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 was
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 became. 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 left groins accompanied by severe pain
was felt at the 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 symtoms; 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 who 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 Sadaarth (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
and vomiting. None were
5mg for 2 days
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 temperature and prevent inflammation were and vomiting. None were
Anal
(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 Inflammatory Drug temperature and prevent inflammation were and vomiting. None were
Anal
(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,
antimicrobial agent infections, gynaecological infection nausea and vomiting. None
Orally
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/ FAMILY STRENGTHS

1. On admission, he could communicate effectively, therefore the needed information was provided.
2. Client could sit up in bed and chat with his wife and other patients in bed closer to him.
3. Client could also feed himself without assistance.
4. Patient was registered with the National Health Insurance Scheme hence his bills were paid by the scheme.
The few drugs that were not available in the
facility were purchased by his wife
5. Patient could care for his mouth, hair, nail etc.
6. The wife was very supportive as she always visited
the patient.
7. Patient and his wife were co-operative with care givers and other patients in the ward.
8. Patient had sufficient knowledge of inguinal hernia.

PATIENT HEALTH PROBLEMS

Careful assessment of the client revealed the following problems. They are listed in order of priority;

1. Pain (inguinal region)

2. Anxiety
3. Insomnia
4. Anorexia
5. Risk for infection
6. Constipation
7. Bleeding from the penis
8. Patient had urinary retention.
NURSING DIAGNOSIS

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

1. Acute pain related to disease condition.

2. Anxiety related to unknown outcome of the surgical operation.
3. Altered nutrition, less than body requirement related to loss of appetite (anorexia).
4. Altered sleep pattern (insomnia) related to acute abdominal pain.
5. High risk for infection related to incisional wound.
6. Physical mobility impaired related to pain at the incision site.
 CHAPTER THREE

PLANNING FOR PATIENT AND FAMILY CARE

This chapter deals basically with the nursing care plan. It involves identifying the client’s health problems and
developing a plan of care to address them. The plan of care could be short or long term.

OBJECTIVES

3.1 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.
 

3.3 LONG-TERM PLANS OF THE CLIENT

1. To prevent postoperative infection.

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