CASE ANALYSIS

A. LEARNING OBJECTIVES
General Objectives:
After this case analysis, the students will be able to enhance/improve their skills,
knowledge and attitude in dealing with patient.

Specific Objectives:
The students will be able to:
ATTITUDE
o To project a professional image of a nurse by demonstrating good manners and
right conduct at all times including appropriate uniform, using congruent words
and actions.
o To accept responsibility and accountability for own decisions and actions, and
adhere to the national and international code of ethics for nurses.
o Provide environment conducive for learning by maintaining cleanliness and
organized area and providing the needed materials to be used.
o To possess a positive attitude towards change and criticisms to be given by
clinical instructors and co-student nurses.
o Show cooperation, collaboration and good relationship and teamwork especially
in communication with other students to provide good presentation and to have
successful outcome.
SKILLS
o Utilize the gathered information for comprehensive health history appropriately to
be used in formulation of nursing care plan.
o Perform a thorough physical assessment and review of system to be able to
compare and contrast the normal and abnormal anatomy and physiology of
patient.
o Perform nursing care interventions and medical interventions appropriately and
carefully to limit and prevent any further harm for the patient.
o Utilize critical thinking skills in analyzing the patients condition and prioritize
the needed care of the patient.
o Enhance communication and good relationship between the patient, doctors,
nurses, clinical instructors and co-student nurses and other members of health
team.
KNOWLEDGE
o Identify the appropriate drugs to be given for the patient, with its action,
contraindication, adverse reaction, and specific nursing responsibilities.
o Analyze the patients condition based on the thorough physical assessment and
comprehensive health history done during the nurse-patient interaction.
o Formulate specific nursing interventions and diagnosis for the patient.
o Understand and trace the pathophysiology of the condition of the patient and its
cause.
o Recall all the theories, concepts and principles that may be applied to the care of
the patient.

B. INTRODUCTION

INGUINAL HERNIA is a protrusion of an organ, tissue, or part of an organ through the

structure that normally contains it. It is an inguinal hernia that results from the failure of
embryonic closure of the deep inguinal ring after the testicle has passed through it. Like other
inguinal hernias, it protrudes through the superficial inguinal ring. It is the most common cause
of groin hernia.
An inguinal hernia is a condition in which intra-abdominal fat or part of the small
intestine, also called the small bowel, bulges through a weak area in the lower abdominal
muscles. An inguinal hernia occurs in the grointhe area between the abdomen and thigh. This
type of hernia is called inguinal because fat or part of the intestine slides through a weak area at
the inguinal ring, the opening to the inguinal canal. An inguinal hernia appears as a bulge on one
or both sides of the groin. An inguinal hernia can occur any time from infancy to adulthood and
is much more common in males than females. Inguinal hernias tend to become larger with time.
Inguinal hernia occurs when soft tissue usually part of the intestine protrudes
through a weak point or tear in your lower abdominal wall. The resulting bulge can be painful
especially when you cough, bend over or lift a heavy object. It is not necessarily dangerous by
itself; an inguinal hernia doesn't get better or go away on its own. An inguinal hernia can lead to
life-threatening complications. For this reason, your doctor is likely to recommend surgical
repair of an inguinal hernia that's painful or becoming larger. Inguinal hernia repair is a common
surgical procedure.
In a man, an inguinal hernia develops in the region where the spermatic cord and blood
vessels to the testicles pass out of the abdominal cavity and into the scrotum. The area where
these pass through is called the inguinal canal. In a woman, an inguinal hernia develops where
the connective tissue binding the uterus exits from the abdomen to join with the tissue
surrounding the vaginal opening.
There are two (2) TYPES of inguinal hernias - indirect and direct.

An indirect hernia are congenital hernias and are much more common in males than
females because of the way males develop in the womb. In a male fetus, the spermatic cord
and both testiclesstarting from an intra-abdominal locationnormally descend through
the inguinal canal into the scrotum, the sac that holds the testicles. Sometimes the entrance
of the inguinal canal at the inguinal ring does not close as it should just after birth, leaving
a weakness in the abdominal wall. Fat or part of the small intestine slides through the
weakness into the inguinal canal, causing a hernia. In females, an indirect inguinal hernia is
caused by the female organs or the small intestine sliding into the groin through a weakness

in the abdominal wall. Indirect hernias are the most common type of inguinal hernia.
Premature infants are especially at risk for indirect inguinal hernias because there is less
time for the inguinal canal to close. It affects men only. A loop of intestine passes down the
inguinal canal from where a testis descends into the scrotum.

A direct hernia are caused by connective tissue degeneration of the abdominal muscles,
which causes weakening of the muscles during the adult years. Direct inguinal hernias
occur only in males. The hernia involves fat or the small intestine sliding through the weak
muscles into the groin. A direct hernia develops gradually because of continuous stress on
the muscles. One or more of the following factors can cause pressure on the abdominal
muscles and may worsen the hernia:
sudden twists, pulls, or muscle strains
lifting heavy
of constipation
weight gain
chronic coughing

Indirect and direct inguinal hernias usually slide back and forth spontaneously through
the inguinal canal and can often be moved back into the abdomen with gentle massage. It affects
both sexes. The intestinal loop forms a swelling in the inner part of the fold of the groin.
Additionally, there are three (3) CLASSIFICATIONS of hernia - reductible, incarcenated and
strangulated.

In a reductible hernia the protrusion can be put back into place.

In an incarcenated hernia the protrusion can't be put back into place without surgery
because some surrounding tissues or parts have grown together.
In a strangulated hernia the protrusion becomes twisted or swollen and interferes with
the normal blood flow and muscle action. Immediate surgery is needed in this type of
hernia.

EPIDEMIOLOGY
Hernias comprise approximately 7% of all surgical outpatient visits.
Male:female ratio is 8:1.
Affect 1-3% of young children.
In men the incidence rises from 11 per 10,000 person years aged 16-24 years to 200 per
10,000 person years aged 75 years or above.

RISK FACTORS

In infants: prematurity, male sex.

In adults: male sex, obesity, constipation, chronic cough, heavy lifting.

CAUSES
Usually, there is no obvious cause of a hernia. Sometimes hernias occur with heavy
lifting, straining while using the toilet, or any activity that raises the pressure inside the abdomen.
Hernias may be present at birth, but the bulge may not be noticeable until later in life. Some
patients may have a family history of hernias. Hernias can be seen in infants and children. This
can happen when there is weakness in the abdominal wall. About 5 out of 100 children have
inguinal hernias (more boys than girls). Some children may not have symptoms until they are
adults.
Any activity or medical problem that increases pressure on the abdominal wall tissue and
muscles may lead to a hernia, including:
Chronic constipation, straining to have bowel movements
Chronic cough or sneezing
Cystic fibrosis
Enlarged prostate, straining to urinate
Extra weight

Fluid in the abdomen (ascites)

Heavy lifting
Peritoneal dialysis
Poor nutrition
Smoking
Overexertion
Undescended testicles
Increased pressure within the abdomen
A pre-existing weak spot in the abdominal wall
A combination of increased pressure within the abdomen and a pre-existing weak spot in
the abdominal wall
Straining during bowel movements or urination
Pregnancy

SIGNS AND SYMPTOMS

Frequently hernias produce no symptoms. However, some people may experience the
following symptoms:
a small bulge in one or both sides of the groin
that may increase in size and disappear when
lying down; in males, it can present as a
swollen or enlarged scrotum
discomfort or sharp painespecially when
straining, lifting, or exercisingthat improves
when resting
a feeling of weakness or pressure in the groin
a burning, gurgling, or aching feeling at the
bulge
Pain or discomfort in your groin, especially
when bending over, coughing or lifting
A heavy or dragging sensation in your groin
Occasionally, in men, pain and swelling in the
scrotum around the testicles when the
protruding intestine descends into the scrotum

TREATMENT
In adults, inguinal hernias that enlarge, cause symptoms, or become incarcerated are
treated surgically. In infants and children, inguinal hernias are always operated on to prevent
incarceration from occurring. Surgery is usually done on an outpatient basis. Recovery time
varies depending on the size of the hernia, the technique used, and the age and health of the
patient. The two main types of surgery for hernias are as follows:

Open hernia repair. In open hernia repair, also called herniorrhaphy, a person is given
local anesthesia in the abdomen or spine to numb the area, general anesthesia to sedate or
help the person sleep, or a combination of the two. Then the surgeon makes an incision in
the groin, moves the hernia back into the abdomen, and reinforces the muscle wall with
stitches. Usually the area of muscle weakness is reinforced with a synthetic mesh or screen
to provide additional supportan operation called hernioplasty.
Laparoscopy. Laparoscopic surgery is performed using general anesthesia. The surgeon
makes several small incisions in the lower abdomen and inserts a laparoscopea thin tube
with a tiny video camera attached to one end. The camera sends a magnified image from
inside the body to a monitor, giving the surgeon a close-up view of the hernia and
surrounding tissue. While viewing the monitor, the surgeon uses instruments to carefully
repair the hernia using synthetic mesh. People who undergo laparoscopic surgery generally
experience a somewhat shorter recovery time. However, the doctor may determine
laparoscopic surgery is not the best option if the hernia is very large or the person has had
pelvic surgery.

COMPLICATIONS
These include:
Recurrence: 0.5-1.0% - most happening within 5 years of operation. The recurrence rate
increases in:
Children aged younger than 1 year.
Elderly patients.
After incarcerations.
In those with ongoing increased intra-abdominal pressure.
Growth failure.
Prematurity.
Chronic respiratory problems.
In girls with sliding hernias.
Infarcted testis or ovary with atrophy.
Wound infection.
Bladder injury.
Intestinal injury.
A hydrocele from fluid accumulation in the distal sac usually resolves spontaneously
but sometimes requires aspiration.
Bleeding

PREVENTION
Although there is not much a person can do to totally prevent a hernia many experts suggest:
Keeping weight down
Keeping the abdominal muscles in shape
Avoid lifting heavy objects
Avoid straining to urinate or defecate
Use proper lifting techniques.
Lose weight if you are overweight.
Relieve or avoid constipation by eating plenty of fiber, drinking lots of fluid, going to the
bathroom as soon as you have the urge, and exercising regularly.
Men should see their health care provider if they strain with urination. This may be a
symptom of an enlarged prostate.

PROGNOSIS
This is generally very good, depending on comorbidity. Indirect hernia usually returns
after 5 years.

C. PATIENTS PROFILE
NAME: Saludario, Narciso
AGE: 77 years old
ADRESS: Lope de Vega, N. Samar
GENDER: Male
BIRTHDAY: December 25, 1935
BIRTHPLACE: Lope de Vega, N. Samar
NATIONALITY: Filipino
RELIGION: Roman Catholic
MARITAL STATUS: Married
EDUCATIONAL ATTAINMENT: Grade 5
DATE OF ADMISSION: January 1, 2013
TIME OF ADMISSION: 12:50pm
ADMITTING PHYSICIAN: Dr. Enzon / Dr. Estanislao
ADMITTING DIAGNOIS: Inguinal Hernia
SOURCE OF INFORMATION: Patient and wife

D. HISTORY OF PATIENT
a. CHIEF COMPLAINT

- Prior to admission, the patient suffers inguinal pain for 7 months. He didnt remember
on what he was doing that causes his condition. When one of his scrotum is in the
inguinal area, and he cannot tolerate the pain, they decided to be confined in the NSPH
last January 7, 2013 at 12:50pm.

b. PRESENT ILLNESS
- Prior to admission, the patient suffers inguinal pain for 7 month. But he cannot
remember on what he was doing that may cause to his current condition. All he was just
doing is to go to farm to work. For this, he first go to Dr. Vers clinic for he is the doctor
of the patient, and give him some medicines and vitamin supplements. The pain is on and
off and sometimes tolerable. He didnt have any urination and defecation problems. Last
Monday, when he cannot already tolerate the pain, they decided with his wife, to go to
hospital to be confined. Because he cannot stand up anymore because of pain.

c. PAST MEDICAL HISTORY

- Prior to admission, patient also suffers from hypertension, and just started last previous
3 years. He also suffers from rheumatoid arthritis and it was started since he was in 60s
and it occurs until now. He is also a diabetic person and he have goiter but was already
treated in Manila. At present, it was discovered that he have tuberculosis. He seeks this
illnesses to Dr. Ver because he is the doctor of the patient and give him medicines and
some vitamin supplements. Cardiocil for hypertension and Diclofenax and Alaxan for his
rheumatoid arthritis. While the goiter problem was started in Manila during the previous
years with his eldest child. But it is the first time that the patient is being hospitalized
because he is always visits the clinic of Dr. Ver if in case of pain/illnesses.

d. FAMILY HISTORY
- According to patient, there are no genetic disease that runs in their family. It was started
in him that these diseases had occurred. According to patient, his brother is also
hypertensive and thinks that it is one of the problem common in their family. In his
wifes side, there are also no diseases that are known. His daughter has also hypertension
but it was treated immediately at Manila.

e. HEALTH PERCEPTION AND HEALTH MANAGEMENT PATTERN

- Prior to admission, patient always seeks the clinics for any pain or problem in his
health. His doctor is Dr. Ver because he is his doctor for rheumatoid arthritis and he
consulted the said doctor for his other health problems. He takes different vitamin
supplements and medicines for pain and for boosting immune system and lowering his
high blood pressure. He takes Cardiocil for hypertension and for rheumatoid arthritis he
takes Diclofenzx and Alaxan. He is asked also to avoid salty foods, seedy vegetables and
salty foods. He never drinks alcohol but he smokes 1 pack each week or every after meal.
He has good body hygiene and even bath himself alone even he has arthritis and
difficulty walking. He says that it is part of growing up and he will just follow what the
doctor saids/ordered. They also have good source of water, they use mineral water and
artesian well for using in the kitchen and in bathing. He also said that he is a workaholic
person and believes that this is the reason of his occurrence of his different condition.

f. NUTRITIONAL AND METABOLIC PATTERN

- The patient eats normally for 3 times a day. They get their food in their farm that is 3km
away from their house and it is because he works as a farmer and his eldest son goes with
him. But because of his different illness/disease the doctor told him to avoid salty and
fatty foods, seedy vegetables and some kind of fishes. His wife prepares the food in their
house. But when at work, he prepares it because sometimes they do not go home at night

but they go home on Saturdays. Patient has good appetite but smokes every after meal.
The patient also takes vitamin supplements and medicines but never drinks alcohol.
During admission, at first the patient is in NPO but changes to DAT on the next day.

g. ELIMINATION PATTERN
- The patient do not have any problems in urinating nor defecating. He urinates 6-7 times
a day prior to admission and defecates 1-2 times a day prior also to admission. And
according to patient, he usually urinates during night time or during sleeping so hes
sleeping pattern is not good. During admission, he urinates for 5-6 times a day and
defecates 0-1 times a day.

h. ACTIVITY-EXERCISE PATTERN
- According to patient, he is a workaholic person and thinks that this is the reason why he
have this different diseases. So he wake up at 5am to go to work by just walking 3km
away from their home and he go to farm with his eldest son. Sometimes they stayed there
up to Saturday and go home at afternoon and back at Monday morning. He is the one
cooking for their food during work. Since his condition started, he cannot work already
and he is at their house always. Just sleeping and walking a little bit, but he cannot work.
He has a crutches using to use when he is walking to ambulate / assist himself.

i. SLEEP-REST PATTERN
- Patient sleeps within normal number of hours of sleep, but it is not straight because he is
disturbed by his urinating every night. He is more urinating at night than day. He dont
also take a nap because of his work and takes a rest just for a while and then back to work
again. He usually wakes up at 5am and rest at 6 or 7pm. During admission, he usually
takes a nap even though he have a good sleep during the night.

j. COGNITIVE PERCEPTUAL PATTERN

- The patient finished up to Grade 5 only. But he can read and write appropriately.
Sometimes he has slight memory loss because of aging.

k. ROLE RELATIONSHIP PATTERN

- The patient is a very good father to their children. He disciplines them well and also to
their grandchildren. He have also good relationship with neighbors and friends. He is the
one working for his family when he was still strong. He goes to work starting Monday
morning and be back at Saturday afternoon just to work and get good for their everyday
meal.

l. SELF PERCEPTION AND SELF CONCEPT PATTERN

- He considers himself as a workaholic person. But according to him its fine and it is the
reality of his life especially that he is just up to Grade 5. And he always thinks that he is
the father of the family and it is his role to work hard so that they have something to eat.
According also to him that he is a God-fearing person and loving and disciplinary father
for his children and grandchildren.

m. VALUE-BELIEF PATTERN
- The patient is a Roman Catholic. He always go to church with his wife every Sunday or
in every special occasion because his wife is very God-centered and he himself is a Godfearing person. He always prays and never fails to believe in God.

E. REVIEW OF SYSTEM
GENERAL APPEARANCE:
- Received patient lying on bed, with facial grimace and guarding behavior. Wearing
brown t-shirt and pants with ongoing D5LR at 20gtts/min.

VITAL SIGNS:

PR: 71 bpm
RR: 23 bpm
TEMP: 37.0C
BP: 140/80mmHg

INTEGUMENTARY
- COLOR: brownish
- TEXTURE: dry skin
- poor skin turgor
- rough skin
- with bruises and scars
-absence of masses/lesions/tenderness

HAIR
- short, whitish with brown color
- not distributed on scalf
- absence of lice/dandruff

NAILS
- no clubbing noted
- trimmed nails
- short dirty nails both hands and feet

HEENT
HEAD:
- well rounded
- absence of masses/tenderness
- absence of dandruff
- symmetric
EYES:
- well rounded, equal
- reactive to light
- using eyeglasses but can see clearly in near objects
- pupils are black, equal and reactive to light.
EARS:
- symmetric
- well hearing
- absence of discharges/tenderness
- clean
NOSE:
- absence of discharges
- absence of tenderness/masses
- nasal hair present

 THROAT AND MOUTH:

- dry lips
- gag reflex present
- pale
- uncomplete teeth
- tooth decay noted
- 2 teeth present in lower mouth
- able to stick out tongue
- no dentures using

NECK AND LYMPH NODES

- symmetric
- absence of scars/bruises
- absence of palpable lymph nodes

NEUROLOGIC ASSESSMENT
- ambulate with crutches
- can read and write well
- slight good vision if near
- good hearing
- can talk normally
- slight good memory due to aging

RESPIRATORY ASSESSMENT
- RR: 31 bpm
- with wheezing in lower lobe
- symmetric
- TB postivie

CARDIOVASCULAR ASSESSMENT
- BP: 140/80 mmHg
- PR: 71 bpm
- absence of murmur sounds
- normal hearbeat
- hypertensive
- no chest pain

MUSKULOSKELETAL SYSTEM
- body weakness
- irritable
- restless
- can sit alone
- crawls
- can stand up with help of SO
-grasp and reach objects.

GASTROINTESTINAL ASSESSMENT
- no abdominal distention
- stool: normal
- 1 2 times a day

GENITOURINARY ASSESSMENT
- 5 6 times a day
- clear white urine
- no problem urinating
- usually urinates at bedtime

MUSKULOSKELETAL
- with mass in feet in hands due to rheumatoid arthritis
- ambulating with crutches
- rheumatoid arthritis positive

REPRODUCTIVE
- scrotum in inguinal area
- no other problems noted

F. COURSE IN THE WARD

DATE

MEDICAL AND
SURGICAL
MANAGEMENT

INDICATIONS FOR
DIAGNOSITIC PROCEDURES,
THERAPEUTIC
MANAGEMENT AND
MEDICATIONS AND NURSING
RESPONSIBILITIES

PATIENT RESPONSE

1/7/13

>Patient was admitted at

the Emergency Room to
Surgery Ward

>Patient was admitted due to

inguinal pain. Patient was assessed
by the doctor. Past medical history
and present health history was
taken. Patient with significant
others were oriented to the unit.
Consent care signed. Informed
attending physician and significant
others about the patients admission.
Patient was wheeled to Surgery
Ward.

> Patient was wheeled to

Surgery Ward still in pain.
>Comfortably lying in the
bed.
>Significant others provide
the needed treatment and
laboratory exams.

>Patient was put on NPO

> To determine any discomforts or

other complications and it serves
for laboratory exams that should be
done that requires nothing per orem
for several hours.

>Patient and SO instructed

not to eat anything by mouth.

>The doctor ordered to

monitor vital signs q shift
and IVF of D5LR @
30gtts/min.

>Vital signs q shift to determine if

there are any abnormalities in the
patients vital signs as well as the
insertion of the IV for homeostasis
of the fluid and electrolytes in the
body.

>BP: 140/80 patient is

hypertensive, T: 38.50c
patient have a fever, PR:
91bpm, RR: 28bpm. Almost
all of his vital signs increase
because of pain occurs in the
patient.

>The ff. lab. works and

diagnostic procedure was
ordered: CBC, BT, UA
and CXR (APLLAT)

>Need to be facilitated immediately

to serve for baseline data and for
treatment management. The
significant others was made aware
of its importance. Result should be
relayed to the attending physician
once available.

>CXR, CBC, BT is in and

read by the attending
physician.

> Refer for SCOD for

follow-up evaluation.

> For referral for SCOD, specialist

in the patients condition for further
evaluation and management.

> Seen by Dr. Estanislao, as

SCOD and new ordered
carried out.

> Second generation cephalosporin

inhibits cell-wall synthesis,

> treats uncomplicated UTIs

and infection of urinary and

Treatment ordered:
>Cefuroxime 750mg q
8hrs

1/7/13

1/8/13

promoting osmotic instability;

usually bactericidal.

lower respiratory tracts.

>Paracetamol 300mg IVT

q 6hrs for fever

> antipyretic or analagesic that

treats fever and mild pain.

> Patients fever decreases

from 38.50c to 37.10c.

>decrease IV rate was

ordered from 30gtts/min
to 20gtts/min.

> to avoid fluid overload of the

body.

> Ordered followed and

changed IV rate from
30gtts/min to 2-gtts/min.

>Lab. works was ordered: >To determine if there is any

Hgt detoriation now
aggravating diseases and to serve as
a guide for pts management of the
disease. Results should be relayed
to attending physician once result is
available.

>diagnostic procedures done

and the result is in.

>Continuity of IV meds.
was ordered

>For continuous management of

acute pain and hypertension.

>Patient D Bp lowered from

140/80 to 120/80 and pain
was reduced from pain rating
scale of 8 to 7. And
sometimes pain is tolerable
sometimes is really in pain.

> Diet changed to DAT

> For strong body system and > Patient can eat or drink
laboratory exams are already done anything
as
tolerated
that requires NPO temporarily.
especially those that can
boost his immune system.

> Still for waiting for > For proper consent of the family > Still waiting for financial
familys decision for OR before doing any procedure to the support of one the children of
client.
the patient that supports them.
But they are informed and
approved for operation.
>Lab works was ordered: > To determine if there is any
12-Lead ECG, creatinine, aggravating diseases and to serve as
FBS
a guide for pts management of the
disease. Results should be relayed
to attending physician once result is
available.

> FBS and Creatinine taken

and with results in. But still
for 12-Lead ECG.

>for CP clearance once

lab results are in

>

>IVF decreased to KVO >

then to consume.

>

>
1/9/13

>still for CP clearance

>for
surgery
herniorraphy

>

prior >

>new treatment ordered: >

Mefenamic Acid 500mg
TID PRN for pain

1/9/13

>Still
for
creatinine
determination
>CP clearance
followed

to

be

>Arithromycin
OD PO

500mg

G. LABORATORY TEST

H. ANATOMY AND PHYSIOLOGY

The gastrointestinal system has two major
components, which are the alimentary canal or also
called as thegastrointestinal tract and the accessory
organs. It has two major functions. First, it is about
breaking down of food and fluid into simple
chemicals that can be absorbed into the
bloodstream and transported through the body and
second, is about elimination of wastes through
excretion of stool. It is an important system
because if it malfunctions, the overall health of the
person will be greatly affected.
The alimentary canal is a hollow muscular
tube that begins in the mouth and extends to the
anus. It also includes the pharynx, esophagus,
stomach, small intestine, and thelarge intestine. On
the other hand the accessory organs are the liver,
biliary duct system, and the pancreas.
Alimentary canal includes:
1. Mouth It primarily deals with chewing, salivating, and swallowing of food. The tongue
provides the sense of taste and saliva moistens the food during chewing. Saliva is produced
by the parotid, submandibular, and sublingual salivary glands.
2. Pharynx or throat It is a cavity that extends from the oral cavity to the esophagus. It
assists in swallowing and propelling the food toward the esophagus.
3. Esophagus It is a muscular tube that extends from the pharynx through the mediastinum
to the stomach. When food is swallowed, the cricopharyngeal sphincter relaxes for the food
to enter the esophagus. Then peristalsis propels liquids and solids through the esophagus
into the stomach.
4. Stomach It is the reservoir for food and it is a collapsible, pouch-like structure in the left
upper part of the abdomen, just below the diaphragm. Its upper border is attached to the
lower end of the esophagus. The stomach contains two sphincters: cardiac sphincter and
pyloric sphincter.
The stomach breaks down food into chime, a semifluid substance, produces intrinsic factor
necessary for the absorption of vitamin B12, and moves the gastric contents to the small
intestine.
1. Small Intestine It is approximately 6 meters long and more or less all digestion and
nutrient absorption takes place in it. It also deals with the secretion of hormones that control
the secretion of bile, pancreatic juices and intestinal juice. It is divided into three:
duodenum, jejunum, and ileum.

The small intestine has structures that helps in the absorption such as the villi, which are
fingerlike mucosa, microvilli, which are tiny projections on the surface of epithelial cells, and the
plicae circulars, which are circular folds on the mucosa.
1. Large Intestine or colon It absorbs excess water and electrolytes, stores food residue,
and eliminates waste materials in the form of feces. It is divided into six segments: cecum,
ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.
Accessory Organs:
1. Liver It is located in the right upper quadrant of the abdomen under the diaphragm and it
has four lobes: the left, right, caudate, and quadrate lobes. It is consists of hepatic cells that
encircle a central vein and radiate outward. The hepatic cells secrete bile and do
many metabolic, endocrine, and secretory functions. The liver metabolizes carbohydrates,
fats, and proteins and detoxifies various toxins in the plasma. It is also responsible for
converting ammonia to urea, synthesizing plasma proteins, nonessential amino acids, and
vitamin A, regulating blood glucose levels and in secreting bile.
2. Gallbladder It is a small pear shaped structure that is positioned halfway under the right
lobe of liver. It stores and concentrates bile produced by the liver and releases it into
the common bile duct for delivery to the duodenum.
Bile is a greenish liquid that emulsifies fat and promotes intestinal absorption of fatty acids,
cholesterol, and lipids.
1. Pancreas It can be seen horizontally in the abdomen behind the stomach. Its head and
neck extend into the curve of the duodenum and its tail is against the spleen.
It is responsible for the exocrine and endocrine functions. Its exocrine function includes scattered
cells that secrete many digestive enzymes every day. Clustered lobules and lobes release their
secretions into the pancreatic duct then the pancreatic duct runs the pancreas and joins the bile
duct from the gallbladder before entering the duodenum. While its endocrine function involves
the islets of Langerhans which is composed of two types of cells: beta cells that secrete insulin
and alpha cells that secrete glucagon, blood glucose levels stimulate their release.
Digestion and Elimination
Digestion begins in the mouth where mastication, salivation and swallowing takes place.
When a food is swallowed, the hypopharyngeal sphincter relaxes, making the food enter the
esophagus. In the esophagus, the glossopharyngeal nerve stimulates peristalsis which moves the
food toward the stomach. As the food passes the esophagus, glands secrete mucus, which
lubricates the bolus. As the food bolus enters the stomach, digestive juices are secreted and the
stomach stretches. When the stomach stretches, gastrin is produced. Gastrin stimulates the motor
functions and secretion of gastric juices by the gastric gland. These include pepsin, intrinsic
factor, proteolytic enzyme and hydrochloric acid.
Peristalsis churns the food into tiny particles and mixes it with the juices, forming chyme.
Chyme is then moved into the antrum of the stomach, where it backs up against the pyloric
sphincter before being released into the duodenum. Carbohydrates, fats, and proteins are being
broken down by the intestinal contractions and digestive secretions, allowing it to be absorbed in
the intestinal mucosa and to the bloodstream. The chyme thereafter passes through the small
intestine and later on the ascending colon where it is reduced to indigestible substances.
As the bolus goes to the large intestine absorption continues without producing hormones
or digestive enzymes. It travels from the ascending colon, past the right abdominal cavity, to the
livers lower border and crosses below the liver and stomach by way of transverse colon. It
descends through the left abdominal cavity to the iliac fossa through the descending colon. It
then travels through the sigmoid colon then to the rectum and finally moves out to the anal canal
as waste product.

I. PATHOPHYSIOLOGY

J. HEALTH TEACHINGS

Make certain client voids after hernia surgery, because urinary retention is common
problem.
return client to general diet as soon as he tolerates food.
client should be told not to engage in any lifting 4 to 6 weeks after surgery.
ice pack is usually applied to incisional area to control pain and reduce swelling in
scrotal area
position client so as to elevate the scrotum and have war scrotal support when out of
bed.

Case analysis
(INGUINAL HERNIA)

submitted by:
somoray, maria jescele m.
bsn-iv

submitted to:
RONA L. ALCERA, rn, MAN
instructor