BULACAN STATE UNIVERSITY

City of Malolos, Bulacan

COLLEGE OF NURSING

In Partial Fulfillment of the Requirements in NCM 104 B (RLE)

A Case Study of a 27 year old male, with Incarcerated Inguinal Hernia who underwent Herniorrhaphy
Submitted to:
Ms. Kathleen B. Ong R.N Mr. Floresco Adaoag R.N
Mr. Marvie Cadacio R.N Ms. Jesusa Capispisan R.N

Submitted by:
Group Leader:
FAJARDO, Ma. Janine M.
Members:
DELLOSA, Rowena A. GUTIERREZ, Lenita D.
ENTERESO, Jennica D. INOCENCIO, Graceline L.
EUGENIO, Oliver B. ISAGUNDE, Avon Loraine S.P.
GARCIA, Pauline G. JORE, Edward John
JOSE, Grace Anne S.
 INTRODUCTION

This is a case study of a 27 year old male with Incarcerated Inguinal Hernia who underwent Herniorrhaphy who was admitted at Bulacan Medical Center, Malolos,

Bulacan last, November 17, 2010.

A Hernia is a protrusion of an internal organ or part of an organ through a tear, hole or defect in the wall of a body cavity (ie the abdominal wallmuscle). Inguinal

Hernia is a condition in which intra-abdominal fat or part of the small intestine bulges through a weak area in the lower abdominal muscle which in this case occurs in the

inguinal ring, the opening to the inguinal canal. An Incacerated Inguinal Hernia on the other hand, is a hernia that becomes stuck in the groin or scrotum and cannot be

massaged back into the abdomen. Common causes and risk factors of Incarcerated Inguinal Hernia are as follows; lifting heavy objects, obesity, pregnancy, genetic

predisposition, and persistent coughing such as smokers cough.

Inguinal Hernia happens most often in males than in females.

The study of a patient with Incarcerated Inguinal Hernia has been chosen by this group for its significance and connection to us students who are in depth search for

knowledge and experience as we study this case, which one of the main focus of a third year level students who are studying Medical Surgical Nursing. The study of its

occurrence, medical and nursing management along with the responsibilities, causation and possible complications, advantage and disadvantage would provide better

understanding on how our responsibilities as soon-to-be nurses should be, by gaining knowledge, skills and learning through hands-on experiences, observation through the

use of critical thinking skills and patient centered interaction and assessments.

• Objectives:

GENERAL OBJECTIVE:

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• To obtain a comprehensive understanding and learning of the client’s experienced health problem and for us student nurses to perform responsibilities and respond

promptly to the needs of the patient for his recovery and promotion of well being.

STUDENT CENTERED OBJECTIVES:

• KNOWLEDGE:

-To be able to familiarize self about the disease; Incarcerated Inguinal Hernia

- To be able to identify the different signs and symptoms of the disease.

-To be able to know the possible prevention and proper management of inguinal hernia.

• SKILLS:

-To be able to apply nursing interventions that can help manage patient’s condition.

-To be able to pertain proper nursing management to help prevent the occurrence of possible complications. .

-To be able to build up skills to augment nursing practice.

• ATTITUDE:

-To be able to develop an optimistic outlook towards providing holistic care of patient

-To be able to provide support during the treatment process

-To be able to promote encouragement to the patient

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 CLIENT CENTERED OBJECTIVES:

• To establish therapeutic communication and rapport with the patient for effective patient-nurse interaction all throughout the care providing process.

• To carry-out proper Nursing Interventions that will promote patient’s comfort and safety.

• To educate patient regarding his condition, hence be able to provide awareness regarding the management of the disease.

NURSING ASSESSMENT

A. Biographic Data
Name: Patient RM
Address: San Jose Del Monte, Bulacan
Religion: Catholic
Age: 27
Sex: Male
Race: Asian
Marital Status: Single
Educational Attainment: High School Graduate Date of Admission: November 17, 2010;
Occupation: Carpenter Time of Admission: 5:05PM

B. Chief Complaint:
*“Nahihirapan akong umihi at masakit ang ari ko, nagsuka na din ako kaya dinala na ako sa hospital” as verbalized by the client.
C. History of Past Illness
For his childhood illnesses, he experienced asthma, mumps and chicken pox. He also said that he was able to complete the immunizations when he is a child.
He has an allergy in cement powder, he feels itchy whenever it touches his skin. It was his first time to be hospitalized. As for his asthma, he took herbal medicines as
given by his grandmother.
4
 D. History of present illness
Patient RM was admitted at Bulacan Medical Center at 5:05 PM of November 17, 2010. He said that he had difficulty in urinating and he feel pain in his
groin every time he walks He said that this happened after he played basketball last November 16, 2010 from 8 AM to 3 PM having only little time of rest.

E. Family History
According to patient RM both her paternal and maternal family has history of Heart attack and hypertension. His father has complications in gall bladder and
liver. His aunt have history of pneumonia.
GENOGRAM
Paternal Family Maternal Family
R
70 L L Ms
75 75 72

C B R G A R A
58 55 53 50 48 45 40

R R L E J E L
58 55 53 50 47 45 42
Legend - Patient
- male - female -Heart Attack

- Lung Infection -Pneumonia

- complication in gall bladder & liver

B R C E R R C - Hypertension - deceased
29 27 25 21 20 18 16 5
- complication because of alcohol
 FUNCTIONAL HEALTH Prior to Hospitalization During to Hospitalization
PATTERN

1. Health Perception and health For him, he said that he is a healthy man. He does He rated his health as 3 in the scale of 1-10 in the present
exercises and he is also goes to gym. Before the because he can’t do his regular activities. He stated that there
Management Pattern
hospitalization, he doesn’t experience any illness and any is also pain that is why he think that he is unhealthy.
pain in his body. He think that his sickness happened
because of over fatigue. For him, being healthy is having
no illness.

2. Nutritional and Metabolic Pattern November 14 November 15 November 16 Patient RM is in NPO diet during his hospitalization.
Breakfast: Breakfast: Breakfast:
1 cup coffee 1 bowl of porridge None
(230 ml) 1 pc egg he never ate
1 glass of water 2 glasses of water anything for he
2 cups of rice continue to
1 pc fried vomit
galunggong Lunch: Lunch:
(medium size) 2 cups rice ½ cup noodles
Lunch: 1 slice of chicken 1 glass water
2 cups of rice leg part with one
1 slice of pork cup of tinola soup
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 with sinigang 2 glasses of water
soup
2 glasses of Dinner: Dinner:
water None None
Dinner: he never ate he never ate
2 cups of rice anything for he anything for he
1 slice of pork continue to vomit continue to
with sinigang vomit
soup.
2 glasses of
water
3 days prior to admission, patient RM ate regularly
with good appetite but since November 15, 2010, he
experienced vomiting and he had a poor appetite that is
why he can’t eat fully.

3. Elimination Pattern Urine Stool Urine Stool

4. Activity and Exercise Pattern
Color: amber Color: brown Color: tea colored Color: brown
Odor: pungent Odor: foul smell Odor: pungent Odor: foul smell
Frequency: 3-5 times a Frequency: once a day Frequency: 3-4 times a day Frequency: 2 times a week
day Consistency: semi formed Amount: 1000ml/ day Consistency: liquid form
Amount: 1200ml/ day
Patient RM also experienced vomiting, he said that he His urine and stool output had decreased during the time
had vomited 3 times, each vomit is about 200 ml and the of his hospitalization. His stool formation is in liquid form
content of it depends on the food he ate. and he defecated only twice in one week.
_0_ Feeding _II_ Feeding
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 _0_ Dressing _II_ Dressing
_0_ Bathing _II_ Bathing
_0_ Grooming _II_ Grooming
_0_ Toileting _II_ Toileting
_0_ Bed Mobility _II_ Bed Mobility
_0_ General Mobility _II_ General Mobility

Level 0 - Full Self Care Level 0 - Full Self Care

Level I - Requires equipment or device
Level II - Requires assistance or supervision from another
person.
Level III - Requires assistances or supervision from
another or device.
Level IV – is dependent and does participate.
Level I - Requires equipment or device
Level II - Requires assistance or supervision from another
person.
Level III - Requires assistances or supervision from another
or device.
Level IV – is dependent and does participate.

5. Sleep Rest Pattern
6. Cognitive Perceptual Pattern
Patient RM is fully independent with all his activities prior During hospitalization, Patient RM’s level of activity had
to admission. He is active in playing basketball and he decreased. He needs an assistant for every activity that he
often goes to gym. does because his body feels weak according to him.
Sleep 9PM 8PM 10PM According to Patient RM, he can’t sleep inside the hospital,
Awake 7AM 8AM 7AM every time he tries to sleep, he is easily disturbed by the noise
Total 10 hrs 12 hrs. 9hrs.
The time of sleep of Patient RM is regular prior to his inside the ward. He can’t do noontime naps because of the
admission. He is not taking noontime naps. environmental factors. When he sleep, he wakes up
immediately that is why he feels that his sleep is so fast. He
can’t find ways to relax himself.
He easily learns things when somebody teaches or lectures There are no changes in his cognitive pattern during his

8

7. Self Perception Pattern
8. Role Relationship Pattern
9. Sexuality Reproductive Pattern
10. Coping Stress Tolerance Pattern
11. Value Belief Pattern
him. He can easily express and verbalize his thoughts. hospitalization.
For him, he said that he is responsible and industrious. Patient RM said that he thinks that he doesn’t have a purpose
Even though he is getting annoyed easily, he still performs right now. He verbalized “nahihiya na ako kasi nahihirapan
the tasks that are assigned to him. na sa akin yung nanay ko.”
He lives with his mother and siblings. They are a nuclear During the hospitalization, he depends almost everything to
type of family in their household. His family is not his mother because of his inability to do things.
dependent to him because he has many other siblings. He
usually spends time with his friends, cousin and his
playmates in basketball. His work is good for him and his
income is just enough for him. With regards to their
neighbors, they are in good terms.
He has no problems with regards to his sexual relationship. He doesn’t do any sexual activity during hospitalization.
He is using withdrawal method when doing sexual
intercourse and he doesn’t have problems doing it.
When feeling tensed, he relieves himself by saying some To cope up with stress, Patient RM just talks to his relatives
jokes. He drinks alcoholic beverages sometimes. He talks that visit him.
to his cousin to open any problem so that he can solve it.
For him, having a work is one of the big changes in his
life.
For him, family comes first. He is not the kind of person He always pray to God every time during hospitalization. He
that is very faithful, he just believes but does not attend said that God gives him the strength inside he hospital.
mass or worships.
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Growth and Development
Psychosocial
Stage Generativity VS Stagnation
Definition Creativity, productivity, concern
for others, self indulgence , self
concerns, lack of interest in
commitments
Analysis The client is productive then
before he is admitted in the
hospital. He also works for his
self progress and to give his part
in his family. Now that he is
admitted he feels a bit
unworthiness for he can’t work
and his activities are limited due
to pain.
ANATOMY AND PHYSIOLOGY
GASTROINTESTINAL SYSTEM
REPRODUCTIVE SYSTEM
Psychosexual
Genital
Energy is directed toward sexual Use rational thinking and
maturity and function and
development of skills headed to
cope with environment.
He is well mature in the sense
that he works for his family and
develop skill for his well being.
He is not a kind of person that
would be at ease without doing
something.
Cognitive
Formal-Operational Phase
reasoning is deductive and
futuristic.
He is moody and uneasy. He
shows rational thinking in
following Doctors order. And
things that are advised to him
for his own well being.
Moral
Law-and-Order Orientation
The person wants established
rules from authorities and the
reason for decisions and
behaviors that social and sexual
rules and traditions demand the
response.
He is a moody in then. And
more moody now. He abides
rules of the doctors for his own
well being. His decisions are
based on his own belief.
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 The human male reproductive system (or male genital system) consists of a number of sex organs that are a part of the human reproductive process. In the case of
men, these sex organs are located outside a man's body, around the pelvic region.

The main male sex organs are the penis and the testes which produce semen and sperm, which as part of sexual intercourse fertilize an ovum in a woman's body and
the fertilized ovum (zygote) gradually develops into a fetus, which is later born as a child

The inguinal canal is a passage in the anterior (toward the front of the body) abdominal wall which in men conveys the spermatic cord and in women the round
ligament. The inguinal canal is larger and more prominent in men.
testes are components of both the reproductive system (being gonads) and the endocrine system (being endocrine glands). The respective functions of the testes are
producing sperm and producing hormone Testosterone.
scrotum (also referred to as the cod or scrot) is a dual-chambered protuberance of skin and muscle containing the testicles and divided by a septum. It is an extension
of the abdomen, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly pubic hairs at puberty.
The spermatic cord is the name given to the cord-like structure in males formed by the ductus deferens and surrounding tissue that run from the abdomen down to
each testicle.

The human abdomen (also called the belly) is the part of the body between the pelvis and the thorax. Anatomically, the abdomen stretches from the thorax at the
thoracic diaphragm to the pelvis at the pelvic brim. The pelvic brim stretches from the lumbosacral angle (the intervertebral disk between L5 and S1) to the pubic symphysis
and is the edge of the pelvic inlet. The space above this inlet and under the thoracic diaphragm is termed the abdominal cavity. The boundary of the abdominal cavity is the
abdominal wall in the front and the peritoneal surface at the rear.

PATHOPHYSIOLOGY

Modifiable Factor: Non-Modifiable

- Occupation (Carpenter) Factor:
- Activity (Basketball) Sex (Male)
- Previously diagnosed
with Inguinal Hernia

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 Excessive use of
abdominal muscles

Increased pressure in the compartment

of the abdomen develops

Intra-abdominal wall (containing

membranes or muscles) becomes
weakened

Relaxation of Thinning of the

abdominal wall fascia
musculature

Evolves into a
hole
Part of the small intestine pushes
through a hole in the abdominal
wall, slides through the inguinal
canal, and creates a loop

The loop part of the small intestine

got trapped in the hernia sac

Bulges through a weak area in the

muscles and appear on the right
side of the scrotum
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 Compression of the scrotum

Cell damage
scrotum

Inflammatory response

Redness Blood vessel near the site of injury Heat

are dilated

Increased permeability of capillary Insterstitial Filtration WBC, enter tissue and begin to
engulf bacteria

Plasma leak from blood stream into

Inflammation
tissue

Swelling of tissue of scrotum

Inflamed tissue reaches nociceptors

Stimulation of pain receptors 13

 PAIN

B. Definition of the Disease

Inguinal Hernia - is a condition in which intra-abdominal fat or part of the small intestine, also called the small bowel, bulges through a weak area in the lower
abdominal muscles. It occurs in the groin - the area between the abdomen and thigh. This type of hernia is called inguinal because fat or part of the intestine slides through
a weak area at the inguinal ring, the opening to the inguinal canal. An inguinal hernia appears as a bulge on one or both sides of the groin.

C. Modifiable and Non-modifiable Factors

• Modifiable Factors

Occupation
-If the work requires prolonged standing and lifting of heavy objects, the intra-abdominal wall may become weakened.

• Non-modifiable Factors

Sex
-Inguinal hernia is more common in males than females.
-Approximately 90% of all inguinal hernia repairs are performed on males.

Age

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 -Since abdominal walls weaken as a person ages, inguinal hernia tends to occur in the middle-aged and elderly.
-Direct inguinal hernia occurs in older patients as a result of relaxation of abdominal wall musculature and thinning of the fascia.

D. Causes
-Prolonged standing, lifting, and straining to have a bowel movement
-During uterine development, the testes descend out of the abdomen into the scrotum. These pass out of the abdominal cavity into the inguinal canal via the deep
(internal) ring and then into the scrotum via the superficial (external) ring.
-Marked obesity
-Heavy lifting
-Excessive coughing or sneezing
-Straining with defecation or urination
-Chronic obstructive pulmonary disease (COPD)
-Family history of hernias

E. Signs and Symptoms

-A small bulge in one or both sides of the groin that may increase in size and disappear when lying down; in males, it can present as a swollen or enlarged scrotum
-Discomfort or sharp pain - especially when straining, lifting, or exercising (that is relieved when resting)
-A feeling of weakness or pressure in the groin
-A burning, gurgling, or aching feeling at the bulge

PHYSICAL ASSESSMENT

BODY PART ASSESSED TECHNIQUE NORMAL FINDINGS ACTUAL FINDINGS REMARKS

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 A.GENERAL APPEARANCE
1.Body built INSPECTION Proportionate Proportionate: Mesomorph Normal
2.Posture INSPECTION Relaxed, erect posture Can not stand comfortably Deviation from normal due
to leg injury at the right
side of the legs
3.Dress, grooming, hygiene(odor) INSPECTION Clean, neat, no bad odor Clean, with slight body odor Deviation from normal due
to poor hygiene
4.Obvious physical deformities INSPECTION No deformities :healthy Not in healthy appearance Deviation from normal due
appearance to lack of exercise
5.Height INSPECTION 5’5”
6.Weight INSPECTION 50kg
B. VITAL SIGNS
1.Temperature INSPECTION 36.5-37.5°C 36.2°C Normal
2.RR INSPECTION 12-20 RPM/CPM 12RPM/CPM Normal
3.PR/ BP INSPECTION 60-100BPM/ 120/80mmHg 64BPM/ 100/70mmHg Normal
C. MENTAL STATUS
1.Level of consciousness INSPECTION Responsive: responds to Responsive: responds to Normal
questions clearly and questions clearly and
appropriately appropriately
2. Orientation INSPECTION Cooperative Cooperative Normal
3. Language and Communication INSPECTION Understandable; exhibits thought Understandable; exhibits thought Normal
association association
D. SKIN AND NAILS INSPECTION
1.Examine the expose part INSPECTION Convex curvature: smooth Lesion due to wound cause by Deviation from normal due
texture, intact epidermis surgery at hypogastric area to irritation and obstruction
of airway
2. Nails INSPECTION AND Highly vascular and pink in Highly vascular and slightly pale Normal
PALPATION color, prompt return to pink in color, prompt return to pink

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 color in 2-3 seconds color in 2-3 seconds
E. HEAD AND FACE
1.Skull condition and proportion INSPECTION Normocephalic and Normocephalic and Normal
symmetrical ;smooth skull symmetrical ;smooth skull
contour contour
2.Palpate for mass, presence of PALPATION Smooth: uniform consistency; uniform consistency; absence of Normal
infestation; tenderness and hair absence of nodules or masses nodules or masses
conditions
3.Face(symmetry and movements) INSPECTION Symmetrical facial features and Symmetrical facial features and Normal
movements; palpebral fissures in equal movement
equal in size
F. EYES INSPECTION
1.Eyebrows INSPECTION Hair evenly distributed: skin Hair evenly distributed: skin Normal
intact; eyebrow symmetrically intact; eyebrow symmetrically
aligned: equal movement aligned: equal movement
2.Eyelids INSPECTION Skin intact: no discharge; no Symmetric in position Normal
discoloration: lids close
symmetrically
4.Eyeballs symmetric movement INSPECTION Symmetric movement Symmetric movement Normal

5.Conjnctiva(bulbar and palpebral) INSPECTION AND Bulbar; transparent; capillaries Bulbar; transparent; capillaries Normal
PALPATION sometimes evident. Palpebral; sometimes evident. Palpebral;
shiny: smooth: pink orvred shiny: smooth: pale in color
6.Sclera INSPECTION White White Normal
7.Pupils INSPECTION Black in color; equal in size:’ Black in color; equal in size:’ Normal
round: briskly reactive to light round: briskly reactive to light
and accommodation and accommodation
Reaction to light: illuminated Reaction to light: illuminated
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 pupil constricts (direct response): pupil constricts (direct response):
no illuminated pupil constricts no illuminated pupil constricts
(consensual response) (consensual response)
Reaction to accommodation: Reaction to accommodation
pupils constricts when looking at
near objects: pupils converge
when object is move toward the
nose. Peripheral vision is intact
8. Lacrimal apparatus INSPECTION AND No edema or tearing No edema or tearing Normal
PALPATION
9. Visual acuity INSPECTION Able to read news print Able to read news print Normal
G. EARS
1.auricles Color same as facial skin: Color same as facial skin: Normal
symmetrical: aligned with the symmetrical aligned with the
lower cantus of the eye lower cantus of the eye
2.Pinna PALPATION Mobile: firm: pinna recoils after Mobile: firm: pinna recoils after Normal
it is folded it is folded
3.External Canal INSPECTION No discharge No discharge; dry cerumen Normal
4.Heaing Acuity INSPECTION Normal voice tone audible Normal voice tone audible Normal
5.Septum INSPECTION Intact and In midline Intact and In midline Normal
6.Muccus membrane INSPECTION Pinkish Pinkish Normal
7. Patency PALPATION Air moves freely in and out of Air moves freely in and out of Normal
the nasal cavities the nasal cavities
8. nasal cavity INSPECTION No obstructions No obstructions Normal
9.Siuses PALPATION Not tender Not tender Normal
H. MOUTH
1.Lips INSPECTION Uniform pink color: moist: Uniform brownish in color: Normal
smooth texture: symmetry of moist: smooth texture: symmetry
contour of contour
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2. Mucosa INSPECTION AND Uniform pink color Uniform pink color Normal
PALPATION
3.Tongue INSPECTION AND Central position: pink color, Central position: pink color, Normal
PALPATION moves freely: no tenderness moves freely: no tenderness

4. Teeth INSPECTION 32 permanent teeth, smooth, 2 permanent teeth with tooth Deviation from normal due
shiny white tooth enamel decay to poor oral hygiene
5. Gums INSPECTION AND Pink gums, moist firm texture Pink gums, moist firm texture Normal
PALPATION
I.PHARYNX
1.Uvula INSPECTION Midline Midline Normal
2.Mucosa INSPECTION Pinkish Pinkish Normal
3.Tonsils INSPECTION Pink ad smooth: no discharge Pink and smooth: no discharge Normal
4.Gag reflex INSPECTION Present Present Normal
J. Neck
1.Muscle strength INSPECTION AND RANGE OF Coordinated: smooth movement Coordinated: smooth movement Normal
MOTION with no discomfort with no discomfort
2.Trachea INSPECTION AND Central placement in midline of Central placement in midline of Normal
PALPATION the neck the neck
3.Palpate Thyroid INSPECTION AND Lobes are not palpable Lobes are not palpable Normal
PALPATION
K.BREAST AND AXILLA
1.Breast symmetry and contour INSPECTION Breast are round and generally Even with the chest wall, Normal
symmetric: no tenderness, generally symmetric: no
masses and lesions tenderness, masses and lesions
2.Skin characteristics INSPECTION AND Skin uniform in color; skin Skin uniform in color; skin Normal
PALPATION smooth and intact smooth and intact
3.Nipple condition and presence of INSPECTION AND Bilaterally round and dark brown Bilaterally round and dark brown Normal
discharge PALPATION in color: no presence of in color

19
 discharge
L. CHEST AND LUNGS
1.Shape and configuration INSPECTION Anteroposterior to transverse Spine is vertically aligned Normal
diameter ratio of 1:2; Spine is
vertically aligned

2. Lung expansion PALPATION Full and symmetric chest Full and symmetric chest Normal
expansion expansion
3. Fremitus PALPATION Bilateral symmetry of vocal Bilateral symmetry of vocal Normal
fremitus fremitus
4.Breathing pattern INSPECTION Quiet, rhythmic, effortless Normal in breathing pattern Normal
5. Breath sound AUSCULTATION Vesicular and bronchovesicular Normal in breath sound Normal
6. Costal angle INSPECTION AND Less than 90 Less than 90 Normal
PALPATION
M. CARDIOVASCULAR
1.Precordium
a. Aortic and pulmonic INSPECTION AND No Pulsation No Pulsation Normal
PALPATION
b. Tricuspid INSPECTION AND No Pulsation; no lifts or heaves No Pulsation; no lifts or heaves Normal
PALPATION
c. Apical INSPECTION AND Palpation visible in 50% of adult No lift or heave Normal
PALPATION and palpable I most PMI in 5th
LICS at or medial to MCL: No
lift or heave
d. Epigastric INSPECTION AND Aortic pulsations Aortic pulsations Normal
PALPATION
e. Auscultating the heart AUSCULTATION S1: usually heard at all sides. S2: usually heart at all sites, Normal
areas above Usually louder at apical area louder at the base of the heart
S2: usually heart at all sites,
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 louder at the base of the heart
S3: in children and young adults
S4: older adults
2. Carotid artery PALPATION AND Symmetric pulse volume, full Symmetric pulse volume, Normal
AUSCULTATION pulsations: thrusting quality thrusting quality remain same
remain same when client breaths, when client breaths
turns head and changes from
sitting to supine position: elastic
arterial wall
3. Jugular vein INSPECTION Veins not visible Veins not visible Normal
N. ABDOMEN
1.Skin condition INSPECTION Uniform in color Not uniform in color cause by Deviation from normal due
surgery to irritation and obstruction
of airway
2.Contour and symmetry INSPECTION Symmetric contour Not symmetry in contour Deviation from normal due
to irritation and obstruction
of airway
3.Abdominal bowel sounds AUSCULTATION Audible bowel sounds Audible bowel sounds Normal
4. Presence of muscle guarding, INSPECTION AND No Tenderness Presence of tenderness Deviation from normal due
extension and rebound tenderness PALPATION to leg injury at the right
side of the legs.
O. UPPER AND LOWER
EXTREMETIES
1.Motor strength INSPECTION Equal strength on each body side unilaterally weak Deviation from normal due
to leg injury at the right
side of the legs.
2.Muscle tone PALPATION Normally firm Normally firm Normal
3.Presence of lesions, deformities INSPECTION No lesions; no deformities: no Presence of lesions, no Deviation from normal due
21
and varicosities tenderness deformities, no varicosities to irritation

LABORATARY RESULTS:

LABORATORY DATE ORDERED/ INDICATION/ ACTUAL VALUES NORMAL VALUES ANALYSIS/ NURSING
PROCEDURE DATE RESULT IN PURPOSES INTERPRETATION RESPONSIBILITIES
(prior, during, after)
Urinalysis Date ordered:  To obtain and Color: Amber Color: Amber Normal PRIOR:
11/17/10 provide the Characteristics: Characteristics: Normal  Explain that this
11:59 pm practitioner Turbid Turbid test aids in tha
Date result: with Specific Gravity: Specific Gravity: Normal diagnosis of
11/18/10 information to 1.020 1.010-1.025 renal or urinary
evaluate the Reaction: Acidic Reaction: Acidic Normal tract disease and
client’s health Sugar: none Sugar: none Normal helps evaluate
status through Albumin: - Albumin: - Normal overall body
urine Pus: 15.20/hpr Pus: - function.
examination. RBC: 3-5/hpf RBC: 0-2/hpf  Inform the
Epithelial cells: few Epithelial cells: patient that he
Bacteria: few Bacteria: none Positive, it indicates does not need to
Crystals: few Crystals: none that there is infection. restrict food or
Normal fluids.
Creatinine: 134.8 Creatinine: 90-139  Notify the
mmol/L mmol/L laboratory
practitioner of
medications the
22
 patient is taking
that may affect
test results;
these
medications can
be restricted.
 Explain how to
collect a clean-
catch specimen.

DURING:
 Confirm the
patient’s identity
using two
patient
identifiers
according to
facility policy.
 Collect a
random clean-
catch urine
specimen of at
least 15ml.
 Obtain a first-

23
 voided morning
specimen if
possible.
AFTER:
 Tell the patient
to resume his
usual diet and
medications
stopped before
the test, as
ordered.
 Check for the
color and
characteristics
of the urine.
 Document all
findings.
Hematology Date ordered:  It is a test used WBC: 12.4 x 10 9/L WBC: 5.0-10.0 x 10 Increased due to PRIOR:
11/20/10 to measure 9/L infection and  Ensure that the
4:52pm analyte and to inflammation of small consent for
determine the intestine. management is
Date result: blood type and RBC: 4.17 x 10 12/L RBC: 3.80-5.80 x 10 Normal signed and
11/21/10 compatibity 12/L approved.
on across HGB: 138 g/L HGB: 110-165 g/L Normal  Check for the ID
matching for HCT: .423 HCT: .350-.500 Normal band to
24
 blood PLT: 260 x 10 g/L PLT: 150-390 Normal determine the
transfusion PCT: 189 x 10 21/L PCT: 100-500 Normal proper client to
purposes. MCV: 85 MCV: 80-97 Normal be examine.
MCH: 27.7 pg MCH: 36.5-33.5 Normal  Check for the
MCHc: 326 g/L MCHc: 315-350 Normal order of the
RDn: 14.9 % RDn: 10.0-15.0 Normal doctor.
MPV: 7.3 fL MPV: 6.5-11.0 Normal  Explain that
PDn: 15.1 % PDn: 10.0-18.0 Normal hematocrit and
RBC indices are
tested to detect
11/20/10 WBC anemia and
other abnormal
%LYM: 8.6 L% %LYM: 17.0-48.0 Decreased due to blood
underlying viral conditions.
infection which is  Explain that the
infection with red blood cell
"opportunistic" count is used to
pathogens. evaluate the
%MON: 42% %MON: 4.0-10.0 Increased due to tissue number of RBC
injury and acute and to detect
infection. possible blood
%GRA: 87.2% %GRA: 43.0-76.0 Increased disorder.
 Explain that the
#LYM: 1.01 x 10 9/L #LYM: 1.2-3.2 Normal white blood cell
#MON: 0.5 x 10 9/L
25
#GRA: 10.9 x 10 9/L #MON: 0.3-0.8 Normal count test id
#GRA: 1.2-6.8 Increased used to detect an
infection or
inflammation.
DURING:
 Confirm the
patient’s identity
using two
patient
identifiers
according to
facility policy.
 Perform a
fingerstick using
a heparinized
capillary tube
with a red band
on the
anticoagulant
end.
 Fill the capillary
tube from red-
banded end to
about two-thirds

26
 capacity; seal
this end with
clay.
AFTER:
 Make sure that
the subdermal
bleeding has
stopped before
removing
pressure.
 Instruct the
patient that he
may resume his
usual diet,
activity, and
medications
discontinued
before the test as
ordered. (WBC)
 Document the
findings.
 Report to the
physician the
possible

27
 abnormal values
that have seen.
Electrolyte Result 11/23/10  To measure PRIOR:
the  Check the order
concentration of the physician.
of sodium, K,  Ensure the
calcium, client’s identity.
chloride, DURING:
magnesium  Collect a
and specimen to
phosphate. determine the
 It provides electrolyte
cellular balance.
reaction. Analyte AFTER:
Na 135.9 mmol/L 135-148 mmol/L Normal  Check for the
K 3.95 mmol/L 3.5-5.3 mmol/L Normal actual findings.
Ca - mmol/L 1.1-1.32 mmol/L Increased due to stone  Measure the
formation concentration of
Cl 95.7 mmol/L 96-107 mmol/L Normal the Na, K, Ca,
Cl.
 Increased fluid
intake and
replacement of
lost electrolytes
are usually
28
 sufficient to
restore fluid
balance in
patients who are
mildly or
moderately
dehydrated..
 Adults may
replace lost
electrolytes by
drinking sports
beverages, such
as Gatorade or
Recharge.

PATIENT AND HIS CARE

A. Medical Management

29
 Medical Date ordered/Date Client’s
Management performed/Date General Description Indications/Purposes Response to Nursing Responsibilities
Treatment change the treatment

Intravenous fluid Date Ordered- -Hypertonic solution Is a sterile, non pyrogenic solution The client skin
PRIOR:
of D5LR 1000cc 11/17/10 -Dextrose 5% in Lactated for fluid and electrolyte became moist.
regulated @ Ringers is indicated as a replenishment in a single dose -ensure that consent for management is
25gtts/min, Date performed- source of water, container for intravenous signed and approved
11/17/10 electrolytes and calories administration.
-gather all the necessary supplies before you
or as an alkalinizing
begin
Date Change- agent.
11/18/10

- Inspect the fluid bag to be certain it

contains the desired fluid, the fluid is clear,
Date Ordered-
the bag is not leaking, and the bag is not
11/21/10
expired

Date performed-
11/21/10
- Select either a mini or macro drip
administration set and uncoil the tubing. Do
Date Change-
not let the ends of the tubing become
11/22/10
contaminated.

DURING:
Date Ordered-
-Ensure that right drops are given
11/22/10

Date performed-
- ensure that all medications inserted in the30
11/22/10
fluid is monitored and recorded
B.DRUG STUDY
Generic Name/ Date Ordered, Route of General Action Indication/Purpose Nursing Side Effects
Brand name Given/ Date Administration, responsibilities
Changed dosage, frequency
GN: Cefuroxime Nov. 18. 2010 Route: TIV Cefuroxime is a well Lower Respiratory PRIOR: Diarrhea / Loose
Sodium 4am-12nn-8pm Dosage: 750 mg characterized and tract infection due to S. • Check doctors order. stools, N/V,
Frequency: q 8 hours effective antibacterial pneumoniae, H. • Perform ANST prior Abdominal Pain
BN: Zinacef Nov.19,2010 agent which has Influenzae (including to administering
4am bactericidal activity ampicillin resistant), drugs.
against a wide range Klebsiella species, S. • Determine history of
of common aureus, S. pyrogenes hypersensitivity
pathogens, including and E. coli reactions to
β-lactamase cephalosporins,
producing strains. penicillins and
history of allergies
particularly to drugs
before therapy is
initiated.
DURING:
• Be alert for adverse
reactions and drug
interaction.
AFTER:
• Inform the patient
31
 about the possible
side effects of the
drugs.
GN: Ketorolac Nov.19,2010 Route: TIV Possess anti- Short term PRIOR: Headache,Dizziness,
1st dose 8am Dosage: 30 mg inflammatory management of pain • Assess pain drowsiness, diarrhea,
BN: Toradol Frequency: q 6 hours analgesic and (not to exceed 5 days (note type, location, Nausea, dyspepsia
Nov.21, 2010 antipyretic effects total for all routes and intensity) prior
nd
2 dose 8:30am X3 more dose indicates as a single combined) to and 1-2 hr
or multiple dose following
Nov.22,2010 regimen on a regular administration.
12 nn or as needed schedule • Caution patient
for the management to avoid concurrent
of moderately severe use of alcohol,
acute pain that aspirin, NSAIDs,
requires analgesia at acetaminophen, or
the opioid level, other OTC
ussually in a medications without
postoperative setting. consulting health
care professional.
• Advise patient
to consult if rash,
itching, visual
disturbances,
tinnitus, weight
gain, edema, black
32
 stools, persistent
headche, or
influenza-like
syndromes
(chills,fever,muscles
aches, pain) occur.
DURING:
• Be alert for
adverse reaction of
the drug.
AFTER:
• Inform the
patient about the
possible side effects
of the drugs.
• Advise patient
to report any
discomfort on the IV
insertion site.
GN: Ranitidine Nov.19,2010 Route: TIV Completing inhibits Perioperative to PRIOR: Confusion, dizziness,
8am Dosage: 50 mg gatric acid secretion suppress acid • Assess patient drowsiness,
BN: Zantac Frequency: q 8 hours by blocking the effect secretion,prevent stress for epigastric or hallucinations,
Nov.20, 2010 of histamine on ulcers & prevent abdominal pain and headache,
4am-8pm While NPO histamine H2 aspiration frank or occult blood Arrhythmias, Altered
receptors. Both pneumonitisin in the stool, emesis, or taste, black tongue,
33
Nov.21, 2010 daytime & nocturnal combination with H1 gastric aspirate. constipation, dark
12nn-8pm basal gastric acid histamine antagonist to • Inform patient stools, diarrhea, drug-
secretion, as well as treat certain types of that it may cause induced hepatitis,
Nov.22,2010 food & pentagastrin urticaria & as drowsiness or nausea
12nn-8pm stimulated gastric acid prophylaxis to reduce dizziness.
are inhibited. the incidence of • Inform patient
Nov.23,2010 NSAID – induced that increased fluid
4am-12nn duodenal ulcers. and fiber intake may
minimize
Nov.24,2010 constipation.
8pm DURING:
• Advise patient
to report onset of
black, tarry stools;
fever, sore throat;
diarrhea; dizziness;
rash; confusion; or
hallucinations to
health car professional
promptly.
AFTER:
• Inform patient
that medication may
temporarily cause

34
 stools and tongue to
appear gray black.
GN: Ceftriaxone Nov.19,2010 Route: TIV Ceftriaxone usually is Lower respiratory tract PRIOR: Diarrhea, nausea,
Sodium 12nn-8pm Dosage: 1 g bactericidal in action. infections due to • Check the rashes, electrolyte
Frequency: q 8 hours Like other Streptococcus doctors order. disturbances and pain
BN: Rocephin Nov.20, 2010 cephalosporins, the pneumoniae, • Perform
4am-12nn-8pm antibacterial activity staphylococcus aureus, ANST prior to
of the drug results Haemophilus administering
Nov.21, 2010 from inhibition of influenzae, Klaebsiella drugs.
4am-12nn-8pm mucopeptide pneumoniae and E.coli • Assess
synthesis in the patient’s
Nov.22,2010 bacterial cell wall. underlying
12nn-8pm condition
before starting
Nov.23,2010 therapy.
4am-12nn DURING:
• Be alert
Nov.24,2010 for adverse
12nn-8pm reaction & drug
interaction.
AFTER:
• Inform the
patient about
the possible
side effects of
35
 the drug.
GN: Metronidazole Nov.18.2010 Route: TIV Hinders growth of Indicated in the PRIOR: seizures, dizziness,
4am-12nn-8pm Dosage: 500 mg Several organisms, treatment of serious • Assess patient’s headache, abdominal
BN: Flagyl Frequency: q 8 hours including most infectious caused by infection before pain, anorexia,
Nov.19,2010 anaerobic bacteria and susceptible anaerobic starting therapy & nausea, diarrhea, dry
4am-12nn-8pm protozoa. bacteria. regularly thereafter mouth, furry tongue,
to monitor drug’s glossitis, unpleasant
Nov.20, 2010 effectiveness. taste, vomiting
12nn-8pm • Inform patient
that medication may
Nov.21, 2010 cause an unpleasant
4am-12nn metallic taste.
DURING:
Nov.22,2010 • Be alert for
12nn-8pm adverse reaction &
drug interaction..
Nov.23,2010 • IV infusion
4am-12nn may cause
thrombophlebitis at
Nov.24,2010 site, observe closely.
12nn-8pm AFTER:
• Monitor
neurologic status
during and after IV
infusions.
36
 • Inform patient
that medication may
cause dark urine.

C. Diet

Date started/Date Client responses to Nursing

Type of Diet General description Indication/Purposes Specific foods taken
Changed the diet Responsibilities
prevention of aspiration PRIOR:
NPO Date Started: Is a medical NONE The patient’s SO
instruction meaning to pneumonia complied with the -explain to the patient
(Nothing per orem) 11/17/10
withhold oral ordered diet of what NPO is.
Date Changed:
food and fluids the patient.
11/24/10 for a certain
period of time for -ensure that an IV
various reasons, like fluid is to be inserted
to avoid aspiration in to replace the loss of
unconscious water and food
preoperative and
DURING:
preprocedural clients
who will receive -Assess the patient
anesthesia or

37
 condition.
conscious sedation.

AFTER:

-Monitor V/S of the

patient.

PRIOR:
Generalized liquid Date Started: A liquid diet helps A liquid diet is often Plain water Increased hydration.
diet maintain adequate used before tests, -explain to the patient
11/24/10
hydration, provides procedures or surgeries what generalized
Date Changed:
some important that require no food in liquid diet is.
11/25/10 electrolytes, such as your stomach or
DURING:
sodium and intestines
potassium, and gives -discuss to him the
some energy at a time right fluid he
when a full diet isn't mustacquire.
possible or
AFTER:
recommended
-monitor clients diet.

-monitor client’s
response to the diet.

-monitor I&O.
D. Activityu/Exercise

38
Type of Exercise Date ordered/ Date General Description Indication/Purposes Client’s Response to the Nursing Responsibilities
change exercise
Ambulation Date ordered- Changing position in bed, Promote good blood PRIOR:
walking and prescribed circulation.
11/20/10 -explain to the benefits of
exercise promotes early ambulation to the
Date change-
circulation. patient.

DURING:

-Observe and assess

patient.

AFTER:

Monitor his condition.

• Surgical Management

A. Brief description

Inguinal hernia repair, also known as herniorrhaphy, is the surgical correction of an inguinal hernia. An inguinal hernia is an opening, weakness, or bulge in the
lining tissue (peritoneum) of the abdominal wall in the groin area between the abdomen and the thigh. The surgery may be a standard open procedure through an incision
large enough to access the hernia or a laparoscopic procedure performed through tiny incisions, using an instrument with a camera attached (laparoscope) and a video
monitor to guide the repair. When the surgery involves reinforcing the weakened area with steel mesh, the repair is called hernioplasty.

39
 Purpose
Inguinal hernia repair is performed to close or mend the weakened abdominal wall of an inquinal hernia

Date Ordered : November 17, 2010 05:30pm

Date Performed : November 18, 2010 12:00am

B. Patient’s response to operation

Prior to operation: The client is aware of the operation and not afraid of it.
During the Operation: The client is unconscious during the operation as a result of the anesthetics given to him.
After the Operation: The client is weak in appearance; conscious and coherent; febrile. Exhibits guarding behavior.

C. Nursing Responsibilities
40
Prior to Operation:

 Monitor V/S
 Secure consent for Mash Herniorraphy
 Remove all accessories of the client
 Maintain on NPO status
 Consume IVF as instructed for hydration
 Change clothing to operating gown
 Relieve patient’s anxiety by explaining the procedure
 Prepare all surgical materials needed

During the Operation:

 Check V/S
 Assess level of consciousness
 Check patient’s chart for
o Consent form
o IVF order
 Counting of all the instruments
 Site for incision preparation
 Notify surgeon that patient is ready
 Assist surgeon

41
  Count all the materials used
 Document the procedure done

After the Operation:

 Maintain patient flat on bed

 Monitor V/S every 15 minutes for 2 hours until stable then every 1 hour
 Check doctor’s post-op orders and adjust IVF accordingly
 Post-op meds given
 With NGT intact for decompression
 Emphasize NPO
 Monitor I/O

NURSING PROBLEM PRIORITIZATION

NUMBER PROBLEM/NURSING DIAGNOSIS JUSTIFCATION

1 Acute Pain Using ABCD’s of life as pain is represented by the pain

should be at high priority in this case. Pain is highly

subjective and presence of this can affect many facets of

a person’s functioning

42
 2 Impaired Tissue integrity Using Maslow’s Hierarchy of Needs, to maintain tissue

integrity is one of the physiologic needs of an

individual, further more this is an actual problem and

should be given priority.

3 Risk for infection Since this is a potential problem it should be prioritize

next to the actual problem. Risk for infection belongs to

the second level of Maslow’s Hierarchy of Needs which

is safety and security

NURSING CARE PLAN

• ACUTE PAIN

43
 CUES NURSING SCIENTIFIC PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS KNOWLEDGE

SUBJECTIVE: Acute pain related Herniorraphy Long Term Goal: INDEPENDENT: • GOAL MET:
( mechanical
“Sobrang sakit to actual tissue trauma/tissue injury) • After 30 minutes of • Note location of • As this can influence The patient was able

nang tahi ko” as damage nursing intervention surgical procedures the amount of pain to report reduction of
Release of
verbalized by the secondary to Biochemical the client will be experienced presence pain from pain scale
mediators
patient. presence of able to report of known/ unknown of 9/10 it was reduce
Sensitizations of
surgical incision nociceptors reduction of pain complications may to 7/10

OBJECTIVE: at the RLQ of the from pain scale of wake the pain more
Release of substance
• 27 abdomen P ( neurotransmitter 9/10 it will be severe than
that assist in
year old male transmission of reduced to 7/10 anticipated
impulses across the
• Post synapse) Short Term Goal:

- mash • After 15 minutes of • Note when pain occurs • To medicate

A-delta fibers
Herniorraphy nursing intervention (e.g. only ambulation prpphylactically as

• Pai Transmit signals to the client will be every evening) appropriate

thalamus
n scale of 9/10 able to identify non-

• Faci Somatic sensory pharmacological • Provide comfort • To promote non-

cortex
al grimace methods that provide measures (assist in pharmacological pain

• Gua Pain perception relief from pain. position changes, management

rding behavior • After 15 minutes of nurse’s presence, quite

• Irrit nursing intervention and calm activities) 44

ability the client will be • Use of non-

Reference:
 • IMPAIRED TISSUE INTEGRITY

CUES NURSING SCIENTIFIC PLANNING INTERVENTION RATIONALE EVLUATION

DIAGNOSIS KNOWLEDGE

SUBJECTIVE: Impaired Tissue Occurrence of Long Term Goal: INDEPENDENT; • GOAL MET:
inguinal Hernia
“Sobrang sakit nang Integrity related to • After 48 hours • Assess surgical wound  For The client was able to

tahi ko” as surgical incision at Need for intentional nursing ( location size) comparative display progressive
trauma (surgery)
verbalized by the RLQ of the abdomen intervention the • Inspect wound daily for baseline improvement in
Incision at RLQ of
patient. the abdomen client will be able changes  Promotes wound healing and

OBJECTIVE: to display timely prevented

Impaired Tissue
• Post- integrity progressive interventions/ complication to occur

mash improvement in • Change wound dressing revision of plan

Herniorraphy Reference: wound healing and aseptically of care

Fundamental of
• Cont Nursing, 7th Edition, will prevent  Keep the wound  To prevent
Kozier
rolled complication to dry and clean further

movements occur.  Cleanse the area complication

• Surg Short Term Goal: of wound gently

ical incision at • After series of with the use of

RLQ of the nursing required

45
abdomen. intervention the solutions

client will be able  Cover with

to: sterile gauze

 Identify • Provide optimum

appropriate nutrition including

interventions Vitamin C. and increase

that promotes protein intake  Provide

wound healing positive nitrogen

 Demon • Encourage adequate rest balance to aid in

strate behaviors periods tissue healing

and

interventions  To prevent

that facilitates fatigue/ limit

healing metabolic

 Identify demands and

situations maximize energy

(fever, for more DEPENDENT: available for

than 24 hours)  Provide healing.

46
 that suggest appropriate and healing

referral to devices (splints)

physician to  To support

prevent serious the surgical

complications incision from skin

to occur and tissue

breakdown.

• RISK FOR INFECTION

CUES NURSING SCIENTIC PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS KNOWLEDGE

SUBJECTIVE: Risk for infection to Occurrence of Long Term Goal: INDEPENDENT: • GOAL MET:
inguinal Hernia
No cues actual tissue damage • The client will • Assess surgical incision The client remained

OBJECTIVE: secondary to Need for intentional remain free of any for localized sign of free of any symptoms
trauma (surgery)
 Surgical presence of surgical symptoms of infection of infection after 24
incisions at Incision at RLQ of
@RLQ incision at RLQ the abdomen infection after 24 • Change surgical wound  To prevent hours of nursing
 Post Mash
Herniorrhap hours of nursing dressing as indicated the spread of intervention.
hy Skin is not intact
intervention using aseptic technique. microorganisms

Risk for infection

47
 Short Term Goal: • Keep wound clean and  As moisture

• The client will dry promotes

Reference:
Fundamentals of able to identify microbial growth
Nursing 7th edition,
Kozier methods that will • Remove and replace  To reduce

be useful in dressing if it is already bacterial

reducing the risk soak colonization

of acquiring • Encourage position  To aid in

infection after 8 changes and deep blood circulation

hours of nursing breathing exercise and prevent

intervention further

• The client will be respiratory

able to DEPENDENT: infection

demonstrate • Administer and monitor

techniques that medication regimen and  To determine

will be useful in note client’s response its effectiveness

the prevention of and presence of

infection after 8 untoward side

hours of nursing effects.

48
 intervention

• After 8 hours of

nursing

intervention the

client will be able

to verbalized

understanding of

individual risk

factors that will

prevent him in

acquiring infection

DISCHARGE PLANNING

MEDICATIONS
• Medications prescribed by the physician include:

 Cefuroxime 500mg BID

 Mefenamic Acid 250mg PRN for pain

• Instruct the client to take the antibiotic for 7-14 days as prescribed.

49
 • Patient was advised to continue home medications to maintain a normal functioning of the body and to maintain homeostasis.

• The treatment regimen ordered by the physician must be followed strictly and should not be stopped to prevent aggravation of the condition.

EXCERCISE
• Instruct patient to do active range of motion (R.O.M.) to restore normal body functions.

• Advise the patient to do light exercise, such as walking to limit fatigue.

TREATMENT
• Instruct patient to follow the health teaching provided by the health educator, including all medications for faster recovery.

HEALTH TEACHING
• Avoid activities that increase intra-abdominal pressure (lifting, coughing, or straining) that may cause the hernia to increase in size

• Attention to rest, within 3 months after surgery to avoid vigorous activity and avoid heavy physical labor.

• Emphasize proper daily wound cleaning.

• Emphasize proper hand hygiene.

OUTPATIENT FOLLOW-UP CARE

• Instruct the patient to seek or return after a week at Bulacan Medical Center- Out-Patient Department.

50
 • Getting adequate rest during the client’s first week at home will do reach to prevent the possibility of this complication.

DIET
• Advise the patient to maintain g general liquid diet as ordered by the physician.

• Instruct patient to have proper diet especially foods rich in Vitamin (Citrus fruits; orange), protein for faster wound healing.

• Maintain adequate hydration.

SPIRITUAL
• Seek God’s help and guidance by means of praying and holding their faith to our Almighty God.

CONCLUSION

In this case study Incarcerated Inguinal Hernia was given more understanding by proponents. It has been noted that incarcerated inguinal hernia is the protrusion of
a tissue through the wall of the cavity in which it is normally contained, and a serious complications from a hernia result from the trapping of tissues in the hernia -- a
process called incarceration. Trapped tissues may have their blood supply cut off, leading to damage or death of the tissue which the nurse should monitor and watch-out for.
By this, early detection of the illness seemed necessary for it can prevent complications or even death.
The case study has enabled us to obtain comprehensive learning, and help us in identifying and understanding the possible problems that compromise the health of
the patient, fortunate nursing care interventions was developed the physical, mental and emotional well-being of the patient. Its goal has been met through objectives that
have been specially focused on both the client and student’s welfare.
We acquired and enhanced our knowledge about the disease, the factors that contribute to the development of the client’s condition. Build trust and gained respect
among the nurses and was able to deepen information about his condition. Met the needs of the client in the best way possible, either physically, mentally, socially,
spiritually and emotionally .
BIBLIOGRAPHY

51
 Medical and Surgical Nursing 12th edition, Sardarth and Bruner
 www.wikipedia.com
 www.scribd.com
 Fundamentals of Nursing 8th edition, Kozier
 Nurse’s Drug Handbook, 2008th edition, George R. Spratto and Adrienne L. Woods
 NANDA

52