St.

Anthony’s College
San Jose Antique
Nursing Department

Pt. Name: A.J.C

Age: 65
Sex: M
Date of Birth: October 22, 1953
Pre-Operation Diagnosis: Indirect Inguinal hernia, Left, Reducible Incomplete
Operation perform: Mesh Hernioplasty Left

A hernia is a protrusion of a viscous or a part of viscous through an abnormal opening in the walls of its containing cavity.
There are two main types of an inguinal hernia - direct, in which viscera protrude directly through the peritoneal wall and the posterior wall of the inguinal canal;
indirect, on the other hand, is distinguished by protrusion through the deep inguinal ring and passage adjacent to the spermatic cord, eventually terminating in the
testes. Additionally, the indirect inguinal hernia is recognized by its location in relation to the inferior epigastric artery, by passing laterally from this blood vessel,
while a direct hernia passes medially. The pathogenesis of indirect inguinal hernia presumably includes both congenital and acquired factors. During embryonic
development, the testes, once they are formed, descend into the scrotum covered by processus vaginalis, a protrusion of the parietal peritoneum created during
organogenesis. As the testes descend, processus vaginalis should obliterate, but for some reason, this process does not occur in some individuals, which predisposes
visceral protrusion through this processus. This type of hernia is often seen in neonates at birth and infants, but adults are also commonly affected and a significant
predilection toward male gender is established

In indirect inguinal hernias arise lateral and superior to the course of the inferior epigastric vessels, lateral to the Hesselbach triangle, and then protrude through the
deep or internal inguinal ring into the inguinal canal. An indirect hernia enters the inguinal canal at the deep ring, lateral to the inferior epigastric vessels. It passes
inferomedially to emerge via the superficial ring and, if large enough, extend into the scrotum while direct hernia is usually caused when the wall of the abdominal
muscles becomes weak. That allows a portion of the intestine to push through the abdominal wall. This weakening can develop over time, due to everyday activities
and aging. In some cases, improperly lifting something heavy can put extra pressure on those muscles, allowing them to weaken and tear.

The first sign of an inguinal hernia is a small bulge on one or, rarely, on both sides of the groin—the area just above the groin crease between the lower abdomen
and the thigh. The bulge may increase in size over time and usually disappears when lying down. Other signs and symptoms can include discomfort or pain in the
groin—especially when straining, lifting, coughing, or exercising—that improves when resting feelings such as weakness, heaviness, burning, or aching in the groin
a swollen or an enlarged scrotum in men or boys.
Indirect and direct inguinal hernias may slide in and out of the abdomen into the inguinal canal. A health care provider can often move them back into the abdomen
with gentle massage.

Causative factors of indirect inguinal hernia are when a fetus is still in the womb, there is an internal opening to the inguinal canal, but this usually closes before
birth. When the inguinal canal opening fails to close completely by the time of birth, this allows a portion of fat or intestine to slip through and cause an indirect
hernia. In females, the ovaries and other parts of the reproductive system can slide through the opening and cause a hernia. Indirect hernias are the most common
type of inguinal hernia. Although they occur in both sexes, they are more common in males than females. And some other causes are: heavy lifting constipation and
strain with bowel movements being overweight smoking.

It can be diagnose through physical exam the doctor will examine the individual, often asking them to stand and cough or strain, as this is the time when a bulge is
most likely to occur. The tests used to diagnose a hernia include X-rays and ultrasounds.
The tests include: abdominal X-ray: An X-ray machine is positioned over the abdominal area and a small amount of radiation is used to take a picture.
Computerized tomography (CT) scan: A person either drinks a solution, or a special dye, known as contrast medium, is injected into a vein. This helps to see blood
vessels and blood flow on the X-ray. Ultrasound: A device known as a transducer bounces painless sound waves off organs and body parts to build up an image.

The surgery does not always have to be immediate, but if an inguinal hernia is discovered, it must be monitored closely by a doctor to see if the symptoms get
worse. If the tissue of the hernia becomes trapped or incarcerated, then surgery will be more urgent.
There are two types of general surgical procedure for inguinal hernia:
Open hernia repair: This is usually done under general anaesthesia. A cut is made in the groin and the fat and intestines are moved back into the abdomen. Often,
synthetic mesh will be placed over the weak area to prevent it reoccurring.
Laparoscopic hernia repair: Usually done under general anaesthesia, small cuts are made and a laparoscope, a thin tube with a camera on the end, is inserted. Using
the camera images as a guide, the repair procedure is done.

The type of repair may depend on the nature of the hernia. Three types of hernias are most common, including:
Reducible hernia: When the hernia can be pushed back into the opening it came through.
Irreducible or incarcerated hernia: When the organ or abdominal tissues have filled the hernia sac, and it cannot be pushed back through the hole it came through.
Strangulated hernia: When part of an organ or tissue becomes stuck inside the hernia with its blood supply often cut off

In the case of our patient he had an indirect inguinal hernia left it is a reducible incomplete. And Dr.Santacera performed Mesh hernioplasty. In hernioplasty, instead
of stitching the muscle opening shut, the surgeon covers it with a flat, sterile mesh, usually made of flexible plastics, such as polypropylene, or animal tissue.
The surgeon makes small cuts around the hole in the shape of the mesh and then stitches the patch into the healthy, intact surrounding tissues.
Damaged or weak tissues surrounding the hernia will use the mesh, as a supportive, strengthening scaffold as they regrow. Hernioplasty is better-known as tension-
free hernia repair.
 St. Anthony’s College
San Jose Antique
Nursing Department

Pt. Name: A.J.C

Age: 65
Sex: M
Date of Birth: October 22, 1953
Pre-Operation Diagnosis: Indirect Inguinal hernia, Left, Reducible Incomplete
Operation perform: Mesh Hernioplasty Left

PRE-OPERATION

ASSESSMENT NURSING RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Subjective: Moderate Anxiety All people General: .1. Assess level of 1. Helps determine After the nursing
“Nakulbaan ako,kag related to experience some After 30 mins.-1 fear. Note signs of the kind of interventions, the
ginaready ko dun unfamiliarity with degree of anxiety (a hours nursing denial, depression or interventions patient was able to:
akun kaugalingon the surgical tense emotional intervention the narrowed focus of required.
nga after kng procedure as state) as they face patient will be able attention. 1. To appear relax.
operation my mga evidenced by new, challenging, or to report decreased
discomfort aq nga expressed concerns. threatening life fear, anxiety reduced 2. Explain 2. Fear is lessened 2. Report readiness
mabatyagan”as situations. In clinical to a manageable procedures and care by information and to undergo surgery.
verbalized by a settings, fear of the level and blood as delivered. Repeat knowledge. Anxiety
patient. unknown, pressure is in a explanations may reduce 3.Verbalize anxiety
unexpected news normal range. frequently as needed. comprehension is gone or reduce to
Objective: about one’s health, requiring repetition a more manageable
Temp.- 36.7 and any impairment Specific: of important level
PR- 76 bpm of bodily functions After 1hour of information.
RR- 20 cpm engenders anxiety. nursing intervention
BP-140/80 before the settled 3. Acknowledge 3. Knowing feelings
Reference: Textbook operation, the feelings of normalcy are normal can allay
of Medical- Surgical patient will be able feelings in this anxiety that client is
Nursing by: to: situation. losing control.
Smeltzer, Bare, 1. Appear relaxed.
Hinkle and Cheever. 2. Verbalize 4. Encourage patient 4. Provides
readiness for the to share thoughts and opportunity to
upcoming surgery. feelings. examine realistic
fears and
3.Report anxiety is misconceptions.
gone or reduced to
manageable level
5.Establish a 5. To establish trust
therapeutic and showing interest.
relationship,
conveying empathy
and unconditional
positive regard.

6. Listening actively 6. To establish

and focus on the rapport.
patient discussed her
personal feelings.

7. Instructed deep 7.For relaxation

breathing exercise.
 St. Anthony’s College
San Jose Antique
Nursing Department

Pt. Name: A.J.C

Age: 65
Sex: M
Date of Birth: October 22, 1953
Pre-Operation Diagnosis: Indirect Inguinal hernia, Left, Reducible Incomplete
Operation perform: Mesh Hernioplasty Left

INTRA-OPERATION

ASSESSMENT NURSING RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Objective: Impaired Skin The skin is the General: Independent: After 2 hours of
V/S taken: Integrity related largest organ in the After 1 hour of 1.Monitor patient’s 1. To have baseline nursing
BP- to surgical body and serves a nursing status and vital data. interventions, the
T: incision as variety of important interventions, the signs. goal was met. The
PR- evidenced by functions in patient will be able patient was able to:
RR- disruption maintaining health to: 2. Assess skin. Note 2.Establishes 1. Maintain wound
Oxygen of epidermis and and protecting the 1. Maintain wound color, turgor comparative intact.
Saturation: dermal tissue. individual from intact. and sensation. baseline providing 2. Demonstrate
injury. Impaired skin 2. Demonstrate opportunity for timel behaviors that
integrity is not a behaviours that y reduce tension
frequent problem for reduce tension intervention. on suture line.
most healthy people on suture line. 3.Describe and 3.Verbalize
but is a threat to 3. Verbalize measure wounds 3..Maintaining clean, understanding
older people: to understanding and observe dry skin of condition and
clients with of condition changes. provides a causative factors
restricted mobility, and causative 4. Demonstrate good barrier to infection. of infection.
chronic illnesses or factors of skin hygiene. 4.Wound dressings After 1 hour of
trauma: and to those infection. Provide and protect the wound nursing
undergoing invasive apply wound and the interventions, the
health care Specific: dressings carefully. surrounding tissues. patient’s vital signs
procedures. After 1 hour of were
nursing 5.Provide routine still in its normal
Reference: interventions, the incisional care 5. To assess and level
Fundamentals of patient’s vital signs being careful to keep avoid infection. as evidenced by:
Nursing by: Kozier, will still be in dressing dry BP: 120/80 mmHg
Erb,Berman, Snyder normal and sterile. P: 88 bpm
pg.856 level. R: 20 cpm
6.Inform patient of Oxygen saturation:
the purpose of 6.To increase 98%
self-care practices. compliance and to
provide basic
knowledge on how
to manage wound.
7. Keep the side rails
up always. 7. To ensure patient’s
Maintain quiet, calm safety.
environment. To help patient feel
comfort and
relax.
 St. Anthony’s College
San Jose Antique
Nursing Department

Pt. Name: A.J.C

Age: 65
Sex: M
Date of Birth: October 22, 1953
Pre-Operation Diagnosis: Indirect Inguinal hernia, Left, Reducible Incomplete
Operation perform: Mesh Hernioplasty Left

POST- OPERATION

ASSESSMENT NURSING RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Subjective: Pain related to Complex responses After 1 hours 1. Monitor vital 1. To have a baseline After 1 hours of
Sakit ang pilas ko s Surgical Incision of tissue and of nursing signs. data. nursing
ginoperahan”as nerve endings due to intervention, the intervention the
verbalized by patient trauma from surgery client’s reported pain 2. Instruct the client 2. To prevent client had been
(incision) and cause will subside. to avoid strenuous bleeding of the able to:
Objective: hypersensitivity to exercise and surgical incision Reduce pain.
Facial grimace the central nervous activities. made from the verbalize
Protective behavior: system that causes operation. non-pharmacologic
Restless unpleasant physical methods to
sighing and emotional 3. .Accept client’s 3. Pain was a provide relief.
reactions and description of pain. subjective
responses. Acknowledge the experience and
pain experience and cannot be felt by
convey acceptance others.
of client’s response
to pain.
4. Observe non- 4 Observations may
verbal cues/pain be congruent with
behaviors and other verbal reports.
objectives defining
characteristics, as
noted, especially in
persons, who can’t
communicate.

Dependent:
5.Give analgesic as 5. To reduce pain.
prescribe
 RLE Requirements
for
OR DUTY

Submitted By:
SR.JASMIN T. LARIZA, MSLT Submitted To:
BSN-4 JERRY V. ABLE, MAN, RN
OR Clinical Instructor
 St. Anthony’s College
San Jose Antique
Nursing Department

Pt. Name: C.B.M

Age: 52
Sex: M
Date of Birth: 09/18/67
Pre-Operation Diagnosis: Senile Nuclear Cataract
Operation perform: Extracapsular cataract extraction (ECCE)
PRE-OPERATIVE PHASE

ASSESSMENT NURSING RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Subjective: Moderate Anxiety Vague uneasy General: Independent: After the nursing
“Medyo ginakulbaan related to feeling of After 1 hour of 1.Monitor patient’s 1. Possible interventions, the
ako”as verbalized by the unfamiliarity with discomfort or dread nursing status and vital increase in patient was able to:
patient. the surgical accompanied by intervention the signs. blood
procedure as autonomic patient will pressure and 1. To appear relax.
Objective: evidenced by response; a feeling 1.Demonstrate pulse rate
Patient is alert, oriented expressed concerns. of apprehension behaviours that accompanied 2. Report readiness
to time, place and caused by reduced anxiety by shallow to undergo surgery.
person,ambulatory,pupil anticipation of 2.Verbalize and irregular
s are round and equal danger. It is an understanding breathing 3.Verbalize anxiety
V/S: alerting sign that of his condition. showed is gone or reduce to
Temp. warns of impending anxiety a more manageable
RR: danger and enables manifestation level
PR: the individual to Specific: s in patients.
SpO2 take measures to After 1 hour of 2. Provide the 2. Adequate
deal with that nursing necessary patient information
threat. intervention the information prior to and good
patient appear surgery. delivery will
relaxed and report change the
 anxiety is reduced perception
to a manageable and mindset
level. of the patient.
3. Calm soul
that affect the
level of
emotion and
3. Encourage the anxiety.
Reference: patient to express
Nurse’s pocket his feelings before
Guide pg.28 the surgery.

4. Instructed deep 4. To relax.

breathing exercise.

5.. Establish a 5. To established

therapeutic rapport and
relationship, trust.
conveying empathy
and unconditional
positive regard.
 EXTRACAPSULAR CATARACT EXTRACTION

Extracapsular cataract extraction (ECCE) is a type of eye surgery in which the lens of the eyes are removed, leaving the elastic capsule
covering the lens which is left partially attached to allow the implantation of an intraocular lens (IOL).

Purpose
1. The main purpose of ECCE is to restore clear vision by removing the clouded and discolored lens and replacing it with an IOL.
Cataract operations are some of the oldest recorded surgical processes dating back to 1750 B.C.
2. It is a cataract surgery that involves removing the eye’s natural lens while leaving the back of the capsule which holds the lens in
place. This process requires a much smaller incision as compared to the older process called Intracapsular Cataract Extraction. A
modified version of Extracapsular Cataract Extraction is called Phacoemulsification and uses an even smaller incision which requires
no sutures at all.
3. The natural lens become cloudy, usually due to the aging process. This cloudy lens is called a cataract. The main objective of modern
cataract surgery is to remove this hazy lens and replace it with a tiny plastic prescription lens that will be permanently implanted in
your eye.

Extracapsular Cataract Extraction

Extracapsular Cataract Extraction is a method of cataract surgery that involves removing the eye’s natural lenses while leaving the back of
the capsule that holds the lens in place. This procedure requires a much smaller incision than the older process called Intracapsular Cataract
Extraction in which the lens and the entire capsule were removed.

In this procedure, the surgeon makes a tiny incision in the white of the eye near the outer edges of the cornea. The size of this depends on
whether the lens of the nucleus is to be removed all in one piece or whether it will be dissolved into tiny pieces and then vacuumed out. The
surgeon then enters the eye through this incision and carefully opens the front of the capsule that holds the lens in place. After the nucleus or
hard center is removed, you may need sutures if your cataract was removed in one piece. If the phacoemulsification technique is employed,
sutures are usually not required to close the incision.

St. Anthony’s College

 San Jose Antique
Nursing Department
Pt. Name: C.B.M
Age: 52
Sex: M
Date of Birth: 09/18/67
Pre-Operation Diagnosis: Senile Nuclear Cataract
Operation perform: Extracapsular cataract extraction (ECCE
INTRA-OPERATIVE PHASE

ASSESSMENT NURSINGDIAGNOSIS RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Impaired Comfort Perceived lack After 30 Independent: After the nursing
“Budlayan ako related to situational of ease, relief, mins. of 1.Adjust patient 1. To provide intervention the
magpsteady control and nursing position (head) non patient will:
lantaw sa transcendence intervention pharmacologic
dalom”as in physical and the patient al pain 1. Feel
verbalized by the environmental. will learn management. comfort
patient. the Dependent: 2. Learn to
technique to 1. Interact with follow the
Objective: Reference: steady his the client in 1. Assuring the instruction
Patient is laying Nurse’s pocket eyeball to a therapeutic client that he of the
Guide:pg.136
in OR bed with look down. manner. needs to surgeon.
proper OR attire. cooperate in 3. Feel relax.
Patient is order to have a
responsive, alert, successful
oriented in place, operation.
time and 2. Acknowledg
persons. e feelings of 2. Knowing
normalcy feelings are
feelings in normal can
 this allay anxiety
situation. that client is
losing control.

St. Anthony’s College

San Jose Antique
Nursing Department
Pt. Name: C.B.M
Age: 52
Sex: M
Date of Birth: 09/18/67
Pre-Operation Diagnosis: Senile Nuclear Cataract
Operation perform: Extracapsular cataract extraction (ECCE

ASSESSMENT NURSING RATIONALE PLANNING INTERVENTION RATIONALE EVALUATTION

DIAGNOSIS
Subjective: Deficient Absence or General: Dependent: After the nursing
“hindi gali ako knowledge deficiency of After 30 minutes of 1. Provide 1. To prevent intervention the
ako pwede related to cognitive nursing intervention information overload patient:
mangmug-at insufficient information the patient will : relevant only
doc.?” information( related to 1. Verbalize to the 1. Verbalize
Objective: post eye specific topic. understanding situation. 2. This could knowledge about
Patient is alert, surgery) of his 2. Provide encourage his condition.
oriented to condition. positive continuatio 2. Follow the
Reference:
place, time, 2. Perform reinforcement n of efforts. instructions of
Nurse’s pocket
persons and Guide:pg.505 necessary physicians and
ambulatory. procedure 3. Explain to the 3. That he nurses.
OD has cover correctly and client may know 3. The client is
by gauze. explain instruction in what he relax and
reasons for his level of needs to do discharge.
the action. understanding. in his
3. Initiate condition.
necessary life
style changes. Independent:
1. Prescribing of
Specific: may go home 1. Client take
After 30 minutes of medication. his
nursing intervention 2. Give instructions medication
the patient will of may go home in 12 rights
verbalize medications. of
understanding of his medication.
condition, disease
process and treatment.