Nursing care plan for Inguinal Hernia

Hernia is a protrusion or projection of an organ or organ part through an abnormal opening in the containing wall of its cavity, a hernia results. An inguinal hernia occurs when the omentum, the large or small intestine, or the bladder protrudes into the inguinal canal. In an indirect inguinal hernia, the sac protrudes through the internal inguinal ring into the inguinal canal and, in males, may descend into the scrotum. In a direct inguinal hernia, the hernial sac projects through a weakness in the abdominal wall in the area of the rectus abdominal muscle and inguinal ligament. 

Hernia is classified into three types: 

• Reducible, Hernias can be reducible if the hernia can be easily manipulated back into place 
• Irreducible or incarcerated, this cannot usually be reduced manually because adhesions form in the hernia sac. 
• Strangulated, if part of the herniated intestine becomes twisted or edematous and causing serious complications, possibly resulting in intestinal obstruction and necrosis. 

Inguinal hernias can be direct which is herniation through an area of muscle weakness, in the inguinal canal, and inguinal hernias indirect herniation through the inguinal ring. Indirect hernias, the more common form, can develop at any age but are especially prevalent in infants younger than age 1. This form is three times more common in males. 

Causes for Inguinal Hernia

An inguinal hernia is the result of either a congenital weakening of the abdominal wall, traumatic injury, aging, weakened abdominal muscles because of pregnancy, or from increased intra-abdominal pressure (due to heavy lifting, exertion, obesity, excessive coughing, or straining with defecation). Inguinal hernia is a common congenital malformation that may occur in males during the seventh month of gestation. Normally, at this time, the testicle descends into the scrotum, preceded by the peritoneal sac. If the sac closes improperly, it leaves an opening through which the intestine can slip, causing a hernia. 

Complications for Inguinal Hernia

Inguinal hernia may lead to incarceration or strangulation. That can interfere with normal blood flow and peristalsis, and leading to intestinal obstruction and necrosis. 

Diagnostic tests

Commonly No specific laboratory tests are useful for the diagnosis of an inguinal hernia. Diagnosis is made on the basis of a physical examination. Although assessment findings are the cornerstone of diagnosis, suspected bowel obstruction requires X-rays and a white blood cell count, which may be elevated. 

Treatment for Inguinal Hernia

The choice of therapy depends on the type of hernia. For a reducible hernia, temporary relief may result from moving the protruding organ back into place. Afterward, a truss may be applied to keep the abdominal contents from protruding through the hernial sac. Although a truss doesn't cure a hernia, the device is especially helpful for an elderly or a debilitated patient, for whom any surgery is potentially hazardous. 

Herniorrhaphy is the preferred surgical treatment for infants, adults, and otherwise-healthy elderly patients. This procedure replaces hernial sac contents into the abdominal cavity and seals the opening. Another effective procedure is hernioplasty, which involves reinforcing the weakened area with steel mesh, fascia, or wire. Strangulated or necrotic hernia requires bowel resection. Rarely, an extensive resection may require a temporary colostomy 

Nursing Assessment Nursing care plan for Inguinal Hernia

Patient History, an infant or a child may be relatively free from symptom until she or he cries, coughs, or strains to defecate, at which time the parents note painless swelling in the inguinal area. On adult patient may occurs of pain or note bruising in the area after a period of exercise. More commonly, the patient complains of a slight bulge along the inguinal area, which is especially apparent when the patient coughs or strains. The swelling may subside on its own when the patient assumes a recumbent position or if slight manual pressure is applied externally to the area. Some patients describe a steady, aching pain, which worsens with tension and improves with hernia reduction 

Physical Examination, If the patient has a large hernia, inspection may reveal an obvious swelling in the inguinal area. If he has a small hernia, the affected area may simply appear full. As part of your inspection, have the patient lie down. If the hernia disappears, it's reducible. Also ask him to perform Valsalva's maneuver; while he does so, inspect the inguinal area for characteristic bulging. 

Auscultation should reveal bowel sounds. The absence of bowel sounds may indicate incarceration or strangulation. Palpation helps to determine the size of an obvious hernia. It also can disclose the presence of a hernia in a male patient. Primary Nursing Diagnosis: Pain related to swelling and pressure Primary nursing Outcomes: Pain, disruptive effects; pain level Primary nursing Interventions: Analgesic administration; pain management 

Nursing Diagnosis
Common Nursing diagnoses found on Nursing care plan for Inguinal Hernia

• Activity intolerance 
• Acute pain 
• Ineffective tissue perfusion: Gastro Intestinal 
• Risk for infection 
• Risk for injury 

Nursing outcomes nursing care plans for Inguinal Hernia

• The patient will perform activities of daily living within the confines of the disease process. 
• The patient will express feelings of comfort. 
• The patient's bowel function will return to normal. 
• The patient will remain free from signs or symptoms of infection. 
• The patient will avoid complications. 

Nursing interventions Nursing care plan for Inguinal Hernia

• Apply a truss only after a hernia has been reduced. For best results, apply it in the morning before the patient gets out of bed. 
• Assess the skin daily and apply powder for protection because the truss may be irritating. 
• Watch for and immediately report signs of incarceration and strangulation. 
• Closely monitor vital signs and provide routine preoperative preparation. If necessary, When surgery is scheduled 
• Administer I.V. fluids and analgesics for pain as ordered.
• Control fever with acetaminophen or tepid sponge baths as ordered.
• Place the patient in Trendelenburg's position to reduce pressure on the hernia site. After surgery,
• Provide routine postoperative care.
• Don't allow the patient to cough, but do encourage deep breathing and frequent turning.
• Apply ice bags to the scrotum to reduce swelling and relieve pain; elevating the scrotum on rolled towels also reduces swelling. 
• Administer analgesics as necessary. 
• In males, a jock strap or suspensory bandage may be used to provide support. 

Patient teaching home health guide

• Explain what an inguinal hernia is and how it's usually treated.
• Explain that elective surgery is the treatment of choice and is safer than waiting until hernia complications develop, necessitating emergency surgery. 
• Warn the patient that a strangulated hernia can require extensive bowel resection, involving a protracted hospital stay and, possibly, a colostomy.
• Tell the patient that immediate surgery is needed if complications occur.
• If the patient uses a truss, instruct him to bathe daily and apply liberal amounts of cornstarch or baby powder to prevent skin irritation.
• Warn against applying the truss over clothing, which reduces its effectiveness and may cause slippage. Point out that wearing a truss doesn't cure a hernia and may be uncomfortable. 
• Tell the postoperative patient that he'll probably be able to return to work or school and resume all normal activities within 2 to 4 weeks. 
• Explain that he or she can resume normal activities 2 to 4 weeks after surgery.
• Remind him to obtain his physician's permission before returning to work or completely resuming his normal activities. 
• Before discharge, Instruct him to watch for signs of infection (oozing, tenderness, warmth, redness) at the incision site. Tell him to keep the incision clean and covered until the sutures are removed. 
• Inform the postoperative patient that the risk of recurrence depends on the success of the surgery, his general health, and his lifestyle. 
• Teach the patient signs and symptoms of infection: poor wound healing, wound drainage, continued incision pain, incision swelling and redness, cough, fever, and mucus production. 
• Explain the importance of completion of all antibiotics. Explain the mechanism of action, side effects, and dosage recommendations of all analgesics. 
• Caution the patient against lifting and straining.