INDIRECT INGUINAL HERNIATION
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
Pamphlets and visual aids
After 30-45 minutes of 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
53 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
54 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
55 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
56 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
57 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
58 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
59 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,
60 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
61 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
62 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
63 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
64 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.
65 LEARNING
OBJECTIVES
LEARNING CONTENTS STRATEGIES TIME ALLOTMENT RESOURCES EVALUATION
After 30-45 minutes of student nurse-client interaction, the patient’s mother will be able to:
- State the uses of pain management.
- Utilize different non-pharmacological pain 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- pharmacological pain management.-
Breathing exercises, Music therapy, Massage,
Distraction, Heat and
Interactive discussion
Lecture discussion
Return Demonstration
Pamphlet giving
30-45 minutes Manila Paper-₱ 5.00 Bond Paper-₱5.00
Pamphlets and visual aids
After 30-45 minutes of student nurse-client interaction, the patient’s mother was be able to:
- State the uses of pain management.
- Utilize different non-pharmacological pain management.
- Manifest a relief in pain.
66 Cold, Laughter *
How to do deep breathing exercises.
LEARNING OBJECTIVES
LEARNING CONTENTS STRATEGIES TIME ALLOTMENT RESOURCES EVALUATION
After 30-45 minutes of student nurse-client interaction, the patient’s 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
Interactive discussion
Lecture discussion
Pamphlet giving
30-45 minutes Manila Paper-₱ 5.00 Bond Paper-₱5.00
Pamphlets and visual aids
After 30-45 minutes of student nurse-client interaction, the patient’s mother was be able to:
- State the uses of Tepid sponge bath to relieve fever.
- make client manifest signs of relief from hyperthermia
67 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
68 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
69 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.
70 X. Discharge Planning
Medication
Advise the client’s parents that medications should be taken regularly as prescribed, on exact dosage, time, & frequency
Report any side effects or adverse effect of the medication
Exercise/Environment
Advise the client’s caregiver to give the patient some time to heal. For about a week, avoid strenuous activities. He may gradually resume normal activities, such as walking or playing when he is ready.
Treatments
Inform client’s caregiver to fully participate in continuous treatment. Make sure the patient get plenty of rest when get home for the first 2 or 3 days. Advise the client’s parents that they may apply a cold compress to the incision area for 20 minutes at a time for pain for the first few days.
Wrap the compress or ice in a towel.
Compliance to the medication.
Health Teaching
Teach all about the post operation care of herniotomy; how to care of the operation site.
Advise the client’s parents to take good care of the patient’s incision and dressings. And will need to keep the incision covered with bandages for the first 2 to 3 days. The parents may wash the area with mild soap and water after the stitches are gone.
71
Out Patient
Follow scheduled check-up by the doctor
Advise the client’s parents to take good care of the patient’s incision and dressings.
Advise the client’s caregiver to report any unusual condition of the operation site.
Diet
High-fiber diet to prevent straining (pushing) during bowel movements. Raspberries, pears, whole-wheat pasta, cooked barley, beans and broccoli are good sources of fiber.
Advise to drink more liquids after surgery.
Spiritual
Always believe, pray, trust and have faith to God
Conclusion
In our two days of handling and rendering care to our client SAM we gain more knowledge about the indirect inguinal hernia and we are able to identify the potential problems of our client. 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.
72
And at the end of this paper, we the Group 2 of BSN 3D we’re glad that we acquire the necessary knowledge and important nursing interventions on our chosen case, indirect inguinal 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