of tenderness Normal Normal

Inspection

Normal

Eyebrows

Inspection

Normal

Eyelashes

Inspection

Normal

Eyelids Conjuncti va

Inspection Inspection

Distributed evenly and curved upward Same color as the skin Pinkish palpebral and bulbar conjunctiva no lesion or drainage present Smooth, symmetric with same color as the face

Distributed evenly and curved upward Same color as the skin Pale palpebral and bulbar conjunctiva no lesion or drainage present Smooth, symmetric with same color as the face

Normal Abnormal

Ears

Inspection

Normal

Nose

Inspection

Normal

Mouth Lips Buccal mucosa Gums Inspection Inspection Inspection Slightly pink color, moist and tightly fit against each tooth Moist, slightly rough on dorsal surface 32 adult teeth Firmly set, white and shiny Neck Inspection Proportional to the size of Slightly pink color, moist and tightly fit against each tooth Moist, slightly rough on dorsal surface 30 adult teeth Brown and black discoloration of the enamel Proportional to the size of Normal Pink, moist symmetric Pink, soft, moist Dark, moist, symmetric Pink, soft, moist Abnormal Abnormal Normal

Tongue

Inspection

Normal

Teeth

Inspection

Abnormal

the body and head Palpation No palpable lumps or areas of tenderness Free from lesions and scars Chest symmetric, spine vertically aligned. Full and symmetric expansion. Auscultation Percussion notes resonate except over the scapula. Excursion is 3-5cm bilaterally. Vesicular and bronchovesic ular breathe sounds. Anterior Thorax Inspection Free from lesions and scars Symmetrical chest movement Auscultation Respiratory rate within normal range [16 20 cpm] Trachea is

the body and head Normal No palpable lumps or areas of tenderness Presence of 3cm scars on left midscapular line Chest symmetric, spine vertically aligned. Full and symmetric expansion. Percussion notes resonate except over the scapula. Excursion is 3-5cm bilaterally. Vesicular and bronchovesic ular breathe sounds. Presence of 2 cm scar on midsternal line Symmetrical chest movement Respiratory rate of 25 cpm Normal Abnormal

Posterior Thorax

Inspection

Abnormal

Palpation

Normal

Percussion

Normal

Normal

Normal Normal

Normal Normal

bronchial and tubular in sound Abdomen Inspection Skin color same as the body, symmetric movement Clicks or gurgling sounds occur irregularly and range from 5-35 per minute Percussion Tympany over stomach and gas-filled bowels; dullness over the liver and spleen or full bladder No tenderness, relaxed abdomen Liver may not be palpable, no tenderness, boarders feels smooth Tenderness may be present near xiphoid process or sigmoid colon Bladder not palpable Genitals Pubic hair

Trachea is bronchial and tubular in sound Skin color same as the body, symmetric movement Gurgling sounds occurred irregularly 30 times per minute

Normal

Normal

Bowel sounds

Auscultation

Normal

Normal There is tympany over stomach and gas-filled bowels Normal No tenderness, relaxed abdomen Palpable liver, no tenderness, boarders feels smooth Presence of tenderness near xiphoid process Not palpable

Palpation (Light)

Normal

Palpation (Deep)

Normal

Normal

Inspection Penis Inspection

Triangular distribution

Triangular distribution

Normal

Penile skin intact slightly wrinkled and same color as the body skin Smooth and semifirm

Penile skin intact slightly wrinkled and same color as the body skin Smooth and semifirm

Normal

Palpation Scrotum Inspection Scrotal skin is loose and darker in color. Scrotum appears asymmetric Palpation Testicles are rubbery and smooth. Scrotal skin is loose and darker in color. Marked asymmetry in size of right scrotum (right scrotum is larger) Testicles are rubbery and smooth.

Normal

Abnormal

Normal

Abnormal Testis is about 2 x 4 cm Right testis is 4 x 6 cm Abnormal Inspection No swelling or bulges Extremiti es Inspection Upper Extremiti es -skin color same as the whole body, free from lesions and scars -skin color is same as the whole body, Presence of tattoo on right deltoid region Abnormal Presence of bulges while client is bearing down

Inguinal Area

Palpation -free from masses, warm to touch no presence of edema and varicosities Free from masses, warm to touch -free from masses, warm to touch no presence of edema and varicosities -free from masses, warm to touch

Normal

Inspection Lower Extremiti es

Normal

Palpation

Normal

IV. Review of Systems

SYSTEM

SIGNS & SYMPTOMS

DATE

CAUSE

Integumentary System

Rashes (Small liquid blisters all over the body) rashes on upper extremities (Hermans Sign) Muscle pain Headache

1999

Chicken Pox

2004 Dengue fever

Masculo-skeletal System Nervous System

2004 2004 2002 (2x) 2003 2005

Dengue fever Dengue fever Viral Cause

Respiratory System

Dry none productive cough Cough and colds

(3x) 2002 (2x) 2003 and 2005 (3x) 2000 & 2005

Bacterial / Viral Cause

Cardiovascular System Gastrointestinal System

loose watery stool, abdominal cramping Loss of appetite Abdominal Pain

Acute Gastro Enteritis

2004 Dengue fever

A CASE PRESENTATION ON A PATIENT DIAGNOSED WITH INDIRECT INGUINAL RIGHT HERNIA

PRESENTED TO:

Teresita Ortin-Oliver, RN, MAN, MPM, MD, FPOGS, FICS

PRESENTED BY:

Dianne Aura Abad BSN IV

VI.

Laboratory Result

Hematology Report

Date: (02/11/13)
PARAMETER Hemoglobin Hematocrit White Blood Cells Neutrophils Lymphocytes Eosynophils Platelet Count NORMAL FINDINGS 14.0-18.0 g/dL 40-50 % 5,000-10,000/mm 0.55-0.70% 0.20-0.40% 0.01-0.08 150,000450,000/mm ACTUAL FINDINGS 10.5 g/dL 32% 7,460/mm 0.60% 0.27% 0.10 328,000/mm INTERPRETATION Decreased Decreased Normal Normal Normal Increased Normal

Fecalysis Report

Date: (02/07/12)
PARAMETER NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION

Physical Properties Color Consistency

Brown Semi-formed

Dark Tarry Semi-formed

Abnormal Normal

Urinalysis Report

Date: (02/07/12)

VII. Pathophysiology

NON MODIFIABLE FACTORS Male Age Having inguinal hernia

MODIFIABLE FACTORS Occupation (Farmer) Having weak abdominal muscles from poor diet, lack of exercise Straining during urination or bowel movements

Increased pressure in the abdominal compartments Intra-abdominal wall of inguinal canal into the Improper closure of inguinal area Intra abdominal fat slides through the inguinal canal Bulge at the right side of S/Sx: Increasingly more uncomfortable and tender to Hernia increase in size Pressure in the groin exacerbated by exertion
Indirect Inguinal Right Swollen / Hernia Enlarged
S/Sx: Pain

Feeling of heaviness or pressure in the groin S/Sx: Aching, burning sensation during heavy lifting, straining or

Right