153294346 case-study-of-indirect-inguinal-hernia-r

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Bulacan State University

2
College of Nursing
City of Malolos, Bulacan
A Case study of Indirect Inguinal Hernia
Presented by:
Group 2A BSN 3D
Nerissa Federis
Marjelene Flores
Jaecelyn Junio
Joanna Marie Llano
Hannah Gail M. Lorenzo
Jeffrey C. Lumba
Presented to:
Sir Marcial Espiritu, RN, MSN
Table of Contents:

3
I. Introduction……………………………………………………………………………………………………………………….Page2
II. Objectives……………………………………………………………………………………………………………………….Page6
III. Nursing Assessment…………..……………………………………………………………………………………………….Page8
IV. Anatomy and Physiology ……………………………………………………………….…………………………………….Page19
V. Pathophysiology……………………………………………………………………………………………………………….Page21
VI. Patient and His Care………………………………………………………………………………………………………….Page37
VII. Nursing Problem Prioritization…………………………………………………………………………………………….Page47
VIII. Nursing Care Plan………………………………………………………………………………………………………….Page49
IX. Health Teaching………………………………………………………………………………………………….………….Page52
X. Discharge Planning ………………………………………………………………………………………………………….Page70
XI. Conclusion……………………………………………………………………………………………………………….….Page71
XII. Bibliography……………………………………………………………………………………………………………….Page71

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I.INTRODUCTION
This is the case study of baby S.A.M, a 4 year old client from Tambubong, Baliuag, Bulacan, he was admitted at Baliuag District Hospital last May 14,
2013 at 1:15 p.m with a chief complaint of Indirect Inguinal Hernia and Undescended Testes.
A hernia occurs when the contents of a body cavity bulge out of the area where they are normally contained. These contents, usually portions of intestine
or abdominal fatty tissue, are enclosed in the thin membrane that naturally lines the inside of the cavity. Hernias by themselves may be asymptomatic (produce
no symptoms) or cause slight to severe pain. Nearly all have a potential risk of having their blood supply cut off (becoming strangulated). When the content of
the hernia bulges out, the opening it bulges out through can apply enough pressure that blood vessels in the hernia are constricted and therefore the blood supply
is cut off. If the blood supply is cut off at the hernia opening in the abdominal wall, it becomes a medical and surgical emergency as the tissue needs oxygen
which is transported by the blood supply. Different types of abdominal-wall hernias include the following:
 Inguinal (groin) hernia: Making up 75% of all abdominal-wall hernias and occurring up to 25 times more often in men than women, these hernias are divided into
two different types, direct and indirect. Both occur in the groin area where the skin of the thigh joins the torso (the inguinal crease), but they have slightly
different origins. Both of these types of hernias can similarly appear as a bulge in the inguinal area. Distinguishing between the direct and indirect hernia,
however, is important as a clinical diagnosis.
o Indirect inguinal hernia: An indirect hernia follows the pathway that the testicles made during fetal development, descending from the abdomen
into the scrotum. This pathway normally closes before birth but may remain a possible site for a hernia in later life. Sometimes the hernia sac
may protrude into the scrotum. An indirect inguinal hernia may occur at any age.
o Direct inguinal hernia: The direct inguinal hernia occurs slightly to the inside of the site of the indirect hernia, in an area where the abdominal
wall is naturally slightly thinner. It rarely will protrude into the scrotum. Unlike the indirect hernia, which can occur at any age, the direct hernia
tends to occur in the middle-aged and elderly because their abdominal walls weaken as they age.
 Femoral hernia: The femoral canal is the path through which the femoral artery, vein, and nerve leave the abdominal cavity to enter the thigh. Although
normally a tight space, sometimes it becomes large enough to allow abdominal contents (usually intestine) to protrude into the canal. A femoral hernia
causes a bulge just below the inguinal crease in roughly the mid-thigh area. Usually occurring in women, femoral hernias are particularly at risk of
becoming irreducible (not able to be pushed back into place) and strangulated. Not all hernias that are irreducible are strangulated (have their blood supply
cut off ), but all hernias that are irreducible need to be evaluated by a health-care provider.

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 Umbilical hernia: These common hernias (10%-30%) are often noted at birth as a protrusion at the bellybutton (the umbilicus). This is caused when an opening in
the abdominal wall, which normally closes before birth, doesn't close completely. If small (less than half an inch), this type of hernia usually closes gradually by
age 2. Larger hernias and those that do not close by themselves usually require surgery at age 2-4 years. Even if the area is closed at birth, umbilical hernias can
appear later in life because this spot may remain a weaker place in the abdominal wall. Umbilical hernias can appear later in life or in women who are pregnant or
who have given birth (due to the added stress on the area).
 Incisional hernia: Abdominal surgery causes a flaw in the abdominal wall. This flaw can create an area of weakness in which a hernia may develop. This occurs
after 2%-10% of all abdominal surgeries, although some people are more at risk. Even after surgical repair, incisional hernias may return.
 Spigelian hernia: This rare hernia occurs along the edge of the rectus abdominus muscle through the spigelian fascia, which is several inches to the side of the
middle of the abdomen.
 Obturator hernia: This extremely rare abdominal hernia develops mostly in women. This hernia protrudes from the pelvic cavity through an opening in the pelvic
bone (obturator foramen). This will not show any bulge but can act like a bowel obstruction and cause nausea and vomiting. Because of the lack of visible
bulging, this hernia is very difficult to diagnose.
 Epigastric hernia: Occurring between the navel and the lower part of the rib cage in the midline of the abdomen, epigastric hernias are composed usually of fatty
tissue and rarely contain intestine. Formed in an area of relative weakness of the abdominal wall, these hernias are often painless and unable to be pushed back
into the abdomen when first discovered.
Hernia Causes:Although abdominal hernias can be present at birth, others develop later in life. Some involve pathways formed during fetal development,
existing openings in the abdominal cavity, or areas of abdominal-wall weakness.Any condition that increases the pressure of the abdominal cavity may contribute to
the formation or worsening of a hernia. Examples include: obesity,heavy lifting,coughing,straining during a bowel movement or urination,chronic lung disease and

6
fluid in the abdominal cavity. A family history of hernias can make you more likely to develop a hernia.
The signs and symptoms of a hernia can range from noticing a painless lump to the severely painful, tender, swollen protrusion of tissue that you are
unable to push back into the abdomen (an incarcerated strangulated hernia).Reducible Hernia: It may appear as a new lump in the groin or other abdominal area. It
may ache but is not tender when touched. Sometimes pain precedes the discovery of the lump. The lump increases in size when standing or when abdominal
pressure is increased (such as coughing). It may be reduced (pushed back into the abdomen) unless very large. Irreducible hernia: It may be an occasionally painful
enlargement of a previously reducible hernia that cannot be returned into the abdominal cavity on its own or when you push it. Some may be chronic (occur over a
long term) without pain. An irreducible hernia is also known as an incarcerated hernia. t can lead to strangulation (blood supply being cut off to tissue in the hernia).
Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting. Strangulated hernia: This is an irreducible hernia in which the entrapped
intestine has its blood supply cut off. Pain is always present, followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting).
The affected person may appear ill with or without fever. This condition is a surgical emergency.
Hernia Diagnosis:If you have an obvious hernia, the doctor may not require any other tests (if you are healthy otherwise). If you have symptoms of a hernia
(dull ache in groin or other body area with lifting or straining but without an obvious lump), the doctor may feel the area while increasing abdominal pressure
(having you stand or cough). This action may make the hernia able to be felt. If you have an inguinal hernia, the doctor will feel for the potential pathway and look
for a hernia by inverting the skin of the scrotum with his or her finger.
Our client have a Indirect Inguinal Hernia (Reducible Hernia).The diagnostic procedure done with our client is Physical Examination.The other laboratory
examinations like Hematology, Urinalysis, and X-ray. The patient’s medication were Morphine sulfate,Ketamine,Paracetamol, Mefenamic acid.
During gestation, a boy's testicles develop inside his abdomen, and then, sometime before birth, they push through a tunnel in the tissue between the groin
and the abdomen (called the inguinal canal) and descend into the scrotal sac.In girls, the ovaries descend through the tunnel and into the pelvis. At that point, the
passage through the abdominal wall should close up.In about 5 percent of babies (mostly boys, and especially those who were premature), the opening remains large
enough to allow a loop of the intestine to poke down into the tunnel. Inguinal hernias do not improve on their own. You'll notice a firm, oblong lump about the size
of your thumb either in your baby's groin area or the scrotum. You may not notice the lump for weeks or even months after your child is born.It may bulge out when
he's active or crying, then disappear back into the abdomen when your baby is relaxed. Hernias occur more often in children who have one or more of the following
risk factors: a parent or sibling who had a hernia as an infant, cystic fibrosis, developmental dysplasia in the hip, undescended testes, abnormalities of the urethra.
About 25% of males and 2% of females develop inguinal hernias; this is the most common hernia in males and females.Data from developing countries is
limited hence the exact prevalence and incidence is not known. Gender and anatomic distribution of Hernias is believed to be similar to developed countries.
Generally most of the hernias occur in the groin in adults.Approximately 75% of all hernias occur in the groin; two thirds of these hernias are indirect and one third
direct.Indirect inguinal hernias are the most common hernias in both men and women; a right-sided predominance exists.Incisional and ventral hernias account for
10% of all hernias. Only 3% of hernias are femoral hernias.Between 10% and 30% of children have an abdominal wall hernia; most hernias of this type close

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spontaneously by age 1 year. The incidence of incarcerated or strangulated hernias in children is 10-20%; 50% of these occur in infants younger than 6 months.
Sex: Approximately 90% of all inguinal hernia occur in males. Femoral hernias (although rare) occur almost exclusively in women because of the differences in the
pelvic anatomy. The female-to-male ratio of Obturator hernias is 6:1. Age:Indirect hernias usually present during the first year of life, but they may not appear until
middle or old age. Direct hernias occur in older patients as a result of relaxation of abdominal wall musculature and thinning of the fascia. Umbilical hernias usually
occur in infants and reach their maximal size by the first month of life. Most hernias of this type close spontaneously by the first year of life, with only a 2-10%
incidence in children older than 1 year. HerniaIncidence http://www.medindia.net/surgicalprocedures/hernia-incidence.htm#ixzz2TahgRVDl
We chose this case because we are aiming to gain more knowledge and explain all the necessary information about Indirect Inguinal Hernia. In addition, our
group will learn the needed action for this type of disease in hospital setting aside from the knowledge acquired in Nursing Education. And this study also aims to be
a reference for future studies and researches of other nursing students.
II. OBJECTIVES
CLIENTS OBJECTIVES
GENERAL
 To render the necessary nursing intervention for the patient having Indirect Inguinal Hernia.
SPECIFIC
Knowledge
 To evaluate an assessment for the client having Indirect Inguinal Hernia.
 To develop awareness for the client’s mother understand her son’s disease.
 To able to understand the importance of complying with the client’s medication.
Skills
 To conduct an assessment for the client having Indirect Inguinal Hernia.
 For the client’s mother to be able to manage her son in times of sickness triggers.
 To be able to practice self care activities appropriately.

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Attitude
 To be able to improve discipline in order to manage himself greatly.
 To be able to comply with treatments to promote recovery.
 To be able to build trust with the hospital personnel.
STUDENTS OBJECTIVES
GENERAL
 For us, nursing students to obtain a broad understanding about Indirect Inguinal Hernia through completing the necessary action and data for this case study.
SPECIFIC
Knowledge
 To increase knowledge about Indirect Inguinal Hernia.
 To learn the probable cause, sign and symptoms of Indirect Inguinal Hernia.
 To improve knowledge about how to do the ideal nursing intervention for clients with Indirect Inguinal Hernia.
Skills
 To do the necessary nursing intervention in hospital for client with Indirect Inguinal Hernia.
 To give the known medication for client with Indirect Inguinal Hernia.
 To do the necessary nursing intervention in hospital for client with Indirect Inguinal Hernia.
Attitude
 To observe and understand the behavior of client having Indirect Inguinal Hernia.
 To develop our nursing responsibilities.
 To give the proper care and build a genuine nurse-patient relationship conducive to good health.

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III. Nursing Assessment
A.BIOGRAPHIC DATA
Name: Baby S.A.M
Age: 4 teas old
Sex: Male
Civil Status: Single
Position in the family: Only child
Address: Tambubong, Baliuag, Bulacan
Birth date: May 27, 2008
Occupation: none
Nationality: Filipino
Religion: Roman Catholic
Educational Attainment:
Date of Admission: May 14, 2013Time: 1:15pm
Initial diagnosis: Indirect Inguinal Hernia Right: undescended testis Right for Herniotomy
Final diagnosis: Indirect Inguinal Hernia Right: undescended testis Right for Herniotomy
B. REASON FOR VISIT/CHIEF COMPLAINT
“Simula nung 5 months old palang siya, may luslos na sya sa kanang singit niya, tapos ngayong 4 years old lang siya pwedeng ipaopera sabi
ng Doctor.” As verbalized by the client’s mother.
C. HISTORY OF PRESENT ILLNESS
Patient’s condition started since he was a 4 months old baby as he cry actively it bulge out, then disappear back into the abdomen when he
stoped crying. The client was admitted in the hospital on May 14, 2013at 1:15pm.

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D. HISTORY OF PAST ILLNESS
The patient mother stated that baby S.A.M develop an Asthma but disappeared when the baby reached 2 years old. According also to his mother
he experienced coughs and colds. She does not have any regular medical and dental check-ups. He has a complete vaccine.
VACCINES AGE NUMBER OF DOSE DOSE ROUTE SITE
BCG Any time at birth
School entrance
1 0.05ml
0.01ml
ID
ID
Right deltoid
DPT 1 ½ months 3 0.5ml IM Upper outer portion of the thigh
OPV 1 ½ months 3 2 gtts Oral Mouth
Hepa B At birth 3 0.5ml IM Outer portion of the thigh
Measles 9 months 0.5ml Subq. Outer part of the arm

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E. Family Health Illness History (GENOGRAM)
According to the client’s mother, the client’s grandfather at her side, died due to cancer a long time ago. At the client’s father side, his
grandfather is with hypertension and Diabetes Mellitus. With regards to his mother’s siblings, one already died due to vehicular accident.
(Kozeir 8th edition, p. 434 volume 1)
BA
62
(+) hpn, DM
NA
60
GM
65
(+)Cancer
SM
63
AAM
23
MM
24
BM
25
PA
26
TA
29
JM
33
LM
27
SAM
4 YRS OLD
(+) IIH
DA
34
Legend:
Female
Male
Client
(+) IIH- Indirect Inguinal Hernia
(+) hpn- Hypertension
(+) DM- Diabetes Mellitus

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F. Functional Health Pattern
1. HEALTH PERCEPTION/HEALTH MANAGEMENT PATTERN
2. NUTRITIONAL METABOLIC PATTERN
Prior to Hospitalization During Hospitalization
According to the client’s mother, the client is playful and doesn’t complain
of any pain regarding his son’s hernia.
After the surgery, the client stated that his circumcised penis hurts but
the incision from herniotomy doesn’t hurt that much. He stated that he
wants to play and go out to the hospital already.
According to the Client’s mother, Before the client was hospitalized He used
to drink Bottled milk about 350mL thrice a day, In morning then after siesta
then before he goes to sleep. He used to eat a lot. And drinks at least 5 glasses
of water a day.
After the surgery, The client was ordered with DAT once fully
awake. He is with an IVF of D5 0.3 NaCl 500 cc at 40-42 gtts/min.
72 HOUR DIETARY RECALL
Date Noted Time of the Day Foods Taken
May 15,2013
(Tuesday)
Breakfast and
Lunch
(noon time)
1 small bowl of
Tinola with two
small pcs of
chicken
1 bottle
(350mL) of
Milk

13
Dinner
(evening)  1 small Bowl of
Lugaw with 1
small pc of
chicken
 1 bottle
(350mL) of
water
May15, 2013
(Wednesday)
Breakfast
(morning)
Lunch
(noon)
Dinner
(evening)
NPO
 NPO


1 small bowl of
Lugaw
1 bottle
(350mL) of
water
June 29, 2012
(Friday)
Breakfast
(morning)
Lunch
3 pcs of
pandesal
1 cup of coffee
(150ml)
1 small bowl of
pinakbet
1 cup of rice

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3. ELIMINATION PATTERN
2 glasses of
water (500 ml)
Prior Hospitalization During Hospitalization
According to the client’s mother, the client used to defecate at
least once a day and urinates for at least 3-4 times a day.
Character Color Odor Frequency Discomfort
Stool solid brown foul
odor
1 time No
Discomfort
Urine Regular
urination
water-
colored
urine
no
foul
odor
3-4 times
a day
No
discomfort
Perspiration : The client’s perspires much because he always
used to play with his cousins.
According to the client’s mother, the client defecates once a day. His urine is just the same
before he was hospitalized.
Character Color Odor Frequency Discomfort
Stool Solid stool Brown No
odor
1time Having
discomfort
due to pain
in the
circumcised
penis.
Urine Regular
urination
water-
colored
urine
no
foul
odor
2-3 times
a day
Having
discomfort
due to pain
from
circumcision.
Perspiration : The client’s perspire because of the pain
experiencing

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4. ACTIVITY/EXERCISE PATTERN
5. SLEEP/REST PATTERN
Fully dependent with his mother
Feeding =4 toileting =2 grooming =2
Bathing =2 dressing =2 bed mobility =4
LEGEND:
0- Full Self Care
1- requires use of equipment or device
2- requires assistance or supervision from other person
3- requires assistance or supervision from other person/ device
4 dependent and does not participate
Fully Dependent with his mother
Feeding =4 toileting = 2 grooming = 2
Bathing =2 dressing = 2 bed mobility = 2
LEGEND:
0- Full Self Care
1- requires use of equipment or device
2- requires assistance or supervision from other person
3- requires assistance or supervision from other person/ device
4 dependent and does not participate
The client, as stated by her mother, was always sleeping at exactly
8PM and wakes up at 6AM during school days. To be exact, he sleeps for
about 10 hours. But sometimes, he used to be awake before lunch. And
then he used to take a nap for at least 2 hours in the afternoon.
The client sleeps at 9PM to 6AM, to be exact, he sleeps at 9 hours. He
can’t sleep in the afternoon because he is not comfortable in the hospital and
stated the, “mainit kasi po dito.”

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6. COGNITIVE PERCEPTUAL PATTERN
7. ROLE RELATIONSHIP PATTERN
8.COPING STRESS TOLERANCE
The client has no problem in vision, hearing and sensory
perception.
The client has no problem in vision, hearing and sensory
perception.
The client is an only child but used to play with his cousins. When his
mother is at school, his auntie takes good care of him.
His father leaves at work to take care of him together with his mother.

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9. VALUES BELIEF PATTERN
G. Growth and Development
THEORY PSYCHOSOCIAL COGNITIVE PSYCHOSEXUAL MORAL
STAGE Preschool (3 to 5 years)
Initiative vs. Guilt
Pre operational stage
2 to 7 Years
Phallic stage
3-6 years old
genitalia
Pre-conventional morality
Stage 1: Obedience or
punishment orientation
After doing school works, He used to play with his cousins to relieve stress. The client talks to his mother to relieve stress of staying in the hospital
without TV.
The client is a Roman Catholic and goes to church to attend mass every
Sunday.
The client believed that praying to God will make him recover from his
surgery easily.

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Exploration
DEFINITION Children need to begin
asserting control and power
over the environment. Success
in this stage leads to a sense of
purpose. Children who try to
exert too much power
experience disapproval,
resulting in a sense of guilt.
Children begin to think
symbolically and learn to use
words and pictures to
represent objects. They also
tend to be very egocentric, and
see things only from their
point of view.
Developemental changes
Children at this stage tend to
be egocentric and struggle to
see things from the perspective
of others.
While they are getting better
The third stage of
psychosexual development is
the phallic stage, spanning the
ages of three to six years,
wherein the child's genitalia
are his or her
primary erogenous zone. It is
in this third infantile
development stage that
children become aware of their
bodies, the bodies of other
children, and the bodies of
their parents; they gratify
This is the stage that all young
children start at (and a few
adults remain in). Rules are
seen as being fixed and
absolute. Obeying the rules is
important because it means
avoiding punishment.

19
with language and thinking,
they still tend to think about
things in very conrete terms
physical curiosity by
undressing and exploring each
other and their genitals, and so
learn the physical (sexual)
differences between "male"
and "female" and
the gender differences between
"boy" and "girl".
FINDINGS PASS PASS PASS PASS
REMARKS Positive. The client , shows
that he has the power to
question what is happening to
him.
Positive. The client is in pre
operational stage ask a lot of
things to his mom and explain
it by using some gestures or
Positive. The client has more
on his feelings on his mother.
Positive. He obeys when in
command.

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pictures.
IV. Anatomy and Physiology

21
The inguinal canal is a passage in the anterior (toward the front of the body) abdominal wall which in men conveys the spermatic cord and in women the round
ligament. The inguinal canal is larger and more prominent in men. Each person has two, on the left and right sides of the abdomen.
The small intestine (or small bowel) is the part of the gastrointestinal tract following the stomach and followed by the large intestine and is where much of
the digestion and absorption of food takes place.
The superficial inguinal ring (subcutaneous inguinal ring or external inguinal ring) is an anatomical structure in the anterior wall of the human abdomen. It is a
triangular opening that forms the exit of the inguinal canal, which houses the ilioinguinal nerve, the genital branch of the genitor femoral nerve, and the spermatic
cord (in men) or the round ligament (in women)
The deep inguinal ring (internal or deep abdominal ring, abdominal inguinal ring, internal inguinal ring) is the entrance to the inguinal canal.
The spermatic cord is the name given to the cord-like structure in males formed by the vas deferens and surrounding tissue that run from the abdomen down to
each testicle
The testicle is the male gonad in animals testes are components of both the reproductive system and the endocrine system. The primary functions of the testes are to
produce sperm (spermatogenesis) and to produce androgens, primarily testosterone.

22
V. Pathophysiology
MODIFIABLE RISK FACTORS NON MODIFIABLE RISK
FACTORS
Inguinal ring will not closed
Increased pressure in the compartment of the
abdomen
Causing malfunction of the inguinal
ring
Intra abdominal wall (membranes and muscles) of the inguinal
canal into the scrotum becomes weakened
Evolves to a hole or defect
Nutrition Weak abdominal wall Age Gender Hereditary

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A. PHYSICAL ASSESSMENT
VITAL SIGNS: PR=131 bpm TEMPERATURE=37.6 degree RR=26 cpm
Height = 3’5” Weight = 35.2 lbs BMI : 14.7 Underweight
PAIN SCALE: 3/5 according to Wong Baker Face Pain Scale
May 15, 2013
Pain or discomfort to the affected
organs
Scrotum enlarged or swollen
Fatty substance or part of the small intestine slides
through the inguinal canal
INDIRECT INGUINAL HERNIATION

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PARTS TO BE ASSESSED TECHNIQUE NORMAL FINDINGS ACTUAL FINDINGS REMARKS
General appearance
1. Body built in relation to
client’s age, lifestyle & health
Inspection
Proportionate and varies with
lifestyle
He has a proportionate
(mesomorph) body built which
is appropriate with his lifestyle
Normal
2. Client’s posture & gait,
standing, sitting & walking
Inspection
Relax, erect posture,
coordinated body movements
n/a n/a
3. Client’s overall hygiene &
grooming
Inspection Neat He is neat and clean. Normal
4. Body & breath odor Inspection
No body odor or minor body
odor relative
no body odor Normal
5. Signs of distress in posture
or facial expression
Inspection No distress noted
There are sign of restlessness,
the patient is irritated and cries
at time
deviation from normal due to
pain felt by the patient
6. Obvious signs of health or
illness
Inspection Healthy appearance Weak in appearance
Deviation from normal due to
pain felt by the patient
7. Client’s attitude Inspection Cooperative Cooperative once kept calm Normal
8. Client’s affect/mood;
appropriateness of the clients
response
Inspection Appropriate to the situation Appropriate to the situation Normal

25
9. Quantity of speech, quality
& organization
Inspection
Understandable, moderate
pace; exhibits thought
association
Understandable and in a
moderate pace; exhibits
thought association answer to
question appropriately
Normal
10. Relevance & organization
of thoughts
Inspection
Logical sequence; makes
sense; has sense of reality.
Has a sense of reality Normal
SKIN
1. Skin moisture Inspection
moisture in skin fold and
axillae
Moist skin folds Normal
2. Skin Texture Inspection smooth smooth Normal
3. Skin turgor Inspection and palpation Springs back Springs back
Normal
Hair and Nails
1. Fingernails plate shape to
determine its curvature &
angle
Inspection
Convex curvature, angle of
nail plate about 160 degrees.
Convex and has less than 180
degree
Normal

26
2. Fingernail & toenail bed
color
Inspection
Highly vascular and pink in
light skinned clients; dark-
skinned clients may have
brown or black pigmentation
in longitudinal streaks.
Pinkish in color Normal
3. Tissues surroundings nails Inspection Intact epidermis.
He has an intact epidermis
with no hangnails
Normal
4. Fingernail & toenail texture Palpation Smooth texture. Smooth nail texture Normal
5. Blanch test of capillary
refill
Palpation
Prompt return of pink or usual
color (generally less than 4
seconds.)
The color return to the original
color in 2 seconds
Normal
1. Evenness of growth over the
scalp
Inspection Evenly distributed hair. His hair is well distributed Normal
2. Hair thickness & thinness Palpation Thick/thin hair. He has a thick hair Normal
3. Presence of infections or
infestations
Inspection Not present. Not present. Normal
4. Texture & oiliness over the
scalp
Palpation Silky, resilient hair. Silky, resilient hair. Normal

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SKULL
1. Size, shape & symmetry Palpation
Rounded (normocephalic and
symmetrical, with frontal,
parietal, and occipital
prominences); smooth skull
contour.
Head is symmetrically round. Normal
2. Nodules or masses &
depressions
Palpation
Smooth, uniform consistency;
absence of nodules or masses.
No mass or nodules noted; Normal
FACE
1. Facial features Inspection
Symmetric or slightly
asymmetric facial features;
palpebral fissures equal in
size; symmetric nasolabial
folds.
Symmetric or slightly
asymmetric facial features;
palpebral fissures equal in
size; symmetric nasolabial
folds.
Normal
2. Symmetry of the facial
movements
Inspection
Symmetrical facial
movements.
Facial movements are
symmetrical
Normal
EYEBROWS & EYELASHES
1. Evenness of distribution &
direction of curl
Inspection
Hair evenly distributed; skin
intact. Eyebrows
asymmetrically aligned equal
movement. Eyelashes curl
slightly outward.
Eyebrows and eyelashes are
both evenly distributed,
symmetrical aligned.
Eyelashes curl slightly
outward.
Normal
CORNEA

28
1.Clarity & color Inspection
Transparent, shiny and
smooth; details of the iris are
visible. In older people, a thin
grayish white ring around the
margin, called arcussenilis,
may be evident.
Details of iris are visible.
Transparent, shiny and
smooth.
Normal
IRIS
1. Shape & color Inspection Flat and round
Flat and round and uniform in
color.
Normal
PUPILS
1. Color, shape & symmetry of
size
Inspection
Black in color; equal in size;
normally 3-7 mm in diameter;
round, smooth border.
Firm and equal pupils Normal
EYELIDS

29
1. Surface characteristics &
ability to blink
Inspection and Palpation
Skin intact, no discharge, no
discoloration. Lids close
symmetrically approximately
15-20 involuntary blinks per
minute; bilateral blinking.
When lids open, no open, no
visible sclera above corneas,
and upper and lower borders
of cornea are slightly covered.
Eyelids skin are intact, no
noted discharge, and no noted
discoloration. Lids close
symmetrically. Client
exhibited 18 involuntary
blinks per minute.
Normal
CONJUNCTIVA
1. Bulbar conjunctivas color,
texture & presence of lesions
Inspection
Transparent; capillaries
sometimes evident.
Transparent, capillaries
evident, no discharge was
noted.
Normal
2. Palpebral conjunctivas
color, texture & presence of
lesions
Inspection
Shiny, smooth, pink or red in
color.
Shiny, smooth and pale in
color
starvation
SCLERA
1. Color & clarity Inspection
Sclera appears white
(yellowish in dark- skinned
clients).
Sclera appears white Normal

30
EAR’S AURICLE
1. Color & symmetry of size
&position
Inspection
Color same as facial skin,
symmetrical, auricle aligned
with outer canthus of eye,
about 10cm from vertical.
Color is same with facial skin,
symmetrical with each other,
auricle aligned with outer
canthus of eye, about 10 cm
vertical
Normal
2. Texture & elasticity & areas
of tenderness
Palpation
Mobile, firm and not tender,
pinna recoils after it is folded.
Both pinna recoils after being
folded. Mobile, firm and not
tender.
Normal
EXTERNAL EAR CANAL
1. Cerumen, skin lesions, pus
& blood
Inspection
Distal third contains hair
follicles and glands. Dry
cerumen in various shades of
brown
No noted pus, blood and odor.
Minimal cerumen noted.
Distal third contains hair
follicles.
Normal
HEARING ACUITY TEST
1. Client’s response to normal
voice tones
Inspection Normal voice tones audible
Client responds to normal
voice tones
Normal
NOSE
1. Shape, size or color &
flaring or discharge from the
Inspection
Symmetric and straight
No discharge or flaring
No discharge and/or flaring
noted. Symmetrical on both
Normal

31
nares Uniform color sides. Also uniform in color.
2. Presence of redness,
swelling, growths & discharge
or nares using the flashlight
Inspection
Mucosa pink
Clear, watery discharge
No lesions.
Mucosa are intact and pinkish;
minimal moist noted inside;
no swelling or nodules found.
Normal
3. Position of nasal septum Inspection
Nasal septum intact and in
midline, intact
Nasal septum is intact and in
midline
Normal
4. Test patency of both nasal
septum
Inspection
Air moves freely as the client
breathes through the nares
Air moves freely as the client
breathes through each nares
Normal
5. Tenderness, masses &
displacement of bone &
cartilage
Palpation Not tender; no lesions
No tenderness, no lesions
noted. No displacement of
bone & cartilage.
Normal
LIPS
1. Symmetry of contour color
& texture
Uniform pink color
Soft, moist, smooth texture
Symmetry of contour
Ability to purse lips
Uniform pale to pink color
Soft, moist, smooth texture
Symmetry of contour
Ability to purse lips
starvation

32
TEETH
1. Inspect for color, number &
condition & presence of
dentures
Inspection
20 baby teeth
Smooth, white, shiny tooth
enamel
20 baby teeth, 4 front teeth are
with cavities
teeth cavities
GUMS
1. Color & condition Inspection
Pink gums (bluish or dark
patches in dark-skinned
clients)
Moist, firm texture to gums
Slightly pale gums, moist, firm
texture
starvation
TONGUE/FLOOR OF THE MOUTH
1. Color & texture of the
mouth floor & frenulum
Smooth tongue base with
prominent veins
Smooth tongue base with
prominent veins
Normal

33
2. Position, color & texture,
movement & base of the
tongue
Central in position
Pink in color (some brown
pigmentation on tongue
borders in darj-skinned
clients); moist; slightly rough;
thin white coating
Smooth, lateral margins, no
lesions
Raised papillae (taste buds)
Moves freely, no tenderness
Centered; pink in color,
slightly rough, has thin white
coating, smooth, no lesions;
moves freely.
Normal
ABDOMEN
1. Skin integrity Inspection
Unblemished skin, uniform in
color, silver white striae
(stretch marks) or surgical
scars.
Uniform in color with surgical
incision
surgical procedure done
2. Abdominal contour Inspection
Flat, rounded (convex) or
scaphoid(concave)
Convex in shape.
Normal
3. Bowel Sounds Auscultation Audible bowel sounds Audible bowel sounds Normal

34
Summary of Physical Assessment:
General Appearance: Sign of Distress in Posture and Facial Expression - There are sign of restlessness, the patient is irritated and cries at time
Obvious Signs of health or illness- Weak in appearance
Conjunctiva: Palberal conjunctivas color texture and presence of lesions- Shiny, smooth and pale in color
Lips: Symmetry of contour color and texture- Uniform pale to pink color, soft , ,oist snooth texture, symmetry of contour
Gums: Color and condition- pale, firm texture.
Abdomen: Skin Integrity - Uniform in color with surgical incision

35
COMPLETE BLOOD COUNT – April 25,2013
T – 42.2 degree
TEST ACTUAL FINDINGS NORMAL FINDINGS
WBC 8.8 x 109
3.5 – 10 x109
RBC 4.2 x 1012
3.80 – 5.0 x 1012
HGB 124 g/L 110 - 165
HCT 0.354 L/L 0.350 – 500
PLT 208 x 109
/L 150 – 390
PCT 0-166 x 10-2
/L 0.100 – 0.600
WBC FLAGS DIFF:
% LYM 41.4% 17.0 – 48.0 %
% MON 17.5% 4.0 – 10.0 %
% GRA 4.1 % 43.0 – 76.0 %
Chrisger L. Santos
Medtech Lic # 46436
HEMATOLOGY – April 17, 2013
TEST ACTUAL FINDINGS NORMAL FINDINGS
HGB 147 g/L
HCT 0.40 g/L
WBC 11.5 x x 109
/L
PLATELET COUNT 208 x 109
/L
SEGMENTERS 53.0
LYMPHOCYTES 47.0
Chrisger L. Santos
Medtech Lic # 46436

36
URINALYSIS
April 17, 2013
TEST FINDINGS
Color Light Yellow
Characteristic Slightly Cloudy
Reaction Alkaline
SPGP 1.015
Albumin Negative
Sugar Negative
WBC 0 - 2
RBC 0 – 1
Epithelial Cells few
Bacteria few
April 25 , 2013
TEST FINDINGS
Color Yellow
Characteristic Cloudy
Reaction Acidic
SPGP 1.030
Albumin Negative
Sugar Negative
WBC 2 - 3
RBC 0 – 3
Epithelial Cells few
Bacteria few

37
Chrisger L. Santos
Medtech Lic # 46436
RADIOLOGIC EXAM
Chest
FINDINGS: Both lung fields are essentially clear.
Sinuses and diaphragm are intact.
Heart is within normal limits.
Lux Evelyn C. Trinidad MD, MPA
Radiologist

38
VI. THE PATIENT AND HIS CARE
A. Medical Management
a. IVF, Nebulization, NGT, TPN, Oxygenation therapy
MEDICAL
MANAGEMENT
TREATMENT
DATE ORDERED/ DATE
PERFORMED/ DATE
CHANGE OR D/C
GENERAL DESCRIPTION INDICATIONS/ PURPOSES CLIENT’S RESPONSE TO THE
TREATMENT
NURSING
RESPONSIBILITIES
Intravenous fluid-
D5 0.3 NaCl 500cc
(0.3% Dextrose in Sodium
Chloride)
Date ordered:
Date performed:
Date change:
 Hypotonic
Solution
 40-42 gtts/min
 Used to provide free
water and treat
cellulardehydration.
 Has lower
concentration than
the body fluids.
Signs and symptoms of
dehydration were not noted
such as dry skin.
Prior:
 Review physicians
order
During:
 Watch closely for signs
and symptoms of fluid
overload.
 Monitor I & O
After:
 Maintain patent IV line,
watch for irritation in
the insertion site.
 Monitor I & O
continuously.

39
Intravenous fluid-
D5LR 1L
(5% Dextrose in Lactated
Ringer’s Solution)
Date ordered:
Date performed:
Date change:
 Hypertonic Solution
 Fast drip
 It used to supply
water and
electrolytes (e.g.
Calcium, potassium,
sodium and
chloride.)
 Treatment for
persons needing
extra calories who
cannot tolerate fluid
overload.
Signs and symptoms of
dehydration were not noted
such as dry skin.
Prior:
 Review physicians
order
During:
 Watch closely for signs
and symptoms of fluid
overload.
 Monitor I & O
After:
 Maintain patent IV line,
watch for irritation in the
insertion site
 Monitor I & O
continuously

40
b. Drugs
Generic/ BrandName/
Classification
DATE
(ordered, given, changed,
discontinue)
Route of
Administration,
Dosage, Frequency
Mechanism Action Client’s Response Nursing Responsibilities
Generic Name:
Ibuprofen
Brand Name:
Dolan
Classification:
analgesic; antipyretic
Given
orally,250mg/5mL
Susp ½ tsp for 8hrs.
Blocks the prostaglandins,
substances our body
releases in response to
illness and injury.
Prostaglandins cause pain
and swelling
(inflammation); they are
released in the brain and
can also cause fever.
---- Prior:
 Take the patients vital signs
During
 Advised the patient to take it with
meals or milk if GI intolerance
occurs.
 Advise the patient to report any
signs of N&V, diarrhea or
constipation.
 Monitor input and output
continuously.
After:
 Monitor input & output
continuously.
 Assess forpossible side effects.

41
Generic Name:
Atropine Sulfate
Brand Name:
Artopen
Classification:
Cholinergic blocking drug
Generic Name:
Paracetamol
Brand Name:
Aeknil
Classification:
Analgesic,Antipyretic
Generic Name:
Midazolam Hydrochoride
5 mL
IV push
300mg
IV push
5mg/mL
IV push
To suppress salivation,
perspiration, and
respiratory tract secretions;
to reduce incidence of
laryngospasm, reflex
bradycardia arrhythmia,
and hypotension during
general anesthesia.
Reduces the synthesis of
prostaglandins which are
responsible for the
mediation of pain and
fever.
 Short-term
sedation
• Postoperative amnesia
----
-----
-----
Prior:
 Monitor vital signs.HR is a sensitive
indicator of patient’s response to
atropine.
During:
 The nurse should be alert in to
changes in quality, rate, and
rhythm of HR and respiration and
to changes in BP and temperature.
 Monitor input & output.
After:
continuously.
 Assess forpossible side effects
Prior:
 make sure that the patient to have
no allergies in acetaminophen
During:
 Monitor pulse and respiration
After:
 Assess for patients comfort
Prior:

42
Brand Name:
Dormicun
Classifications:
Benzodiazepine
Generic Name:
Cephalexin Monohydrate
Brand Name:
Ceporex
Classifications:
Antibiotic, Cephalosporin
(first generation)
Generic Name:
Ketamine hydrochloride
Given orally,susp 250
mg/5mL
Susp ½ tsp q8h
5mL
IV push
Inhibits synthesis of
bacterial cell wall, causing
cell death.
Anaesthesia for operations
of short duration and in
-----
------
 Monitor pulse and respiration
During:
 Monitor BP, pulse and respiration
continuously during IV
administration.
 Oxygen and resuscitative
equipment should be available in
case of respiratory depression.
After:
Prior:
 Monitor vital signs
During:
 Advised the patient to take it with
meals for GI upset.
 Advised the patient to report any
adverse effect such as rash,
yellow discoloration of the skin.
 Monitor input & output.
After:
 Advised the patient to consume 2-
3L/day of fluids to prevent
dehydration.
continuously.

43
Brand Name:
Ketazol
Classifications:
Anaesthetic
Generic Name:
Bupivacaine HCL
Brand Name:
Sensorcaine
Classification:
Amide type local
anaesthetic
Spinal Anaesthesia
5mL
case of painful diagnostic
interventions. Induction of
anesth prior to the
administration of IV
anesth.
Block the generation and
the conduction of nerve
impulses, presumably by
increasing the threshold
for electrical excitation in
the nerve, by slowing the
propagation of the nerve
impulse, and by reducing
the rate of rise of the
action potential.
----
Prior:
 Monitor vital signs
 Explain to the patient that this can
cause dizziness, drowsiness;
 nausea, and vomiting.
During:
 Monitor BP, pulse and respiration
continuously during IV
administration
After:
 Assess for patients
comfort
 Monitor input &
output
Prior:
 Inform the patient that they may
experience temporary loss of
sensation and motor activity,
usually in the lower half of the
body, following proper
administration of spinal anesthesia.
During:
 Maintain a patent airway.
 Monitor cardiovascular and
respiratory vital signs and the
patient's state of consciousness.

44
After:
c. Diet
Type of diet Date started General
description
Indications/purpose Specific foods
taken
Clients response to the
diet
Nursing responsibilities
Soft diet
DAT
Foods that are
easily digested
Diet as tolerated
All the foods
that the client
Foods which are easily digested and
pass quickly through your digestive
system. These help to reduce the
amount of time food stays in the
intestines and make bowel motions
soft and easy.
To regain his strength.
Lugaw
Water
Breads
Rice
Cereals
Fresh vegetables
The client understands
why he needs to take a
soft diet.
The client understands
why he needs to eat
nutritious food.
Prior:
Weigh the child before feeding
to make sure that the child
receives the right amount of
food.
After:
Record the fluid intake and
output intake.
Prior:
Tell the purpose of DAT to the
patient.
During:
Monitor and check the food
intake.

45
can ingest. fruits Make sure food the is nutritious
and beneficial to his present
situation.

46
d.Activity/Exercises
Type of Exercises Date Started General Description Indication/purpose Clients Response to the
Activity
Nursing Responsibilities
Ambulation The act of travelling by
foot; is a healthy form of
exercise.
It can help prepare and
condition the body for the
additional stress that
surgery will cause.
Improve muscle tone and
strength in his abdomen.
Prior:
Explain to him why he needs to
perform exercises.
During:
Assits patient while performing
the exercises.

47
B. Surgical Management
Surgical
management
Date performed General description Indication and purpose Client response Nursing responsibilities
Herniorrhaphy
An operation for hernia
that involves opening the
hernia sac,returning the
contents to their normal
place,oblitering the hernia
sac,closing the opening
with strong sutures.
Performed to close or mend the
weakened abdominal wall.
The patient is in
pain.
Prior:
 Explain to the procedure to the
client.
 Take the vital signs.
During:
 Maintain a patent airway.
 Monitor cardiovascular and
respiratory vital signs and the
patient's state of consciousness.

48
After:
 Assess for patients comfort.
VII. Nursing Problem Prioritization
DATE IDENTIFIED CUES PROBLEM/ NURSING
DIAGNOSIS
JUSTIFICATION
May 17, 2013 Subjective:
“medyo mainit siya” as
verbalized by the mother of the client.
Objectives:
> Febrile(37.6 ºC)
> warm to touch
>irritable
>pale
>weak in appearance
>restless
Altered body temperature related to
inflammatory process
-We include this in prioritization
because the patient is already warm to
touch and he is restless.

49
“medyo masakit po” as verbalized by
the client.
Objective:
> facial grimace
> wong baker scale 3/5
> guarding behavior
Acute pain related to surgical incision
on right inguinal area
because the patient’s wong baker scale
is already 3/5.
“di pa siya masyado makakilos” as
verbalized by the mother of the patient.
Objective:
>irritable
>restless
>cries at time
Decreased mobilization related to
discomforts on operation site
because the patient can’t move
normally and not doing his usual
activities.
“di pa siya masyado makakilos” as
verbalized by the mother of the patient.
Objective:
>irritable
>restless
>cries at time
Activity intolerance related to
discomforts on operation site
because the patient can’t move
normally and most of the time he is
depending on his mother.

50
VIII. Nursing Care Plan
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective:
“medyo mainit siya” as
verbalized by the
mother of the client.
Objective:
>Febrile(37.6 ºC)
>warm to touch
>irritable
>pale
>weak in appearance
>restless
>cries at time
>V/S as follows:
BP: 90/50 mmHg
RR: 26 cpm
CR: 131 bpm
Altered body
temperature related to
inflammatory process
Short term goal:
After 1-2 hours of nursing
intervention
 the patient’s body
temperature will
decreased from
37.6 ºC to 37 ºC
 Promote surface
cooling by means of
rendering tepid sponge
bath
 Promote bed rest
 Encourage the mother
to remove wet clothing
of the patient
 Discuss to the mother
the importance
of adequate fluid intake
of the patient
 Helps reduce
high
temperature
 to reduce
tension
 to provide
comfort
After 1-2 hours of
nursing intervention
 the patient’s
body
temperature
decreased from
37.6 ºC to 37 ºC

51
Subjective:
“medyo masakit po” as
verbalized by the client.
Objective:
> facial grimace
> wong baker scale 3/5
> guarding behavior
> irritable
> restless
> cries at time
>V/S as follows:
BP: 90/50 mmHg
RR: 26 cpm
CR: 131 bpm
Acute pain related to
surgical incision on
right inguinal
Short term goal:
intervention the client will
be able to:
 Report pain is
relieved from 3/5
to 1/5
 Provide comfort
measures,quiet
environment, andcalm
activities
 Instructin and
encourage use of
relaxationtechniques
 Keep the area clean
and dry, carefully
dress wounds,
support incision,
prevent infection
 To promote
nonpharmacologi
cal pain
management
 To distract
attention and
reduce tension
 To assist natural
body’s repair
After 2-4 hours of
the client was able to:
 Report pain is
relieved from 3/5
to 1/5

52
Subjective:
“di pa siya masyado
makakilos” as
verbalized by the
mother of the patient.
Objective:
>irritable
>restless
>cries at time
>V/S as follows:
BP: 90/50 mmHg
RR: 26 cpm
CR: 131 bpm
Decreased
mobilization related to
discomforts on
operation site
Short term goal:
intervention the client will
be able to:
 to move willingly
on his own
 demonstrate
techniques and
behaviors that
enable safe
moving or doing
activities
 Provide comfort
measures,quiet
environment, andcalm
activities
 Make yourself available
all the time
 Support and assist the
client in doing such
activities
 Keep the area clean
and dry, carefully dress
wounds, support
incision, prevent
infection
 To promote
nonpharmacolo
gical pain
management
 To help patient
do his activities
 To help patient
do his activities
 To assist
natural body’s
repair
After 3-5 hours of
the client was able to:
 to move willingly
on his own
 demonstrate
techniques and
behaviors that
enable safe
moving or doing
activities

53
IX. Health Teaching
LEARNING
OBJECTIVES
LEARNING CONTENTS STRATEGIES TIME ALLOTMENT RESOURCES EVALUATION
After 30-45 minutes of
health teaching, the
client’s mother will be
able to:
a .know what is Indirect
Inguinal Hernia
b. know the causes, and
risk factor of Indirect
Inguinal Hernia
c .know the sign, test
and symptoms of
Indirect Inguinal Hernia
d. know the possible
 A hernia occurs
when the contents of
a body cavity bulge
out of the area where
they are normally
contained. These
contents, usually
portions of intestine
or abdominal fatty
tissue, are enclosed
in the thin membrane
that naturally lines
the inside of the
cavity. Hernias by
themselves may be
asymptomatic
(produce no
symptoms) or cause
slight to severe pain.
Nearly all have a
potential risk of
having their blood
supply cut off
(becoming
strangulated). When
Interactive discussion
Lecture discussion
Pamphlet giving
30-45 minutes Manila Paper-₱ 5.00
Bond Paper-₱5.00
Transportation-50.00
Total:₱60.00
Manpower:
BSN 3-D, Group 2A
Materials:
Pamphlets and visual
aids
health teaching ,the
client’s mother was able
to:
a .Gain knowledge
about Indirect Inguinal
Hernia
b. Understand the
causes, and risk factor
of Indirect Inguinal
Hernia
c .Understand the sign,
test and symptoms of
Indirect Inguinal Hernia

54
treatment to Indirect
Inguinal Hernia
the content of the
hernia bulges out, the
opening it bulges out
through can apply
enough pressure that
blood vessels in the
hernia are constricted
and therefore the
blood supply is cut
off. If the blood
supply is cut off at
the hernia opening in
the abdominal wall,
it becomes a medical
and surgical
emergency as the
tissue needs oxygen
which is transported
by the blood supply.
Different types of
abdominal-wall
hernias include the
following:
 • Inguinal (groin)
hernia: Making up
75% of all
abdominal-wall
hernias and occurring
up to 25 times more
often in men than
women, these hernias
are divided into two
d. Gain knowledge
about possible treatment
to Indirect Inguinal
Hernia

55
different types, direct
and indirect. Both
occur in the groin
area where the skin
of the thigh joins the
torso (the inguinal
crease), but they
have slightly
different origins.
Both of these types
of hernias can
similarly appear as a
bulge in the inguinal
area. Distinguishing
between the direct
and indirect hernia,
however, is
important as a
clinical diagnosis.
 o Indirect inguinal
hernia: An indirect
hernia follows the
pathway that the
testicles made during
fetal development,
descending from the
abdomen into the
scrotum. This
pathway normally
closes before birth
but may remain a
possible site for a

56
hernia in later life.
Sometimes the hernia
sac may protrude
into the scrotum. An
indirect inguinal
hernia may occur at
any age.
 o Direct inguinal
hernia: The direct
inguinal hernia
occurs slightly to the
inside of the site of
the indirect hernia, in
an area where the
abdominal wall is
naturally slightly
thinner. It rarely will
protrude into the
scrotum. Unlike the
indirect hernia,
which can occur at
any age, the direct
hernia tends to occur
in the middle-aged
and elderly because
their abdominal walls
weaken as they age.
 • Femoral hernia:
The femoral canal is
the path through
which the femoral
artery, vein, and

57
nerve leave the
abdominal cavity to
enter the thigh.
Although normally a
tight space,
sometimes it
becomes large
enough to allow
abdominal contents
(usually intestine) to
protrude into the
canal. A femoral
hernia causes a bulge
just below the
inguinal crease in
roughly the mid-
thigh area. Usually
occurring in women,
femoral hernias are
particularly at risk of
becoming irreducible
(not able to be
pushed back into
place) and
strangulated. Not all
hernias that are
irreducible are
strangulated (have
their blood supply
cut off ), but all
hernias that are
irreducible need to

58
be evaluated by a
health-care provider.

 • Umbilical hernia:
These common
hernias (10%-30%)
are often noted at
birth as a protrusion
at the bellybutton
(the umbilicus). This
is caused when an
opening in the
abdominal wall,
which normally
closes before birth,
doesn't close
completely. If small
(less than half an
inch), this type of
hernia usually closes
gradually by age 2.
Larger hernias and
those that do not
close by themselves
usually require
surgery at age 2-4
years. Even if the
area is closed at
birth, umbilical
hernias can appear
later in life because
this spot may remain

59
a weaker place in the
abdominal wall.
Umbilical hernias
can appear later in
life or in women who
are pregnant or who
have given birth (due
to the added stress on
the area).

 • Incisional hernia:
Abdominal surgery
causes a flaw in the
abdominal wall. This
flaw can create an
area of weakness in
which a hernia may
develop. This occurs
after 2%-10% of all
abdominal surgeries,
although some
people are more at
risk. Even after
surgical repair,
incisional hernias
may return.

 • Spigelian hernia:
This rare hernia
occurs along the
edge of the rectus
abdominus muscle

60
through the spigelian
fascia, which is
several inches to the
side of the middle of
the abdomen.

 • Obturator hernia:
This extremely rare
abdominal hernia
develops mostly in
women. This hernia
protrudes from the
pelvic cavity through
an opening in the
pelvic bone
(obturator foramen).
This will not show
any bulge but can act
like a bowel
obstruction and cause
nausea and vomiting.
Because of the lack
of visible bulging,
this hernia is very
difficult to diagnose.

 • Epigastric hernia:
Occurring between
the navel and the
lower part of the rib
cage in the midline
of the abdomen,

61
epigastric hernias are
composed usually of
fatty tissue and rarely
contain intestine.
Formed in an area of
relative weakness of
the abdominal wall,
these hernias are
often painless and
unable to be pushed
back into the
abdomen when first
discovered.

 Hernia
Causes:Although
abdominal hernias
can be present at
birth, others develop
later in life. Some
involve pathways
formed during fetal
development,
existing openings in
the abdominal cavity,
or areas of
abdominal-wall
weakness.Any
condition that
increases the
pressure of the
abdominal cavity

62
may contribute to the
formation or
worsening of a
hernia. Examples
include:
obesity,heavy
lifting,coughing,strai
ning during a bowel
movement or
urination,chronic
lung disease and
fluid in the
abdominal cavity. A
family history of
hernias can make
you more likely to
develop a hernia.
 The signs
and symptoms of a
hernia can range
from noticing a
painless lump to the
severely painful,
tender, swollen
protrusion of tissue
that you are unable to
push back into the
abdomen (an
incarcerated
strangulated
hernia).Reducible
Hernia: It may

63
appear as a new lump
in the groin or other
abdominal area. It
may ache but is not
tender when touched.
Sometimes pain
precedes the
discovery of the
lump. The lump
increases in size
when standing or
when abdominal
pressure is increased
(such as coughing). It
may be reduced
(pushed back into the
abdomen) unless
very large.
Irreducible hernia: It
may be an
occasionally painful
enlargement of a
previously reducible
hernia that cannot be
returned into the
abdominal cavity on
its own or when you
push it. Some may be
chronic (occur over a
long term) without
pain. An irreducible
hernia is also known

64
as an incarcerated
hernia. t can lead to
strangulation (blood
supply being cut off
to tissue in the
hernia). Signs and
symptoms of bowel
obstruction may
occur, such as nausea
and vomiting.
Strangulated hernia:
This is an irreducible
hernia in which the
entrapped intestine
has its blood supply
cut off. Pain is
always present,
followed quickly by
tenderness and
sometimes symptoms
of bowel obstruction
(nausea and
vomiting). The
affected person may
appear ill with or
without fever. This
condition is a
surgical emergency.
 Hernia
Diagnosis:If you
have an obvious

65
hernia, the doctor
may not require any
other tests (if you are
healthy otherwise). If
you have symptoms
of a hernia (dull ache
in groin or other
body area with lifting
or straining but
without an obvious
lump), the doctor
may feel the area
while increasing
abdominal pressure
(having you stand or
cough). This action
may make the hernia
able to be felt. If you
have an inguinal
hernia, the doctor
will feel for the
potential pathway
and look for a hernia
by inverting the skin
of the scrotum with
his or her finger.

66
LEARNING
OBJECTIVES
student nurse-client
interaction, the patient’s
mother will be able to:
- State the uses of pain
management.
- Utilize different non-
pharmacological pain
management.
- Manifest a relief in
pain.
 Definition of no
management.- Non-
pharmacological or
natural therapies are
things you can do or
think about that help
decrease your pain.
These therapies do
not involve taking
medicines, but work
along with your
medicines. People
have used "natural"
ways to help with
pain and healing
from the very
beginning of time.*
The different non-
management.-
Breathing exercises,
Music therapy,
Massage,
Distraction, Heat and
Lecture discussion
Return Demonstration
Pamphlet giving
Bond Paper-₱5.00
Total:₱60.00
Manpower:
BSN 3-D, Group 2A
Materials:
aids
mother was be able to:
- State the uses of pain
management.
- Utilize different non-
management.
- Manifest a relief in
pain.

67
Cold, Laughter *
How to do deep
breathing exercises.
LEARNING
OBJECTIVES
mother will be able to:
- State the uses of Tepid
sponge bath to relieve
fever.
- make client manifest
signs of relief from
hyperthermia
 A tepid sponge bath
can reduce fever and
stress when
performed correctly.
Most generally, this
type of care is
offered in a hospital
setting to lower an
elevated temperature
but can be completed
easily at home.
"Textbook of Basic
Nursing" advises that
the bath must be
administered for at
least 30 minutes to
be effective.
Constant monitoring
of the patient's body
Lecture discussion
Pamphlet giving
Bond Paper-₱5.00
Total:₱60.00
Manpower:
BSN 3-D, Group 2A
Materials:
aids
mother was be able to:
- State the uses of Tepid
sponge bath to relieve
fever.
- make client manifest
signs of relief from
hyperthermia

68
temperature is
essential, so that it
does not drop below
normal.
Preparation
 Explain to the patient
what you will be
doing. The bath is
ineffective if the
patient is nervous or
frightened. Record
the temperature
before beginning the
bath. Gather the
needed supplies: bath
basin, several
washcloths, towels
and a bath sheet. Fill
the bath basin with
tepid water, 80 to 90
degrees Fahrenheit.
You may need to
refill the basin
several times
throughout the bath,
to prevent the water
from becoming too
cool.

 Soak four washcloths
in the tepid water and

69
wring out the excess.
Place one washcloth
under each of the
patient's arms and
one on each side of
his groin. The blood
vessels are close to
the skin in these
areas, and this will
help to cool the
patient more
effectively. At first,
the patient will be
chilled by this; allow
several minutes for
his body to adjust to
the temperature of
the water.

 Bathing
 Sponge each of the
patient's limbs for
five minutes.
Keeping the lower
half of the patient
covered, begin
sponging his arms
and chest. Work your
way to the legs,
keeping the patient
covered with a towel
in the areas you are

70
not bathing. Sponge
the back and
buttocks for ten
minutes. This time is
essential to lowering
the temperature
effectively. Continue
to monitor the
patient's temperature
at intervals
throughout the bath
procedure. Replace
the tepid water if
chilled. If at any time
the patient becomes
chilled and begins
shivering, stop the
bath.

 Discontinue the bath
once the temperature
has reached a normal
level. Cover the
patient with the bath
sheet.

71
X. Discharge Planning
 Medication
o Advise the client’s caregiver that Medications should be taken regularly as prescribed, on exact dosage, time, & frequency
o Report any side effects or adverse effect of the medication
 Exercise/Environment
o Tell the client’s caregiver that it is much better to provide the client with a well ventilated room.
 Treatments
o Inform client’s caregiver to fully participate in continuous treatment.
o Compliance to the medication.
 Health Teaching
o Teach all about the post op care of herniorrhaphy; how to care of the operation site.
 Out Patient
o Follow scheduled check-up by the Doctor
o Advise the client’s caregiver to report any unusual condition of the operation site.
 Diet
o High-fiber diet to prevent straining (pushing) during bowel movements.
o Advise to drink more liquids after surgery.
 Spiritual
o Always believe, pray, trust and have faith to God.

72
XI. Conclusion
Within the span of 2 day of rendering care to our client SAM We are able to identify potential problems of our client and all our Nursing Care Plan met its goals.
With the help of health teachings and other interventions, parents of S. we are able to learn how to recognize signs and symptoms and other risk factors of the
condition of their son. We are also able to know the necessary interventions to our client after the surgery. They also learned how to do simple interventions for the
client’s problems. They had also recognized the importance of compliance to treatment regimen in order to manage the condition of their son.
And at the end of this paper, we the Group 2 of BSN 3D were glad that we acquire the necessary knowledge and important nursing interventions on
our chosen case, Hernia. We are honored to do this study and are also hoping that this study will be used as one of a source for the future student nurses in their case
studies.
XII. Bibliography
http://en.wikipedia.org/wiki/Inguinal_hernia
http://prezi.com/ncllii1j-14b/indirect-inguinal-hernia/
http://www.scribd.com/doc/25970590/Case-Hernia
http://www.scribd.com/doc/49841652/Final-Case-Study-Hernia-1
http://www.ehow.com/way_5747279_tepid-sponge-bath-procedures.html

153294346 case-study-of-indirect-inguinal-hernia-r

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