INGUINAL HERNIA

 In an inguinal hernia, abdominal fat or a loop of small intestine enters the inguinal canal, a tubular passage
through the lower layers of the abdominal wall.
o A hernia occurs when a part of an internal organ protrudes through a weak point or a tear in the
peritoneum, resulting in a bulge.
 In men, inguinal hernias typically develop in the groin area near the scrotum, on one or both (double
hernia) sides. The resulting bulge can be painful, especially when you cough, bend over or lift a heavy object.

ANATOMY AND PHYSIOLOGY PATHOPHYSIOLOGY

• In human anatomy, the groin (the adjective is
inguinal, as in inguinal canal) is the junctional area
(also known as the inguinal region) between the
abdomen and the thigh on either side of the pubic
bone.
• This is also known as the medial compartment of
the thigh that consists of the adductor muscles of
the hip or the groin muscles.
• The inguinal ligament runs from the pubic tubercle
to the anterior superior iliac spine and its anatomy
is very important for hernia operations.
• Abdomen is the common target spot where the
maximum numbers of hernias like to develop.
• If the abdominal wall is not strong enough and has
some kind of a weakness, it can evolve into a
rupture or defect or hole that is localized.
• Through this orifice or rupture abdominal organs
and adipose tissue may push through and bulge
out.

Types
 Direct Inguinal Hernias
o Caused by connective tissue degeneration of the abdominal muscles, which causes weakening of the
muscles during the adult years.
o Direct inguinal hernias occur only in males. The hernia involves fat or the small intestine sliding through
the weak muscles into the groin.

Conditions which increase intra-abdominal pressure may contribute to the formation of a hernia, including:

 Obesity  Straining with urination or  Ascites

 Heavy lifting defecation  Peritoneal dialysis
 Coughing  COPD  Ventriculoperitoneal shunt

 Indirect Inguinal Hernias

o Is the protrusion of intestine through the inguinal ring caused by a failure of the vaginal process to
atrophy to close prior birth allowing for a hernial sac to develop along the inguinal canal.
o Indirect hernias are the most common type of inguinal hernia.

"Incarcerated" and "Strangulated" Inguinal Hernias

 An incarcerated inguinal hernia is a hernia that becomes stuck in the groin or scrotum and cannot be massaged
back into the abdomen. An incarcerated hernia is caused by swelling and can lead to
↓
 A strangulated hernia, in which the blood supply to the incarcerated small intestine is jeopardized. It is a serious
condition and requires immediate medical attention.
Signs and Symptoms
 Bulges along the pubic or groin area that can
appear to increase in size when you stand up or
cough.
 Pain when coughing, exercising, or bending over
 Burning, heavy or full sensation in the groin
 swelling of the scrotum in men
Assessment and Diagnostic Tests
• Clinical Evaluation - Your doctor will check your
groin area for swelling or a bulge. He'll probably
ask you to stand and cough. This can make a
hernia more obvious.
• Imaging tests such as abdominal ultrasound, CT
scan, or MRI.

Treatment
In adults, inguinal hernias that enlarge, cause symptoms, or become incarcerated are treated surgically. The two main
types of surgery for hernias are as follows:

• Open Hernia Repair – also called herniorrhaphy, The surgeon makes an incision in the groin, moves the hernia
back into the abdomen, and reinforces the muscle wall with stitches.
o Usually, the area of muscle weakness is reinforced with a synthetic mesh or screen to provide additional
support-an operation called hernioplasty.
• Laparoscopic Inguinal Hernia Repair – The surgeon makes several small incisions in the lower abdomen and
inserts a laparoscope, 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.

Most adults experience discomfort after surgery and require pain medication. Vigorous activity and heavy lifting are
restricted for several weeks. The doctor will discuss when a person may safely return to work.

Potential Complications Possible Nursing Diagnoses

 Hernia recurrence – the most common 1. Acute Pain

complication of inguinal hernia repair. 2. Deficient Knowledge
 Risk of general anesthesia 3. Risk for Injury
 Bleeding 4. Risk for Fluid Volume Deficit
 Wound infection
 Painful scar
 Injury to internal organs
NURSING MANAGEMENT
Major Nursing Considerations:
• Administer analgesic appropriate for the severity of pain and age. (Allays pain and discomfort caused
by the incision.)
• Maintain position of comfort. (Facilitates comfort and decreases pain caused by the strain on incision.)
• Instruct in doing sponge baths till the incision heals. (Maintains integrity of the incision.)
• Instruct the patient to avoid pushing, lifting, or engaging in a vigorous activity or gym classes. (Prevents
strain on the incision and possible hernia recurrence.)
• Encourage parents to increase fluid intake and protein-rich diet as ordered. (Promotes return to
nutritional status without causing gastrointestinal strain on the incision.)
 CASE PRESENTATION
+ Patient’s Demographic Data
+ Auza, Michael N. + The recent assessment data are shown below:
+ 37 y.o. ; Male Filipino Catholic, Single + T – 36.7 °C
+ From San Miguel, Bohol + P – 72 bpm
+ Physician – Dr. Ronald L. Ramiro on January 6, + R – 16 cpm
2019 at due to persistent pain in his inguinal + BP – 110/70 mmHg
area.
+ History of Present Illness
+ Patient exclaims of persistent pain in his inguinal area for several days PTA.
+ Past Medical History
+ 1. Immunizations --According to the S.O., the pt. had a complete record of all childhood immunizations.
+ 2. Allergies --The S.O. states that the patient has not experienced or had allergic reactions as of the moment.
+ 3. Accidents --According to the S.O. that so far, he had minor accidents prior to this admission.
+ 4. Hospitalization - According to the S.O., the patient had hospitalizations as a kid.
+ 5. Medicines – The S.O. notes that the patient has been taking OTC drugs.
+ 6. Operation --According to the S.O., the patient hasn't undergone any prior operations.
+ 7. Diet – The S.O. stated that the patient's diet comprises mostly of plant and meat based in balanced amounts.
Pt. does take 9-11 glasses of water a day as much as possible.
+ 8. Lifestyle – The S.O. states that he does exercises sometimes if vacant but manages to do it after work.
+ 9. Existing Diseases – According to S.O., the patient has no existing history of HPN, DM, and bronchial asthma.
+ Family History
+ The patient cannot recall any family member that has any history of HPN, DM, or asthma.
+ Socio-Economic History
+ The S.O. considers themselves as living in a middle-class family. As of his admission, the patients
relatives are doing their best to improve the patients condition and abides by the doctor’s orders.

NURSING CARE PLAN

+ Nursing Care Plan: Acute Pain
+ Subjective data: “Sakit ang akoang bilahan dapit, ana ang doctor basin hernia kuno kani...” as verbalized by patient.
COLDSPA: Sharp pain in the inguinal area that persisted several days PTA, happens intermittently; 7 on pain scale.
+ Objective data: Pt. seen at bed awake and hooked with PNSS 1L at 20 gtts/min; guarding noted on the affected
area; slight inflammation noted ; with the ff. V/S and laboratory results (latest):
+ T – 36.7 °C P – 72 bpm R – 16 cpm BP – 110/70
+ Nursing Diagnosis: Acute pain related to progressive disease process as evidenced by local inflammation, guarding
behavior, and verbal reports of discomfort.
+ Scientific Analysis
+ Pain is a highly subjective state wherein a variety of unpleasant sensations and a wide range of
distressing factors may be experienced by the patient. In a patient with inguinal hernia, internal organs
try to pass across a weak muscular support. This may elicit pressure to the surrounding structures,
causing intense pain and discomfort to the client.
+ Plan of Care
+ After 8 hours of nursing intervention, the patient will exhibit signs of decreased pain sensation as
evidenced by a pain scale of 6 or lower and verbal reports of comfort.
 Nursing Interventions
+ Establish rapport with pt. & S.O. (to facilitate patient and S.O. Participation and trust)
 + Provide morning care (to provide comfort and promote hygiene)
+ Take, monitor, and record V/S and I&O (to provide baseline data during treatment)
+ Regulate IVF (to maintain fluid balance in the vascular system)
+ Increase fluid intake as tolerated (to provide oral protection and prevent dehydration)
Specific Interventions:
 Administer analgesic appropriate for the severity of pain and age. (Allays pain and discomfort caused by the
incision.)
 Maintain position of comfort. (Facilitates comfort and decreases pain caused by the strain on incision.)
 Instruct the patient to avoid pushing, lifting, or engaging in a vigorous activity or gym classes. (Prevents strain on
the incision and possible hernia recurrence.)
 Provide opportunity for rest (to aid in cellular regeneration of the body)

+ Nursing Care Plan: Deficient Knowledge

+ Subjective data: “Wala kayo ko kasabot unsa man gud pamaagi ani sa ako pagpatambal sa akong sakit; nindot
sad nang makahibaw ta unsa ni pamaagi ani...” as verbalized by patient.
+ Objective data: Pt. seen at bed awake and hooked with PNSS 1L at 20 gtts/min; guarding noted on the affected
area; slight inflammation noted ; with the ff. V/S and laboratory results (latest):
+ T – 36.7 °C P – 72 bpm R – 16 cpm BP – 110/70
+ Nursing Diagnosis: Deficient Knowledge related to lack of pertinent information about disease process as evidenced
by request of information about possible treatment procedures
+ Scientific Analysis
+ Necessary information about one's illness is vital to a treatment regimen success. As such, it is important
to provide on-point information to the patient about treatment outcomes and needed procedures that
will be done in the course of the therapy. This will help alleviate anxiety and doubt in the patient while
he or she submits for the institution's care.
Plan of Care
+ After 8 hours of nursing intervention, the patient will exhibit signs of increased information as evidenced
verbal reports of understanding of the specified topic.
 Nursing Interventions
Specific Interventions:
 Assess parent’s knowledge of hernia including its causes, surgical management; Assess parent’s willingness and
interest to execute treatment regimen. (Promotes efficient plan of instruction to ensure compliance.)
 Provide parents and child as appropriate with clear and precise information in understandable language,
utilizing teaching aids and encourage questions. (To ascertain understanding based on age and learning ability.)

DRUG STUDY
+ As the physician made his notes, he ordered the following medications (drugs were not given all at once):

Celecoxib 200 mg 1 tab BID; Drug Class: COX-2 Inhibitor NSAID

+ Works by exhibiting anti-inflammatory, analgesic, and antipyretic action due to inhibition of the enzyme COX-2
Nursing Considerations
+ Assess pt’s history of allergic reaction to the drug
+ Teach patient to avoid aspirin and other NSAIDs (such as ibuprofen and naproxen) during therapy.
+ Advise patient to immediately report bloody stools, blood, or symptoms of liver damage
+ Instruct patient to take drug with food or milk.
 Diosmin + Hesperidin 500 mg 1 tab TID; Drug Class: Vasculoprotective
+ Works by increasing venous tone, improving lymphatic drainage and protecting the microcirculation from
inflammatory processes and apoptosis. By decreasing the expression of some endothelial adhesion molecules, MPFF
inhibits the activation, migration and adhesion of leukocytes at the capillary level.
Nursing Considerations
+ Assess pt’s history of allergic reaction to the drug
+ Avoid pt. exposure to sun, heat, excess standing and being overweight