PATIENT/FAMILY CARE STUDY

ON

N.A

WITH

LEFT INGUINAL HERNIA HERNIA

BY

MR. ADU AMANKWAA KINGSLEY

OF

SCHOOOL OF NURSING AND MIDWIFERY,

UNIVERSITY OF CAPE COAST

FEBRUARY 2022.
 INTRODUCTION

This patient/family care study brings forth an elaborated report of holistic care rendered to Mr.
N. A. “The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities which contributing to health or its recovery (or to peaceful
death) that he would perform unaided if he had the required strength, will or knowledge and to
do this in such a way as to help him gain independence as rapidly as possible” (Henderson
1960) The care started with a nurse-patient and family interaction right on his admission. Mr. N.
A, a 35 year old man was diagnosed with left inguinal hernia. He was admitted on the 15th
February, 2022 by Dr. Kudor, a surgeon of the Cape Coast Teaching Hospital. He came in a
fully conscious state with acute pain at the left inguinal region. He had a bulge at the left groin
area which tends to be painful anytime he tries to cough. He was admitted through the surgical
OPD by General Surgery Team A.

My care and interaction with my client began on the 15th February, 2022 at of 3:30pm which
was the day of his admission at the Male Surgical Ward at the Cape Coast Teaching Hospital.
At the end of the interaction and my care, client’s condition improved remarkably without any
complications. All the signs and symptoms during and before hospitalization were no longer
present. He was discharged on the 18th February, 2022.
Education on the condition was given to prevent recurrence. Three follow–ups at home were
made to assess the health of my patient and family and to ensure continuity of care. Our
interaction finally ended on the 5th March, 2022 when I paid my last visit at home.
This study uses the process outlined in five chapters to describe the care given to Mr. N.
A right from admission through to pre-operative care to post-operative care and highlight the
inconvenient surgical complications (urine retention) leading to traumatic urinal catheterization.
For orderly presentation and organization of materials, this report has been divided into five
chapters.

Chapter one deals with assessment of patient and family which include patient’s particulars and
admission of patient. It also includes literature review of inguinal hernia and validation of data.

Chapter two involves analysis of data obtained from patient/family. The data collected is
compared with standard evidence based literature to establish a diagnosis.
Chapter three is made up of nursing care plan using the nursing process approach. Objectives
and outcome criteria towards improving the health of the patient is set. The care is planned out
within specific time frames directed at addressing all the patient’s presenting problems.

Chapter four deals with implementation of patient/family care plan, summary of actual care and
home visit.

The last chapter comprises of evaluation of nursing care rendered to patient/family, termination
of care, summary and conclusion.
 CHAPTER ONE

ASSESSMENT OF PATIENT/FAMILY
The first step in the nursing process is assessment. During assessment, data is collected from
patient and family. The methods used in the collection of data include observation, review of
patient’s records and interview. Assessment serves as data base upon which other steps of the
nursing process are built. It also helps in the identification of patient’s problems, strengths and
weakness which enable the nurse to plan a comprehensive nursing care for the patient and
family.

PATIENT’S PARTICULARS
Mr. N. A is 35 year old Ghanaian man from Akim-Oda in the Eastern Region. He was born on
16th September, 1987 to Mr. and Mrs. Adutwum. Mr. N. A is dark in complexion and he is the
last born among 5 siblings. Mr. N. A currently stays in Cape Coast in the Central Region with
his newly wedded wife. Mr. N. A has no child and he says his wife is a 5th year medical student
at the University of Cape Coast so they have planned of bearing child after the wife is done with
school. The parents of Mr. N.A are Mr. Charles Adutwum and Mrs. Elizabeth Adutwum both of
whom are all alive. Mr. N. A speaks Twi and English. He weights 69kg and has a height of
1.65m.
Mr. N. A started his education at Joduro Integrated School and had his high school education at
Achimota Senior High where he studied business. He had his undergraduate degree from the
University of Ghana where he studied Human Resource Management and completed in the year
2012. He works as an administrator at Central Region Development Commission (CEDECOM).

FAMILY MEDICAL AND SOCIO ECONOMIC HISTORY

Information gathered from Mr. N.A revealed that there is no known hereditary disease like
diabetes mellitus, hypertension or sickle cell in the family. He said that no family member of his
has been hospitalized before apart from himself. Further interactions revealed that, they
occasionally suffer from headaches, abdominal pains and other minor injuries which when it
occurs they treat by attending any nearby pharmacy shop. He stated that malaria is the only
condition he sometimes get and even with that he becomes healthy some few days after taking
malaria drug he buys from the over the counter drug store.

Mr. N. A stated that he is financially sound and takes care of his wife who is a 5 th year Medical
student at the University Of Cape Coast.
 PATIENT’S DEVELOPMENTAL HISTORY

Mr. N. A was delivered spontaneously by a midwife at the Oda Government Hospital without
any complications. He was born without any abnormality. He was breastfed though not
exclusively for one year and six months and was gradually weaned with porridge. He was
immunized against the vaccine preventable diseases at the time. He started walking at age one
and talking at about age two. He passed through his developmental stages without recording any
problem thus could sit, crawl, and stand on his two feet and walked. He started schooling at the
age of 6years. He experienced his secondary sexual characteristics at age sixteen. He got
married in 2021 at age of 34 and he has no child. He was brought up as a Christian and still
attends Pentecost.

PATIENTS LIFESTYLE AND HOBBIES

Mr. N. A usually wakes up around 5:30am, brushes his teeth, visits the toilet, takes his bath and
drives to work around 7:00am. He usually skips breakfast and if he doesn’t he takes tea and two
slice of bread just some few minutes before he sets off to work. He indicated that his lunch is
always bought from the restaurant. The food he normally takes for lunch is banku and okro stew
or fufu with light soup which he normally takes around 12pm-1pm. He closes from work at
5pm. After work, he usually eats his supper which is mostly his favorite jollof rice which he
either prepares himself or buys from a restaurant. Supper is mostly taken at 6pm-7pm. After
eating, he then takes his bath, relax whilst having a chat his wife. He retires to bed around 9pm.
This has been his normal routine every day except on weekends. He normally goes to the beach
side with his wife to relax when they have nothing to do on Saturday and goes to church on
Sunday at Ola Pentecost. He doesn’t drink alcohol neither does he smoke. His eliminating
patterns are regular. He moves his bowels at least once a day. He also urinates regularly. He
sleeps at least seven hours a day.

PAST MEDICAL HISTORY

According to Mr. N.A, he has never suffered any serious illness in the course of his growth.
However, he sometimes gets malaria which he normally treated with over the counter drugs and
not the hospital. The client said, his first hospitalization was in 2011 during his 3rd year at the
university where he was admitted to the university of Ghana hospital for a day where he
underwent a Malaria treatment. He did not suffer any complication of the condition. He also
indicated that he sometimes felt a bulge and painful sensation at the groins during heavy lifting
which subsides when he calmly presses on the bulge to reduce the bulge.

PRESENT MEDICAL HISTORY

Mr. N. A has been strong enough going about his normal activities until 12th February, 2022
when he noticed a bulge formed at the left groin around 4pm whilst he was at the house. The
bulged was accompanied by severe pain which radiated to the lower abdomen. The pain was so
severe that, he could not even walk. He tried to massage it calmly to push the bulge back in like
he usually does but the more he does it the more painful it was. He then lied down for some
time and the pain subsided in about an hour time around 5pm. Mr. N. A said he didn’t feel the
need for emergent medical attention since the pain subsided. The following day, 13th February
2022, Sunday at church, the pain reoccurred this time with slightly lower pain sensation but it
persisted for longer time than usual. The pain at the lower abdomen and left groin subsided after
3 hours. Mr. N. A said the need for medical attention arose the following day, Monday 14th
February, 2022, around 7pm at home when a large bulge accompanied by severe pain was felt at
the left groins. He said it was severe that he bent down and could not lift his body until his wife
came to assist him. This time his attempt to push the bulge to relieve the pain proved futile. He
said he found it difficult sleeping the whole night and the pain was worst the next morning so
his wife assisted him to the hospital. The wife took him to the surgical OPD at the Cape Coast
Teaching Hospital. He was seen by Dr. Kudor who requested a series of laboratory
investigations to be done and to be admitted to the Male Surgical Ward with the diagnosis of
recurrent Left inguinal Hernia.

ADMISSION OF PATIENT

Mr. N.A a 35 year old man was admitted to the Male Surgical Ward of Cape Coast Teaching
Hospital on the 15th February 2022 at 3:30pm through the surgical OPD (general surgery team
A) unit by Dr. Kudor with the diagnosis of left inguinal Hernia. He was brought to the ward
assisted by his wife. He came exhibiting the following signs and symptoms; slight headache,
abdominal pain, bulging at the left groins and restlessness and showing signs of distress. He was
warmly welcome at the nurses’ station. The patient was assured that he was in good and
competent hands that would do all their best towards his recovery. His vital signs were checked
and recorded as;

Temperature – 36.3˚c

Respiration - 18cpm

Pulse - 80bpm

Blood pressure – 134/84mmhg

On physical examination, a swollen left groin was detected and it bulges and becomes heavier
when he was instructed to cough.

The following laboratory investigations were requested Full Blood Count, Blood Urea and
Creatinine and samples were taken to the laboratory. Patient has registered with National Health
Insurance Scheme (NHIS) so he did not pay deposit but he was informed that NHIS does not
cover all the treatment so the wife must be ready to make such payment when the need arise of
which she agreed. The wife who already knew the ward was briefly oriented to the ward, she
assisted Mr. N.A throughout the orientation of the ward. They were shown the bathroom, toilet,
nurses’ station, and pantry and sluice room. The wife was told of the items the patients will
need throughout his stay; tooth paste and brush, bucket, comb, soap, sponge, towel, pomade etc.
of which they had everything already. Other staff on duty was introduced. He was informed of
visiting hours. Patient’s name, number, diagnosis, date of admission and age were entered into
the admission and discharge book and onto the daily ward state. His condition on admission was
fairly ill.

During the interaction, I introduced myself to the patient and his wife and told them all about
the patient and family care study. After explaining to them, I asked patient if he could permit
me to use him for my care study and he agreed. Patient and wife were educated on the
condition. They were informed that when Mr. N. A’s condition improves, he will be discharged
home for continuity of care.

Mr. N. A was put on the following medications;

Normal saline 1.5litres in 24hour

Dextrose 5% 2litres in 24hours

IV Ciprofloxacillin 200mg 12hourly x 24 hours

IV metronidazole 500mg 8hourly x 24 hours

IM pethidine 75mg 6hourly x 24hours

Supp paracetamol 1g 8hourly x 5days

Patient was to maintain nill per os (NPO) so was given intravenous fluid specifically 500mls of
5% Dextrose.

The following laboratory investigations were requested Full Blood Count, Blood Urea and
Creatinine and samples were taken to the laboratory

PATIENTS CONCEPT OF HIS ILLNESS

Mr. N.A indicated that he has done some search on the internet and has read about his condition.
He also indicated that his wife also educates him on the condition he has. He believes that his
inguinal hernia was a result of weakness of a spot in the inguinal area. He did not attribute the
illness to any supernatural forces. He also believed that he was in the hands of competent health
team and will get better. He said “since others underwent the same surgery and survived, why
wouldn’t I? Besides I have Jesus Christ who will see me through” he concluded.

LITERATURE REVIEW OF LEFT INGUINAL HERNIA

According to Brunner and Suddarth (2008), Hernia is a protrusion of an organ or part of an

organ through the wall of the cavity that normally contain it.
Left inguinal Hernia can therefore be described as a hernia of the groins or the inguinal region.
It occurs when the content of the abdomen bulges through the weak area of the abdominal wall
on the left side of the groins. This can occur at each side of the groins depending on which
abdominal wall muscle has become weak. Inguinal hernias may slide in and out of the
abdominal wall. A doctor can often move an inguinal hernia back inside the abdominal wall
with gentle massage. Inguinal hernias most often contain fat or part of the small intestines. In
girls, inguinal hernias may contain part of the female reproductive system, such as an ovary.
When an inguinal hernia occurs, part of the peritoneum bulges out through the abdominal wall
and forms a sac around the hernia.

INCIDENCE

Hernia occurs in both male and female and at any age but more common in men and older
adults than women. Inguinal hernia is more common in men than in women. And inguinal
hernia forms 75% of all abdominal hernias and occurs 25 times more often in men than in
women. And it can occur in both sides of the groin. It is the most common surgical condition
encountered in general surgical practice and the most common cause of acute intestinal
obstruction in developing countries.

AETIOLOGY

There are two main factors responsible for causing hernia in an individual.

1. A DEFECT OR WEAKNESS OF THE ABDOMINAL WALL WHICH MAY BE DUE

TO;

- A congenital defect which may occur during the seventh month of gestation.
- The weakness of the abdominal wall may be due to old age or infection
- Site of penetration of a blood vessel may become weak.
- Straining or injury may cause a tear of muscular fiber and this weakens the wall

2. REPEATED INCREASE IN INTRA-ABDOMINAL PRESSURE WHICH

PRECIPITATE THE PROTRUSION

This may result from

- Chronic lower urinary tract obstruction
- Chronic constipation
- Straining
- Chronic cough
- Uncontrolled obesity
- Heavy weight lifting or heavy manual work
- Frequent pregnancies
These mechanisms may increase the abdominal wall pressure which may cause progressive
formation of a peritoneal pouch which may become a sac through the potentially weak spot.

Inguinal hernias occur when part of the membrane lining the abdominal cavity (omentum) or
tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles
often along the inguinal canal which convey the spermatic cords in males and in females the
round ligaments of the uterus.

TYPES OF HERNIA

The hernia may be classified according to the anatomical site or severity

ANATOMICAL SITE

1. INGUINAL HERNIA: This is protrusion of the content of the abdominal cavity

through the inguinal canal. With this the inguinal canal is the weak point. It may be
direct or indirect and commonly found in males. Inguinal hernia forms 75% of all
abdominal hernias and occurs 25times more often in men than in women and occurs in
both sides of the groin
DIRECT INGUINAL HERNIA
This passes through the posterior inguinal wall. It is more difficult to repair and is likely to re-
occur after surgery.
INDIRECT INGUINAL HERNIA
This occurs due to weakness in the abdominal wall at a point through which the spermatic cord
emerges in males and round ligament in females. Through this opening, the hernia extends
down the inguinal canal and after into the scrotum or labia majora.

2. Femoral hernia
3. Umbilical hernia
4. Incisional hernia or ventral hernia
5. Para umbilical hernia
6. Cebrebral hernia
7. Diaphragmatic hernia
8. Epigastric hernia
9. Hiatus hernia
10. Sciatic hernia
ACCORDING TO SEVERITY
1. REDUCIBLE HERNIA: A hernia is said to be reducible if the contents or protruding
mass can be placed back into the abdominal cavity when the patient lies down or when pressure
is applied

2. IRREDUCIBLE HERNIA: With this, the protruding mass cannot be moved back into
the abdominal cavity.

3. STRANGULATED HERNIA: It is an irreducible hernia in which the content may

together with their blood supply become obstructed by constriction of the neck of the sac by the
defect in the abdomen through which the hernia protrudes. If the constriction is not relieved
urgently the bowel becomes gangrenous and perforates.

PATHOPHYSIOLOGY OF INGUINAL HERNIA

The inguinal canal is a passage in the lower anterior abdominal wall located just above the
inguinal ligament. This canal is 2.5-4 cm long and passes through the abdominal wall. In the
male it contains the spermatic cord and in the female it contains the round ligament.

As a natural canal with orifices, widening can develop to let other structures from the abdominal
cavity pass through to the extra abdominal space.

The inguinal hernia occurs when an organ or a part of an organ usually the small intestines and
part of the membrane lining the abdominal cavity (omentum) protrude through a weak point of
the inguinal cavity.

CLINICAL FEATURES

1. A bulge formed in the left side of the pubic bone which becomes more obvious when
you are upright, cough or strain.
 2. Burning sensation will be felt at the bulge
3. Pain or discomfort in your groin, especially when you bend over or cough or lift heavy
item.
4. There will be a heavy or dragging sensation in your groin
5. There will be weakness or pressure in your groin.

If the bulge is unable to push back in, the content of the hernia may be trapped in the abdominal
wall. An incarcerated hernia can become strangulated which cuts off the blood flow to the tissue
that is trapped. This strangulated hernia can be life-threatening if it is not treated. Signs and
symptoms of a strangulated hernia include

1. Nausea, vomiting or both

2. Fever
3. Sudden pain that quickly intensifies
4. A hernia bulge that turns red, purple or black
5. Inability to move your bowels or pass gas.

DIAGNOSTIC INVESTTIGATION
- A physical exam is usually all that is needed to diagnose an inguinal hernia. You will be
asked to stand and cough or strain because inguinal hernia is more prominent when standing
upright.
- History taking from the patient
- Signs and symptoms presented by the patient
- Abdominal ultrasound
- CT scan
- MRI

TREATMENT

Hernia can be treated by two means;

- Mechanical reduction
- Surgical method.

MECHANICAL REDUCTION
This is a non- operative treatment in which the hernia is push back into its own cavity. Before
pressure can be applied to the swelling, the hernia must first be reduced by putting the patient in
the dorsal position. Elevate the foot of the bed and apply ice on the herniated site. A truss may
be recommended, however it is not recommended in;
- Infants, where there is a need to wait for a weight gain before surgery or for remission of
another problem such as bronchitis.
– Adult who has an underlying problem needs to be resolved first. A truss does not cure hernia,
it simply prevent the abdominal content from entering the sac. Its side effect may include the
following; Skin Irritation, lesions may result from content rubbing and when not properly fitted,
may cause strangulation of the hernia. Daily bathing and the use of corn starch powder can
lessen the possibility of irritation.
SURGERY
This is the best and appropriate treatment for all hernias and also to prevent continual danger of
strangulation. When strangulation occurs, surgery becomes imperative and is attended
invariably by considerable risk. The surgical procedure involves removal from the surrounding
structures. The content is then replaced in the abdominal cavity and its neck is legated. The
muscle and fascia layer then are sutured together firmly over the hernia or orifice to prevent
recurrence. The incidence of recurrence is 5% to 25%.
Surgery for the treatment of hernia comes in variety of form as;
- HERNIORRHAPHY: The sac is open, any content return into the abdomen.
The neck of the sac is then tied off and excised but no repair of the inguinal canal is required in
children.
- HERNIOTOMY: this is incision of the hernia sac and content returns into the abdomen the
neck of the sac is then tied off and excised but no repair of the floor is done as in children.
– HERNIOPLASTY: A plastic repair of the abdominal wall performed after reduction of the
hernia. This is valuable in cases of large or where the patient does heavy manual work.
PROGNOSIS
Early surgery to repair the hernia has a good prognosis. However the prognosis usually is poor
in patients who seek surgical treatment late. It is also poor in those who develop complication
before surgery.

COMPLICATIONS
- Incarceration or strangulation: This may seriously interfere with normal healing, can cause
ischemia and later necrosis and gangrene which may become fatal.
-Obstruction: For example when a part of the bowel herniates, the bowel contents can no longer
pass through the lumen of the intestine. These result in cramps and later vomiting, absence of
flatus and absence of defecation.
-Inflammation
-Irreducible
-Peritonitis
-Septicemia
- Fistula formation
-Rapture of hernia sac

NURSING MANAGEMENT/PRE-OPERATIVE CARE

The pre-operative care or phase of surgery begins when the decision to have surgery is made to
when the client is transferred to the operating table. Pre-operative preparation therefore is the
care given to client who is to undergo surgery so as to make him or her suitable and comfortable
for the operation. This preparation is divided into three main categories;

PSYCHOLOGICAL PREPARATION
Psychological preparation of client for surgery deals with preparing the mind of the client to
ally fear and anxiety and gain his or her co-operation. Client is educated on his condition, the
type of operation he is to undergo, that an incision would be made around his groin and the
necessary repair made. He is also informed of the possible outcome after the operation. Client is
allowed and encourage to ask questions and appropriate and easy to understand answers are
given to clarify any misconception. Patient is encouraged also to express any fear and problems.
The theater nurse and the anesthetist are invited to visit the client at the ward to explain the type
of anesthesia that would be given and the number of people he is likely to meet at the theater
room. This is to make the client feel at ease and welcomed when he goes to the theater room. If
available, a client who has undergone the same or similar operation and is recovering is
introduced to the client to share his or her experience with the client. Client’s family members
are educated to support him emotionally.

PHYSIOLOGICAL PREPARATION
Various laboratory investigations are done to prepare the patient toward surgery to rule out any
abnormalities. Patient’s nutritional status is then assessed and a well-balanced diet rich in
protein and calorie is maintained. Some of these laboratory investigations may include;
Haemoglobin level estimation, blood film for malaria parasites, platelets count etc.

PHYSICAL PREPARETION
This normally comprise of maintaining the physical body and shaving. Shaving is done from
the umbilicus to the pubis or the mid-thigh under the scrotum for males and inner thigh. Wash
with soap and water, dry with towel on the day before operation. On the day of operation, the
patient is made to take his or her bath with soap and water to maintain a clean skin. After, lotion
(iodine tincture) is used to further clean the operation site and its surroundings and covered with
sterile towel. Patient is fasted for 8 to 12 hours before operation to avoid possible aspiration
pneumonia. Patient is asked to empty his bowel and bladder before operation. The following
immediate physical pre-operative measures should be carried out;
 The right patient should be identified with the condition as well as the operation.
 Patient aesthetical records should be prepared and added to his or her folder.
 The patients consent form should be signed.
 Client mouth should be checked for denture and if any is found, remove to prevent
choking.
 Client jewelries and ornaments should be removed to prevent any electrical shock from
appliances used in the theater room.
 Client vital signs are checked and recorded.
 Client clothes are changed and are gowned with theater gown.
 Client is accompanied to the theater with inserted catheter and his folder.

BOWL PREPARATION

Light nourishing diet is given two days prior to the operation as part of bowel preparation.
Breakfast is omitted on the morning of the surgery to prevent vomiting and aspiration.

EXERCISE
Pre-operation teaching of deep breathing exercise is done and client is advised to splint the
operation site when coughing or during examination as that will lessen pain after surgery.
Patient does the splinting with the hand. Patient is taught how to exercise during post-operative
period to prevent deep vein thrombosis.
POST-OPERATIVE MANAGEMENT
This is the care rendered when client return to the ward from the recovery ward. This phase
begins with the admission of the client to the post anesthetic care unit and ends when healing is
complete. Post-operation care of a client who has undergone an operation for hernia includes;

POSITION: Patient is received from theater and placed in an already prepared bed. He is put in
a recumbent position with the head turned to one side. This aids free flow of secretion from the
mouth. It also prevents aspiration of secretions and also prevents the tongue from falling back.

OBSERVATION: The temperature, pulse, respiration, and blood pressure are taken quarter
hourly for one hour, then half hourly until patient is fully conscious. The wound is observed for
bleeding. Fluid Intake and output chart is maintained.

DIET: intravenous fluids are continued up to the next 48 hours. This is followed by sips of
water and then light diet such as light soup prepared with soft fish and is eaten with soft food.

CARE OF WOUND: Inspection of operational site, start from the day of operation up to the
third day when dressing is changed. This is done using aseptic techniques. Methylated spirit is
used during dressing and dry dressing used to cover wound. Five days after surgery, alternate
stitches are removed and on the seventh day, the remaining is removed.

PERSONAL HYGIENE: Patient’s hygiene is cared for. He is made or assisted to take his or
her bath in bed and pressure sore areas treated accordingly. Oral toileting is done assisted or
unassisted.

ELIMINATION: patient is encouraged to empty his bladder and bowel. In this case, urinary
catheter is passed; urinary bag is emptied when full to prevent infection.

EXERCISE: Patient is helped to carry out passive exercise on the fourth day of post-operative.
Client is assisted to move a few steps around his bed within 24to 48 hours. After 48 to 72 hours,
client should be able to care for him or herself.
 PATIENT EDUCATION
Client is educated on how to bath and how to keep the wound dry. Client is tough to take in
more fluids and fruits to prevent constipation. Client is advised against lifting of heavy objects
for at least the first three months after the operation to prevent incisional hernia and
reoccurrence of condition.

REHABILITATION
Patient is informed the appropriate time he can resume a full time job is after 3 weeks, however,
lifting of heavy items should not be encouraged until after 6 weeks.. He is encouraged to
undertake regular walking exercises to enable him regain his former posture.

VALIDATION OF DATA
This is the act of confirming or verifying data collected from client. The purpose of this is to
keep data as free as possible from errors, bias or misinterpretation.
The information gathered from Mr. N. A was also verified by his wife and some were verified
through my own observation. Other useful information was received from doctors’ notes,
nurses’ notes and laboratory investigation and these sources of information provided were
consistent data without variation. Comparison made from text books of clinical features to that
Mr. N.A manifested also confirmed the diagnosis of left inguinal hernia. I assert that the found
data is dependable and valid and can be relied upon for comprehensive care.
 CHAPTER TWO

ANALYSIS OF DATA
This is the second step of the nursing process. It comprises comparing data that are collected
with established standard, a list of patient and family strengths, health problem and nursing
diagnosis. Here, the relevant or important data collected is compared with the literature review.

COMPARISON OF DATA WITH STANDARDS

The purpose of diagnostic investigations and test is to confirm diagnosis and rule out any other
condition for effective treatment. This includes; diagnostic investigation/test, causes, clinical
features, treatment and complications

DIAGNOSTIC INVESTIGATION
Diagnostic tests are used to confirm or rule out conditions and diseases. This is done to detect
abnormalities, infecting organism and an increase or decrease in the normal constituent of the
internal environment.
The following laboratory investigations were conducted on Mr. N. A;

1. Blood for haemoglobin level estimation

2. Blood for sickling
3. Blood for complete blood count (CBC)
4. Urine for routine examination
 TABLE 1: DIAGNOSTIC INVESTIGATION
DATE SPECIMEN INVESTIGATION RESULT NORMAL VALUES INTERPRETATION REMARKS

16/2/2022 Blood Haemoglobin level 13.3g/ dL Male: 13.2-17.5 g/dL of Within normal range No treatment
9:00am estimation blood. indicating that client has required
Female: 11.6-15.0 g/dL of enough hemoglobin to Patient was advised to
blood. sustain the operation. eat a balanced diet

16/2/22 Blood White blood cell count 6000 WBC/mcL of 4000-11000 WBC/mcL of Values were within No treatment
9:00am blood blood normal range indicating required.
no infection

Blood Platelets count 320,000mm3 200,000-350,000mm3 Within normal Good clothing ability
of blood hence fit for
surgery

Blood Red blood cell count 5.0mmol Male= 4.5-6.5 mmol Within normal range Patient is fit for the
Female = 3.8-5.8 mmol surgical operation
 Blood Sickling test Negative Negative. They are to be No sickling cell found in No treatment
round and biconcave in blood. All cells were of required.
nature. normal shape. Patient was informed
of his sickling status

Blood Blood film for malaria No malaria parasites There should not be any There were no malaria No treatment
parasites seen malaria parasite in the blood parasites in the blood required. patient was
indicating absence of encouraged to sleep
malaria. under insecticide
treated net
16/2/2022 Urine Routine examination Colour-amber Colour-amber Within normal Patient was
pH- 5.0 pH 4.5-8.0 encouraged to take in
specific gravity specific gravity more fluids and to
1.010 1.001-1.035 urinate frequently
Blood Grouping and Cross Blood Group A,B,AB Group A Normal No treatment required
matching and O
 TABLE TWO: COMPARISON OF CLINICAL FEATURES EXHIBITEDBY
PATIENT WITH CLINICAL FEATURES FROM THE TEXTBOOK
CLINICAL FEATURES FROM CLINICAL FEATURES EXHIBITED BY
TEXTBOOK THE PATIENT

1) Hernia may appear suddenly or gradually 1) Client hernia appeared suddenly.

2) There is a visible and palpable swelling 2) There was a visible palpable swelling when
when patient coughs. patient cough.

3) Vomiting may occur. 3) Client did not vomit.

4) There may be associated pain at the 4) There was pain at the left inguinal region.
herniated site.

5) Hernia may be large and reach the scrotum. 5) Client hernia was confined to the left inguinal
region.

6) Hernia may be reduced when gently 6) Client hernia was reduced when it was gently
massaged. massaged.

CAUSES OF HERNIA COMPARED WITH STANDARD

According to the causes of hernia listed under the literature review, the following are the
causes of the patient’s hernia.
Weakness of the abdominal wall due to old age
Increased intra-abdominal pressure
SURGICAL TREATMENT

The surgical treatment is done with local anesthesia and sedation or general anesthesia, in this
procedure, incision is made in your groin and the protruding tissue is pushed back into your
abdomen. The weakened part is then sewed and often reinforced with a synthetic mesh. And
this type of hernia repair surgery where a mesh patch is sewn over the weakened region of
tissue is called HERNIOPLASTY.
 MEDICAL TREATMETN OF PATIENT

The following are the drugs ordered for the client throughout the period of hospitalization.

PREOPERATIVELY

a. Injection pethidine 50mg stat.

b. Intravenous fluids.

- Ringers Lactate 1 litre x 24hours

- Dextrose saline 2 litres x 24hours

POST OPERATIVELY

a. Tablets Ciprofloxacin 500mg bd x 72 hours

b. Tablets Metronidazole 400mg tds x 72 hours
c. Injection Pethidine 100mg bd x24 hours
d. Suppository Diclofenac 50mg bd x 72 hours
e. Intravenous Fluids including
- Dextrose Saline 2 litres x 24hrs

- Ringers Lactate 1 litre x 24hrs.

f. tranxemic acid 500mg x 48hrs

g. Clindamycin 150mg/mL in 2ml injection 30mgx 48hrs

These medications were collected and served accordingly until completion.

 PHARMOCOLOGY OF DRUGS ADMINISTERED TO PATIENT

This encompasses the types of drugs, classification and route of administration, the
therapeutic and side effects of all the drugs that were prescribe and administered to the client.
It has been organized in a tabular form as shown below:-

 
 TABLE THREE: PHARMACOLOGY OF DRUGS ADMINISTERED
DATE DRUGS DOSAGE / ROUTE OF CLASSIFICATION DESIRED EFFECT ACTUAL ACTION SIDE EFFECTS AND

ADMINISTRATION OBSERVED REMARKS

15/2/22 Dextrose [500ml] for x 10 days Glucose-elevating To provide extra water, Water and calories were Extravasation,
saline infusion agents glucose and electrolytes provided hypervolemia, fevers, fast
or slows heartbeat, pain,
redness, severe headache.
None was observed
16/2/22 Ringer Lactate 500ml for 24hrs Alkalinizing agent To provide fluids and Fluid and electrolyte were Agitation, back pain,
intravenous electrolytes provided. bluish color of the skin,
decreased heart rate. None
was observed
16/2/22 Ciprofloxacin [Infusion 2mg/ml in Class To treat varied bacterial Patient showed no sign of Nausea, vomiting, stomach
100ml /infusion] 400mg fluoroquinolones infections infection of any kind pain, heartburn etc. none
for 2 days was observed
16/2/22 morphine 10mg/ml injection Opioid analgesic To reduce pain Pain was relieved Dry mouth, blurred vision
5mg for 2 days and vomiting. None were
observed
16/2/22 Tranxemic 500mg for 2 days Antifibrinolytic To treat and prevent Bleeding from the penis Nausea, vomiting, chills,
acid excessive blood loss from after traumatic fever, severe headache.
major trauma. catheterization was stopped None was observed
16/2/22 Metronidazole 5mg/ml in 100ml. Anti-protozoa agent To treat protozoa infection Patient showed no signs Dizziness, headaches,
500mg for 24hrs especially in the intestines infection of any kind till gastric disturbance. None
or liver discharge were noticed.
17/2/22 Diclofenac Non-Steroidal Anti- 50mg bd x 72horus To relieve pain reduce Pain, temperature and Gastric irritation, nausea
Suppository Inflammatory Drug Anal temperature and prevent inflammation were and vomiting. None were
(NSAID) inflammation controlled, patient never had observed.
temperature above normal
(36.8oC-37.2oC)
17/2/22 Clindamycin 150mg/ml in 2ml IV x Lincomycin To treat bacterial infections Patient showed no sign of Nausea, vomiting,
24hrs antibiotics infection of any kind unpleasant taste in the
mouth, joint pain, etc. one
was observed

17/2/22 Diclofenac 50mg bd x 72horus Non-Steroidal Anti- To relieve pain reduce Pain, temperature and Gastric irritation, nausea
Suppository Anal Inflammatory Drug temperature and prevent inflammation were and vomiting. None were
(NSAID) inflammation controlled, patient never had observed.
temperature above normal
(36.8oC-37.2oC)
18/2/22 Ciprofloxacin 500mg bd x 72hours Broad spectrum To treat intra-abdominal Patient never had any Dizziness, abdominal pain,
Orally antimicrobial agent infections, gynaecological infection nausea and vomiting. None
infection and upper were observed.
respiratory tract infection
18/2/22 Paracetamol [500mg tab] 1g x 5 days Analgesics and To treat mild to moderate Pain was reduced. Trouble breathing and
tab antipyretics pain. talking, tightness in the
chest and throat, wheezing
sound, skin rash. None was
observed
 COMPLICATIONS

With reference to the outlined complications on the literature review, Mr. N.A did not develop any
complication from the inguinal hernia; however, there was surgical complication. Mr. N.A developed post-
op urinary retention. Hematuria developed due to traumatic passage of catheter at the theatre recovery
room.

POST-OP URINARY RETENTION

Postoperative urinary retention occurs when a client after undergoing surgical procedure is unable to
urinate despite having a full bladder. Postoperative Urinary retention (POUR) is a common complication of
surgery and anesthesia. The risk of retention is very high in surgical procedures like, hernia repair,
anorectal surgery, and orthopedic surgery and increases with increasing age.

TREATMENT

The best treatment for postoperative urinary retention is prevention and should involve the entire treatment
team in identifying and optimizing preoperative, intraoperative and postoperative risk factors.

1. Patients at greatest risk of developing Postoperative urinary retention should be identified

preoperatively based on risk factors such as age, sex, comorbidities and surgery type such as hernia
repair, anorectal surgery and orthopedic surgery.
2. Intraoperative risk factors leading to POUR include operative time, intraoperative intravenous fluid
volume, and type of anesthetic used. Operative time more than 2 hours has shown to be a
significant predictor.
3. Postoperative risk factors for the development of POUR include slow time to ambulation and
systemic opioid used.
MANAGEMENT
If POUR develops and the bladder becomes full, the bladder is required to be drained. Urinary
catheterization is recommended to drain the bladder.
 COMPLICATIONS

Hernia repair was successfully done. Patient had the edge to urinate but he was unable to void. He was
examined and diagnosed with Postoperative urine retention. A urine catheter was recommended to drain
the bladder. 20F urine catheter was used. About 50ml of urine was expelled and the catheter balloon was
inflated. Few seconds after inflation, blood started to expel from the penis through the catheter. The
bleeding continued and the catheter was deflated and removed. The catheter size was changed and 18F was
inserted, bleeding continues with no urine coming so the catheter was removed.

Mr. N. A complained of severe pain in the lower abdomen associated to fullness of the bladder. Dr.
Aniagyei was informed and he came to perform a suprapubic tap. Immediately after the tap 300ml of urine
was expelled.

500ml of Normal Saline was set

Tranxemic acid 500mg was given.

PATIENT HEALTH PROBLEMS

PREOPERATIVE PROBLEMS

1. Pain (inguinal region)

2. Anxiety
3. Insomnia
4. Anorexia

POSTOPERATIVE PROBLEMS

5. Pain (incisional site)

6. Risk for infection
7. Patient cannot bath by himself.
8. Patient has wound
9. Patient cannot walk
Careful assessment of the client revealed the following problems. They are listed in order of priority;

PATIENT/ FAMILY STRENGTHS

 1. On admission, he could communicate effectively, therefore the patient could verbalize the intensity
and location of the pain.
2. Patient can verbalized his fears and concerns about the procedure
3. Patient can sleep for few hours when lights are switched off.
4. Patient can take light soup
5. Patient could describe the intensity and location of the pain and could tell comfortable position that
reduces the pain.
6. Patient could inform the nurse if the wound becomes wet and prone to infection.
7. Patient allows assisted bathing from his wife.
8. Patient could tolerate wound dressing.

NURSING DIAGNOSIS

The following nursing diagnoses were formulated from the identified health problems of the client.

1. Acute pain (left inguinal region) related to protrusion of intestine through the abdominal wall
2. Anxiety related to unknown outcome of the surgical operation.
3. Pain related to surgical incision.
4. Impaired skin integrity related to surgical incision.
5. High risk for infection related to incisional wound.
6. Altered sleep pattern (insomnia) related to acute abdominal pain.
7. Physical mobility impaired related to pain at the incision site.
8. Altered nutrition, less than body requirement related to loss of appetite (anorexia).
9. Self-care deficit (bathing) related to general body weakness after the surgery.
 CHAPTER THREE

PLANNING FOR PATIENT AND FAMILY CARE

This chapter deals basically with the nursing care plan. Planning involves writing of the nursing

care plan and it comprises of four components which are:

1. Setting of priorities

2. Establishing patient’s goals and outcome criteria.

3. Planning nursing strategies.

4. Writing nursing care plan

SETTING OF PRIORITIES

This is the process of establishing preferential order of the nursing strategies. In effect, life

threatened problems are solved first.

ESTABLISHING PATIENT’S GOALS AND OUTCOME CRITERIAL

A goal in the nursing process is the expected outcome of nursing interventions. Outcome criteria are

statements that desire specified observable and measurable response of the patient. In view of this,

the achievement of the patient’s goals serves as the criteria for measuring the effectiveness of the

care plan.

PLANNING NURSING STRATAGIES

Nursing strategies are nursing activities performed to achieve the established goals for the patient. It

involves. It involves decision making and choosing one or more nursing strategies recognized as the

best and has the greatest probability of success.

The plan of care could be short or long term.

OBJECTIVES

SHORT-TERM PLANS OF THE CLIENT

1. To relieve his pain within 6 to 8 hour.

2. To allay his/family anxiety within 6 to 8 hours.
3. To promote sleep throughout hospitalization..
4. To prevent client from injuries postoperatively.
 

LONG-TERM PLANS OF THE CLIENT

1. To prevent postoperative infection.

2. To help him recover from the surgery without complications.

WRITING OF NURSING CARE PLAN

The nursing care plan is a written guide used by nursing staffs to meet the needs of the patient at a

given time. It is individualized and aids in the provision for the continuity of care. The nursing care

plan consists of the following:

1. Nursing diagnoses

2. Objectives and outcome criteria

3. Nursing orders

4. Evaluation

The nursing care plan on Mr. N.A is shown below in the table.
DATE NURSING OBJECTIVE/OUTCOME NURSING ORDERS NURSING DATE EVALUATION

/TIME DIAGNOSIS CRITERIA INTERVENTION /TIME

15/2/22 Pain (left inguinal Patient will experience 1. Reassure patient that he will 1) Patient was Patient verbalized

5:00pm region) related to gradual reduction of pain experience diminished pain within reassured that pain that there is

protrusion of within 40 minutes as 40 minutes. will subside with reduced pain and

intestines through evidenced by: proper nursing care, looked cheerful

the abdominal a. Verbalization of 2) Assess the level of pain. medication, and with stable vital

wall. decreased in pain. 3) Make client assume comfortable surgical intervention. signs. Goals fully

b. Relaxed facial position to assist in subsiding met.

expression. 4) Provide quite environment to 2) Client pain level

promote rest. was assessed (5 out of

5) Provide divisional therapy in the 10) using the pain

form conversation. scale and assisted.

3) Client was made to

assume a comfortable

position (supine)

which assisted in

16/2/22 Anxiety related to Patient will be relieved of
anxiety within 1 hour as
8:30am unknown outcome
evidenced by;
of surgery.
a. Patient’s statement of
feeling less anxious
b. Stable temperature ,
pulse, respiration and
blood pressure
c. Relaxed facial
expression
d. Patient agreeing to
undergo surgery
subsiding pain.
6) Patient was
engaged in series of
conversations.
1. Reassure client that competent 1. Client was Goal fully met, as
health team will perform the
reassured of good the patient
surgery and make it a success.
care from competent verbalized the
2. Provide comfortable bed and sit
closer to patient in a comfortable staff. feeling of been less
manner and educate patient on the
2. Client was anxious and has a
need for the surgery.
educated that the relaxed facial
3. Smile at patient and establish eye
to eye contact when speaking with surgery is to correct expression with
him.
the condition and stable blood
4. Invite patients who have
relieve him of his pressure (Temp;
undergone similar operation to
share their experience with the pain. 36.9 ◦C, Pulse; 80
patient.
3. Eye contact and bpm, Blood
5. Explain the condition and every
smiley face was Pressure;120/80mm
procedure for patient to understand.
expressed whiles Hg.
6. Allow and encourage patient to
speaking to him.
verbalize his feelings and concerns
4. Patients who have
about the surgery. undergone similar

operation was

7) Engage patient in a diversion invited to share their

therapy such as general experience.

conversation. 5. Client was told

8. Introduce the operation team to that a wound would

the client. be created at his left

inguinal region;

therefore he will

receive dressing each

day. Also he will

experience pain at

the incision site but

he will be relieved of

it through proper

nursing care.

6. Patient was

encouraged to

verbalize his
 concerns and

feelings on the

surgery.

7. Client was

engaged in a

conversation about

the nature of his

work.

8. The surgeon came

over to explain the

impending surgery to

the patient.

Sleep pattern Client will be able to sleep 1) Reassure client that the pain will 1) Client was

disturbance for about 1-2 hours during subside. reassured that with

(insomnia) related the day and 6-8 hours proper medication

to abdominal pain during the night within 48 and proper nursing

hours as evidenced by, a) management he will

2) Put client in a comfortable bed.
client verbalizing that he be relieved.

had sound sleep

uninterrupted.

2) Client was made

3) Give assisted warm bath (bed or comfortable in a bed

bathing) if needed. of clean bed lining.

3) Client was given

assisted warm

bathroom bath
5) Switch off bright light during
before going to bed
bedtime.
to ensure muscle

relaxation and

promote comfort.

5) Bright lights were

switched off to

provide a dim
 environment to

promote sleep.

16/2/22 Pain related to Client will be relief of pain 1. Reassure the patient that the pain Goals fully met as

8:00pm surgical incision. within 24 hours as will be managed adequately. client has dimin

evidenced by; 2. Assess patients level of pain ished pain as

a. Patient having relaxed 3.Check temperature, pulse, evidenced by;

facial expression respiration and blood pressure a. Client

b. Stable temp, pulse, 4. Position client in a recumbent verbalizing

respiration and blood position. reduction in pain.

pressure. 5. Observe the incisional site for b. Client having

c. Verbalization of no pain. tight adhesions, swelling and relaxed facial

bleeding. expression.

6. Explain the cause of pain to the

client that it as a result of the

incisional wound created during the

operation.

7. Administer prescribed analgesics

(Diclofenac 75mg,
 intramuscularly).

8. Employ diversion therapy

16/2/22 Impaired skin Client’s skin integrity will 1. Reassure client that wound will 22/11/1 Goals were

8:30pm integrity related to be restored within 10 days heal within 10 days. 0 partially met, as

surgical incision. as evidenced by: 2. Inspect wound for tight 10:00a client’s condition

a. Incisional site free from adhesions, swelling and bleeding. m was well for

offensive discharge. 3. Dress wound with alcohol using discharge and by

b. Well opposed skin aseptic technique. then, his wound

edges. 4. Ensure use of sterile materials for was not completely

c. Wound healing with wound dressing. healed.

minimal scar tissue. 5. Administer prescribed antibiotics

(Amoksiclav 1-2g intravenously at

4:00pm).

6. Encourage client to walk to

promote healing.
 16/2/22 Patients wound will be free 1) Reassure patient of a competent 1) Patient was Goal was met as

8:30pm High risk for from infection within 8 care. reassured of expected. Client

infection to days as evidenced by; competent care that had intact skin on

surgical incision. a) wound healing by first his wound will be the eight day.

intention 2) Observe the wound for signs of free from infection.

bleeding on the day of surgery.

2) Wound was under

observation for

bleeding until the

3) Check incision site daily for signs
first day of dressing.
of infection.
No bleeding or wet

dressing observed.

4) Wash hand before and after each

3) The incision site
procedure and dress wound after
was check daily for
three days under strict aseptic
swelling, and
technique.
reddnes and
 discharges but none

5) Check and record vital signs was observed.

especially temperature.

4) Hands were

7) Advice patient to avoid touching washed before and

and wetting dressed wound. after each procedure

performed on the
8) Administer prescribed client.
medication.

5) Vital signs were

check and recorded

within four hours

interval.

7) Client was

advised against
 touching and wetting

dressed wound to

avoid infection.

8) Prescribe

Metronidazole was

administered.

17/2/22 Self-care deficit Patient will bath unassisted 1) Reassure patient. 1) Patient was Goals were met.

8:30am (bathing) related within 72 hours as reassured that very Client was able to

to general body evidenced by the nurse soon; he will be able take his bath

weakness after observing patient carrying to bath by himself. unassisted by the

2) Assist patient to bath in twice a
the surgery. on activity unassisted. third day.
day until he is able to do so on his 2) Client was given
own. assisted bedbath

twice a day for two

3) Encourage the client to clean the
days.
mouth every morning and evening

before going to bed. 3) Patient was

 encouraged to clean

4) Place items frequently used by the mouth by

patient within his reach for easy brushing the teeth

accessibility every morning and

evening with tooth

5) Encourage patient to call for paste before
help/assistance if the need arises. returning to bed.

4) Items frequently

needed by patient

were placed by his

bed side to avoid

physical exertion in

an attempt to reach

them.

5) Patient was

encouraged to call
 for assistance when

in need of help.

17/2/22 Physical mobility Patient will be able to 1) Reassure client of competent 1) Patient was The goal was fully

8:30am impaired, related move out of bed within 48 nursing care. reassured he would met. Client resumed

to pain at the hours as evidenced by; be able to move his physical

incision site. a) Client verbalizing that about to perform his activities especially

he is able to walk. 2) Put patient in a position that is normal activities. walking on the
comfortable to him. ward.

b) The nurse observing that 2) Patient was

client has moved out of assisted to assume a

3) Assist patient to sit up in bed
bed. position which was
during meal time.
comfortable for him

and was change

4) Assist patient to undertake
every 2 hours
passive exercise.

3) Client was

assisted to sit up in

bed during meal

5) Prescribed analgesics to be
time to enhance
administered. physical mobility.

4) Client was

assisted to do

passive exercise by

raising the leg at the

incision site after

every six hours to

prevent deep vein

thrombosis.

5) Paracetamol was

administered as

prescribed to help

relief any pain.

 AMENDMENT OF NURSING CARE PLAN FOR PARTIALLY MET OUTCOME CRITERIA

DATE/ NURSING OBJECTIVE/OUTCOME NURSING ORDERS DATE/ EVALUATION SIGNATURE

TIME DIAGNOSIS CRITERIA TIME
17/2/22 Impaired Clients skin integrity will 1.Reassure client that 12/3/2022 Goals were fully met, as
skin integrity be restored within 10 days wound will heal within 12:10pm patient’s wound was
8:30am
related to as evidenced by: 10 days completely healed with
surgical a. Incisional site free from 2. Inspect wound for well opposed skin edges
incision offensive discharge. tight adhesives, and minimal scar
b. Well opposed skin swelling, bleeding and formation.
edges report.
c. Wound healing by first 3.Dress wound with
intention with minimal alcohol using aseptic
scar tissue techniques
4. Ensure use of sterile
materials and
instruments for wound
dressing.
5. Serve prescribed
antibiotics.
6. Encourage patient to
walk, to promote quick
healing.
CHAPTER FOUR

IMPLEMENTATION OF PATIENT/FAMILY CARE PLAN

Implementation is the fourth phase of the nursing process signifying the giving of care in relation to defined
nursing interventions and goals. This chapter entails the actual nursing care rendered to Mr. N.A and his wife from
the first day of admission till the day of discharge, including home visits and follow-up care.

SAMMARY OF ACTUAL NURSING CARE

DAY OF ADMISSION (22/11/2010)

Mr. N.A was admitted on the 15th February, 2022 at 3:00pm to the Male Surgical Ward of the Cape Coast

Teaching Hospital. He was in the company of his wife. Client complained of pains at the left inguinal region. He

was reassured that the pain would subside. The vital signs were checked immediately and recorded as follows;

 Temperature - 36.3oC

 Pulse - 80 beats per minute

 Respiration - 18 cycles per minute

 Blood pressure - 134/84 millimeter of Mercury

He was reassured again and made to rest. Client’s wife who was to stay with him was taking round to be

introduced to her husband’s new environment on behalf of her husband. The wife who already knew the ward was

shown the toilet, bathroom, treatment room, and nurse’s station briefly. Client was engaged in conversation to

distract his attention from the pain. Nearby windows were opened to ensure proper ventilation and quiet and calm

environment were ensured to enable client have enough rest, in the evening, client had his bath unassisted as well

as his oral care. He was then served his medications before going to bed. Client’s blood sample was taken to the

laboratory at 9:00AM on the 16/2/2022 in the laboratory investigation which was presented in the chapter two.

The following laboratory investigation were conducted on Mr. N.A;

1. Blood for haemoglobin level estimation

2. Blood for sickling

3. Blood for complete blood count (CBC)

4. Urine for routine examination

FIRST DAY ON ADMISSION

FIRST DAY OF ADMISSION (15TH FEBRUASRY 2022)

Mr. N.A was admitted to the Male Surgical Ward through the Surgical out Patient Department (OPD) by General
Surgery Team A at 3:30pm. He was brought in assisted by his wife. He was restless due to pain at the left groin
which radiated to the lower abdomen. On arrival, he was warmly welcomed and received on a comfortable bed
while the nurse in-charge, reassured him and his wife that they were under the care of competent professional
health staff and that they will put up their best to ensure that measures are taken to provide his proper nursing
management to help him recover. His vital signs (temperature, pulse, respiration and blood pressure) were taken
and recorded. His medications which included injection pethidine 50mg stat and intravenous fluids were collected
and served accordingly. The admission entries into the daily ward state as well as the admission and discharge
book were done. His wife was oriented to the ward. She was shown the toilet, bathroom and urinal and nurses’
station. Mr. N.A was instructed to maintain nil per os. The reason for this instruction was explained to him as to
keep intestines and bowels empty for a smooth operation

(DAY OF OPERATION-16/2/22)

Mr. N.A was reviewed by the surgical team at around 10:54am and was recommended for surgical operation. His
blood sample was taken for grouping and cross matching as requested. A tray was set to take the blood
sample immediately to the laboratory. The pre-operative care then started immediately. Mr. N.A was anxious due
to the unknown outcome of the surgery. Mr. N.A and his wife were reassured of a competent care. He was allowed
to expressed his feelings and ask questions about things he does not understand of which he was answered. Brief
answers to their questions were given. He was educated on the condition and that there would be an incision made
at the left inguinal region. The wife who had knowledge of the procedure aided in education which made it easier.
He was reassured not to panic when he sees dressing at the incision because the wound would be managed by the
competent staff that will ensure proper care of the wound to facilitate the healing process of the wound. The nurse
in-charge briefs the client about the impending surgery. Based on the teaching he received about the
surgery, he gladly consented to it and signed to consent forms and the wife witnessed it. Client and wife were
allowed to have a short prayer before he was taken to the theatre. During the time of surgery, client’s drugs and
infusions were made ready and sent to the theatre. His vital signs were checked and recorded to serve as a baseline
data. The site of the operation was cleaned and dried for the operation during the previous night. He was
encouraged to pass out urine to ensure that his bladder was empty. He was assisted in putting on the theatre gown.
All metallic ornaments such as ring, bracelet that patient was wearing was removed and kept for him. Patient’s
signed consent form was taken. Client was sent to the operating theatre on a stretcher at 3:00pm. In organizing for
post-operative care, the following were carried out; a drip stand, resuscitation tray containing mouth gag, tongue
depressant, tongue forceps, bedrails and oxygen were made ready at the bed side. On arriving, the theatre nurse
received him on their stretcher and made him lie down to wait for the ongoing surgery which was almost over.
After, Mr. N.A was received onto the operation bed and put on a recumbent position. Four infusions (normal saline
and ringers lactate, 500 miles each) were taken along to the theatre. The surgery was completed at 6:00pm and
patient brought to the ward from the recovery room in full conscious state at 7:00pm.

POST-OPERATIVE CARE

While in the theatre, the client bed was re-laid with a new bed sheet with vital signs tray, vomit bowl, a receiver
for soiled swabs and injection tray placed by it. He was received into an already prepared operation bed in a semi-
fowler position to facilitate breathing. Vital signs were checked and recorded as temperature 37.3oc, pulse 82 beats
per minute, respiration 20 cycles per minute and blood pressure 132/80mmHg. It was monitored again every 15
minutes for 1 hour, then every 1 hour for 4 hours and every 4 hours for 24 hours. An observation chart was also
prepared to monitor the patient condition. No notable difference was found as his vital signs were within normal
values. Client returned to the ward with 2 of the infusions sent to the theatre with only one of the infusions (normal
saline 500 miles) was in situ. The infusion was hanged on a drip stand to ensure proper flow rate of the infusion.
At 8:00pm, patient complained of pain at the incision site and pain at the suprapubic region where the tap was
made. Mr. N.A’s pethidine 50mg was administered intramuscular. After 30 minutes he appeared calm and had a
sound sleep. The wound was checked from time to time for bleeding. He was also told to maintain nil per os till his
bowel sound returns. He was told that to identify peristalses, is by the passage of flatulence or gurgling sound from
the stomach. Client’s medication which included; Tablets Ciprofloxacin 500mg bd x 72 hours, Tablets
Metronidazole 400mg tds x 72 hours, Dextrose Saline 2 litres x 24hrs, tranxemic acid 500mg x 48hrs, Pethidine
100mg bd x24 hour, Clindamycin 150mg/mL in 2ml injection 30mgx 48hrs were administered accordingly as
ordered.
THIRD DAY -17TH FEBRUARY 2022

(2nd DAYPOST OPERATIVE)

Mr. N.A woke up in the morning at about 7:00am feeling exhausted. This he complained to the nurse. He was

provided with tooth brush and pastes to clean his teeth by his bedside. His wife assisted him with bedbath. His

vital signs was were checked and recorded as follows;

 Temperature 36.1 0C

 Pulse 76 bpm

 Respiration 20 cpb

 Blood pressure 130/80mmhg

He was served with breakfast of waakye and fresh pineapple juice after which he was served with his medication

and recorded as required. He was made to rest in a comfortable position (semi fowler’s) in bed. He was assisted to

change his position frequent in bed to prevent occurrence of bed sore and deep vein thrombosis.

The doctor on his usual rounds at 8:30am reviewed him and ascertained that, passive exercise should be

encouraged to enhance healing of the wound. After being assured that all would be well soon, he was again given a

bed bath having taken his supper and medication he was kept warm in bed. Client in the afternoon had good

company with the sister and friends who came in for visit.

Client in the evening insisted he can take his bath unassisted as well as oral hygiene. He had his supper of jollof

rice and soup and orange and sliced apple which he was able to eat enough. His medication was served and was

again assured that all would be well soon.

FOURTH DAY ON ADMISSION

(3rd DAY POST OPERATIVE 18/2/22)

Client woke up at 7:00am, had his bath and oral toileting unassisted around 7:10am and had his brake-fast after.

He was served with his medications and recorded as required. During the doctor’s rounds, he inspected the wound

and ordered for his discharge to go home and return 28th February, 2022 for review. The bill was assessed and he

had no underlying fee. He was discharged. Though was discharged in the morning, he asked permission from the

ward in charge to stay at the ward till afternoon before leaving finally and permission was granted. His items were

arranged and packed, making sure that nothing was left behind. At around 2:00pm, he and the wife thanked the

entire staff and wave them good bye and were wished farewell. He was discharged with the following drugs to be

taken at home. Acetaminophen suppository 1g, tid. They were educated on how to administer the drug and it side

effects.

PREPARATION OF PATIENT/FAMIY FOR DISCHARGE AND REHABILITATION

Preparation of patient and family for discharge and rehabilitation started from the day of admission. Preparation

took the form of education on client personal and environmental hygiene and continuity of care by taking his drugs

and preventing water to enter his wound to a void infection. He was advised not to lift heavy object and avoid

vigorous exercises to prevent recurrence of condition. He was told to always splint the incision site when coughing

or sneezing to avoid evisceration. Proper personal and environmental hygiene was also emphasized. The need for

enough rest and good ventilation was encouraged. He was advised to eat enough fruit like oranges, pawpaw,

pineapples as well as vegetables to prevent constipation which might lead to straining during defecation. Mr. N.A

and wife were advised on the need for follow up care and to keep the date for review. They were advised on the

need to adhere strictly to the instructions of the drugs he was supposed to take home, and to take them regularly.
FIRST HOME VISIT (PREDISCHARGE VISIT)

Follow up care is where the nurse visits the client at home to ensure continuity of care and strengthen the

relationship between them. It gives an opportunity to the nurse to educate the patient about the environment around

him. Again, it enables the nurse to know the progress of health made by the patient

FIRST HOME VISIT (PREDISCHARGE VISIT)

On the Friday, 18th February 2022, the first home visit was made and it was done when patient was still on

admission. It was done in the company of patient’s wife at 10:00am. The house is located at Ayifua, 3 buildings

away from Ayifua School. It is a cemented 3 storey building with 4 apartments on each floor. Mr. N.A and wife

stay in one apartment on the first floor of the building. Their apartment is a 1 bedroom with living room, kitchen

and washroom. The house is walled with security post. Their source of water is Ghana Water Company. They have

a borehole in the house which supplements the Ghana Water Company’s water.

On observation of the house it was well cleaned with tiled floor. There was no dust on the floor. There were also

two dust bins in the compound which I was told are emptied weekly by Zoomlion Company personnel. The

dustbins in front of the house were emptied. The wife was educated on hand hygiene and the use of mosquito net

as well as environmental hygiene. The wife was reassured of the next visit.
FIRST FOLLOW-UP VISIT – 26TH FEBRUARY, 2022

The first follow-up visit was made on Saturday, 26th February, 2022, a week after discharge. I met the client very
strong and cheerful, and happy to see me again. Upon enquiry, he was very fine and had no problem since
discharge. I assessed his wound to see if there was any sign of infection. The wound was clean and dry, indicating
healing was on course. His drugs were also inspected and he was following the advice given since he was taking
the drugs as prescribed. I reminded him the need to eat balanced diet including fruits and do tolerable exercises. I
reminded him that due to the surgical operation he has undergone he was not supposed to do any activity that can
cause increased intra-abdominal pressure since that could cause complications like wound evisceration. I also
encouraged him to maintain good personal and environmental hygiene to promote healthy living. Before leaving, I
reminded him of the review date which was on 28th of February, 2022. He and his wife were very grateful and
escorted me outside. I was also happy and reminded them that I will be visiting them again as I departed.

SECOND FOLLOW-UP VISIT 12th March, 2022

On this visit, the client was very fine. Mr. N.A was happy to see me and I was happy because his condition had
really improved. On assessment, his wound had healed without any infection and complications and there was no
dressing on the wound. His stiches had been removed and he had also completed his medications. I reminded him
once again the need to avoid strenuous activities, maintaining good personal and environmental hygiene. Mr. N.A
and his wife were informed of the termination of care. I thank the entire family and the patient for their support
during the writing of the care study. They were very happy and grateful to me and had nothing to say than “God
bless you abundantly”. They escorted me
outside the house full of smiles as we departed and bid them goodbye.
 CHAPTER FIVE

EVALUATION OF CARE RENDED TO Mr. N.A AND WIFE

 The last stage of the nursing process helps the nurse to evaluate the nursing care
rendered to the patient to assess the extent to which the pre-established objectives have been attained or otherwise
amend the nursing care plan for partially met objectives and new nursing interventions for unmet objectives.

STATEMENT OF EVALUATION

The nursing care plan for the management of the client was evaluated on
daily basis from admission till discharge. The evaluation statements are therefore
summarized as such.

15TH FEBRUARY, 2022- ADMISSION DAY

Based on the client’s problems, the following objectives were set:-

 To reduce client’s abdominal pain within 6 to 8 hours.

 To improve upon client’s appetite throughout hospitalization.
 To reduce anxiety of client within 6 to 8 hours. These objectives were fully met within the stipulated time
following the strategic nursing orders and interventions.
The evidences to this claim included the following:
 The client verbalized there is no pain and remained calm in bed.
 He ate more than half of her meals daily and her body weight maintained throughout hospitalization.
 He also looked relaxed and cheerful after the nursing interventions.

16TH FEBRUARY, 2011

The problem identified on this day was insomnia due to the pain at the incision site and pain at the suprapubic
region where suprapubic tap was performed. The objective set was therefore
to help him have at least 7 hours uninterrupted sleep every night throughout the period of hospitalization. This
objective was met fully on evaluation, however the patient woke up and started and was still having pain (less
severe) at the incision site. This was evidenced by the
client verbalizing of a 7 hour uninterrupted sleep. The nurse’s report also alluded to the same fact.

17TH FEBRUARY, 2022

The objectives set were fully met. They included the following:

To prevent infection of patient’s wound throughout hospitalization and to relieve patient off constipation. The
evidences to back the above achievements are:

 He never exhibited any sign of infection throughout hospitalization

and beyond.
 He also verbalized the relief of constipation after the nursing intervention.
 The wound also healed by first intention.

On the day of admission, 15th February, 2022 he complained of pain at the left groin due to swollen groin. With

the application of cold compresses and diversional therapy through conversion, pain subsided within 24 hours as

verbalized by patient.

Patient was noticed to be in a state of anxiety due to unknown outcome of surgery very early that morning. An

objective was set for him to relieve him of anxiety within 24 hours.

With effective nursing care rendered, patient became calm with allayed anxiety.
Client had difficulty in sleeping due to the abdominal pain. An objective was set for so that he can have sound

sleep and have enough rest. He was given warm bathroom bath. With other careful nursing interventions, he had a

very sound sleep at night.

On the day of surgery, 16rd February 2022, after he was been brought to the ward, it was observed that patient

might be prone to infection due to surgical incision on the inguinal region.

An objective was set for the client to have an intact skin within the days. The goals were met by subsequent wound

dressings.

On the 17th February, 2022, client had difficulty in walking due to pain at the incision site. An objective was set

that he would be able to walk normally unassisted within 48 hours to perform some minor physical activities such

as; walking to the bathhouse and brushing of teeth.

Through passive exercises and encouragement, client was able to walk.

Due to the pains at the incision site, patient could not perform his self-care activities.

An objective was set to enable patient undertake these activities in due course. With assistance and

encouragement, the goals were met.

AMENDMENT OF NURSING CARE PLAN FOR PARTIALLY MET OR UNMET GOALS/ OUTCOME
CRITERIA

 Based on the competent and effective nursing care rendered to Miss Mary Awafo,
all set targets/objects were met at the stipulated time hence no amendments were made on the plan of care.

TERMINATION OF CARE

It is the last stage of the relationship between nurse and patient. It is the most difficult and important part of that

cordial relationship that existed between the patient, nurses and health team. A good nurse patient relationship was

created and maintained throughout the period of admission. This aspect was made known to master N.A and his
wife on the day of admission. As a result they were not worried about separation when it was made known to them

during my last visit.

Master N.A was looking very healthy and could do anything by himself. The patient and his wife were reminded

on the need to report to the health facility in case of any abnormality. They expressed their profound gratitude for

the care rendered to them.

SUMMARY AND CONCLUSION

On the 15th February 2022, Mr. N.A, a 35years old man was admitted to the Male Surgical Ward through surgical
OPD by General Surgery Team A. by Dr. Kudor with the diagnosis of left inguinal hernia. Various laboratory
investigations were carried out to confirm diagnosis. Hernioplasty was performed on the abdominal wall for the
repair of the weakened part and reinforced with synthetic mesh on 16 th February, 2022. Patient presented with left
inguinal pain which radiated to the lower abdomen, headache and bulge formation at the inguinal region. Using the
nursing process, appropriate and strategic nursing care plan was drawn based on his health problems and carried
out accordingly. Thus; medications, vital signs, wound care, personal hygiene and other personal health care,
needs were diligently carried out which led to his speedy recovery. Each of the health team played their roles to
ensure speedy recovery of Mr. N.A. Patient was managed with the nursing care plan and he recovered without any
complications. His surgical wound was dressed in the hospital till it healed by first intention. Emphasis on the
causes, signs and symptoms, predisposing factors as well as prevention of inguinal hernia were made to patient and
wife. He was discharged on 18th February, 2022. Pre-discharge visit, fellow-up visit were also made to assess the
client’s environment and asses the status of client’s health at home.

CONCLUSION

In conclusion, I personally enjoyed writing the patient and family care study as it gave me the opportunity to put
into practice the theory of nursing especially the nursing process I have learnt in the classroom. It has also helped
me to learn into details the condition I chose, inguinal Hernia. I also had personal experience on how to care for
patients as well as educate patient and family on health issues.
 

Finally, I will recommend that financial support will be given to students to carry out this study so as to reduce the
burden it poses on them.
 BIBLIOGRAPHY

1. Smeltzer, S.C. and Bare B.G. (2007) Brunner and Suddarth’s Textbook of Medical- Surgical

Nursing, (11th Edition), New York, Lippincott

2. Walsh M. and Crumbie A. (2007) Watson’s Clinical Nursing and Related Sciences, (7th Edition),

Bailliere Tindal Elsevier, Toronto.

3. Waugh A. and Grant A. (2006) Anatomy and Physiology in Health and Illness, (10th Edition),

Edinburgh, UK, Churchill Livingstone Elsevier

4. Weller F.B. (2006) Nurses’ Dictionary For Nurses and Health care workers, (24th Edition), London

Bailliere Tindal.

5. Brunner L.s and Suddarth D.S. 92008), Textbook of Medical/Surgical Nursing, (11th Editions). J. B.
Lippoincott Company, Washington Square - USA.
6. Rose and Wilson, (2001), Anatomy and Physiology in Health and Illness,

(11th Edition), Elsevier limited, USA.

7. Bailey and Love’s (2004), Short Practice of Surgery, (24th Edition), Holder Headline Group. London.

8. Mary Miller - Bells, (2005), Clinical Pharmacology (2nd Edition), Lippincott

Williams and Wilkins Company, USA

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