PATIENT/FAMILY CARE STUDY

ON

MR. A.R

WITH

RIGHT INGUINO-SCROTAL HERNIA

BY

ABAAH GIFTY

A FINAL YEAR STUDENT OF

HOLY FAMILY NURSING AND MIDWIFERY TRAINING COLLEGE

BEREKUM

AUGUST, 2022
 PREFACE

The word nursing derives its meaning from the Latin word “nutricus” which means nourishing.

Many people believed that nursing started with Florence Nightingale, however nursing itself dates

back to the beginning of motherhood when nurses were traditionally females. The history of

nursing has its origin in the care of the infants and children, so all mothers were nurses. Thus,

nursing was considered as a traditional medicine.

Currently, nursing is considered as science and therefore makes use of the nursing process (which

is similar to the scientific methods) as a tool for practice. The nursing process comprises of

assessment of patient (data collection), analysis of data, planning of care, implementation and

evaluation of care. It is therefore being made compulsory by the Nursing and Midwifery Council

of Ghana that every final year student nurse presents a patient/ family care study which makes use

of the nursing process, as a partial fulfillment for the award of Registered General Nursing

certificate. The patient/family care study is a total nursing care rendered to a patient/family from

the day of admission till the care is terminated during the last home visit.

The main aim of the study is to equip the student nurse with nursing knowledge and practices in

order to render an individualized /family centered and comprehensive nursing care to the patient

from the day of admission till termination of care. The patient/family care study helps the student

to put into practice knowledge acquired from courses such as microbiology, psychology,

sociology, basic nursing, pharmacology and medical-surgical nursing in taking care of the

patient/family. It helps the student to gather important information on a disease condition to

provide a comprehensive nursing care to the patient and family. The patient /family’s initials has

been used instead of their full names to maintain confidentiality.

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 ACKNOWLEDGEMENT

My first thanks go to the almighty Lord for seeing me through all these years and giving me the

strength and the knowledge to complete this work successfully.

My outmost thanks also to Mr. A.R. and his family for their co-operation throughout the care. My

next thanks go to my supervisor Mr. Eric Obeng whose constructive corrections has made this

study a success and the entire staff of Holy Family Nursing and Midwifery training college

Berekum for imparting knowledge and creating an enabling environment for me to complete my

study successfully.

I would like to also express my sincere appreciation to the entire staff of Sunyani Regional

Hospital, especially medical director, nursing administrator, the nurse in- charge of Male Surgical

ward, and the ward doctor for their support during the study; I say may God richly bless you all.

I would like to again extend my profound gratitude to my guardians; Mr. John Boateng and Mrs.

Comfort Abaah and not forgetting my siblings who by their financial support and encouragement

made this study a success.

I always remain thankful to all my colleagues of RGN 22 for contributing to the success of this

study.

Last but not the least thanks go to the authors and publishers of whose text books I used for the

care study as references, may the good Lord bless them all.

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 INTRODUCTION

For the purpose of confidentiality my patient shall be known as Mr. A.R and abbreviations shall

be used for characters in this care study.

The patient and family care study give the account of total nursing care that was carried out on Mr.

A.R, a 65-year-old man with the diagnosis of right inguinal hernia. He reported to the outpatient

department of Sunyani Regional Hospital on the 1st December 2021 on account of scrotal swelling

with intense pain. He was then admitted to the Surgical Ward to be prepared for surgery and for

further management.

My interaction with him started on the day of his admission and continued until care was

terminated. This was to ensure that his physical, psychological, social and spiritual needs were

met. He was discharged on the 4th December, 2021, with much improvement in his condition. The

nursing process was used in nursing the patient.

The care study consists of six chapters using the nursing process as a guideline. Chapter one

consists of the assessment of the patient and family, chapter two is analysis of data, chapter three

is nursing care plan, chapter four deals with implementation of care. Chapter five contains

evaluation of care rendered and chapter six deals with summary of the care rendered to the patient

and family and the conclusion drawn

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 TABLE OF CONTENT

PREFACE ........................................................................................................................................

ACKNOWLEDGEMENT ............................................................................................................ ii

INTRODUCTION........................................................................................................................ iii

TABLE OF CONTENT............................................................................................................... iv

CHAPTER ONE ........................................................................................................................... 1

ASSESSMENT OF PATIENT/ FAMILY .................................................................................. 1

1.0 INTRODUCTION................................................................................................................... 1

1.1 PATIENT’S PARTICULARS ............................................................................................... 1

1.3 FAMILY’S MEDICAL HISTORY ....................................................................................... 2

1.4 FAMILY’S SOCIO-ECONOMIC ......................................................................................... 2

1.5 PATIENT’S DEVELOPMENTAL HISTORY .................................................................... 2

1.6 PATIENT’S LIFESTYLE AND HOBBIES ......................................................................... 3

1.7 PATIENT’S PAST MEDICAL HISTORY .......................................................................... 3

1.8 PATIENT’S PRESENT MEDICAL/SURGICAL HISTORY ............................................ 4

1.9 ADMISSION OF PATIENT .................................................................................................. 4

1.10 PATIENT’S CONCEPT OF HIS ILLNESS ...................................................................... 6

1.11 LITERATURE REVIEW ON HERNIA ............................................................................ 6

1.12 PATIENT EDUCATION BEFORE DISCHARGE ......................................................... 19

1.13 VALIDATION OF DATA .................................................................................................. 20

CHAPTER TWO ........................................................................................................................ 20

ANALYSIS OF DATA ............................................................................................................... 20

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2.0 INTRODUCTION................................................................................................................. 20

2.1 COMPARISON OF THE DATA WITH STANDARDS ................................................... 20

2.3 COMPARISON OF CAUSES OF PATIENT’S DISEASE CONDITION WITH

STANDARDS IN THE LITERATURE .................................................................................... 23

2.4 SPECIFIC MEDICAL TREATMENT GIVEN TO THE PATIENT .............................. 24

2.5 COMPLICATIONS DEVELOPED BY PATIENT........................................................... 30

2.6 PATIENT /FAMILY STRENGTHS ................................................................................... 30

2.7 HEALTH PROBLEMS ........................................................................................................ 30

2.8 NURSING DIAGNOSIS....................................................................................................... 31

CHAPTER THREE .................................................................................................................... 32

PLANNING FOR PATIENT/FAMILY CARE ....................................................................... 32

3.0 INTRODUCTION................................................................................................................. 32

3.1 OBJECTIVES AND OUTCOME CRITERIA .................................................................. 32

CHAPTER FOUR....................................................................................................................... 43

IMPLEMENTATION OF PATIENT / FAMILY CARE PLAN ........................................... 43

4.0 INTRODUCTION................................................................................................................. 43

4.1 SUMMARY OF ACTUAL NURSING CARE ................................................................... 43

FIRST DAY OF ADMISSION (1ST DECEMBER, 2021) ....................................................... 43

SECOND DAY OF ADMISSION (2ND DECEMBER, 2021) ................................................ 46

THIRD DAY OF ADMISSION (1ST DAY POST-OPERATIVELY) (3RD DECEMBER,

2021) ............................................................................................................................................. 48

FOURTH DAY OF ADMISSION (DAY OF DISCHARGE) (4TH DECEMBER, 2021) ...... 49

PREPARATION OF PATIENT / FAMILY FOR DISCHARGE AND REHABILITATION

....................................................................................................................................................... 50

4.2 FOLLOW UP / HOME VISITS / CONTINUITY OF CARE .......................................... 51

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FIRST HOME VISIT (3RD DECEMBER, 2021): .................................................................... 51

SECOND HOME VISIT (10TH DECEMBER, 2021) ............................................................... 51

DAY OF REVIEW (12TH DECEMBER, 2021) ........................................................................ 52

THIRD HOME VISIT (15TH DECEMBER, 2021) .................................................................. 52

CHAPTER FIVE ........................................................................................................................ 53

EVALUATION OF CARE RENDERED TO PATIENT AND FAMILY ............................. 53

5.0 INTRODUCTION................................................................................................................. 53

5.1 STATEMENT OF EVALUATION ..................................................................................... 53

PATIENT WAS RELIEVED OF PAIN ................................................................................... 53

PATIENT AND FAMILY WERE RELIEVED OF ANXIETY ............................................. 54

PATIENT WAS RELIEVED OF INCISIONAL SITE PAIN ................................................ 54

PATIENT’S INCISIONAL WOUND HEALED DEVOID OF INFECTION ...................... 55

PATIENT WAS ASSISTED WITH SELF-CARE ACTIVITIES (BATHING AND

GROOMING).............................................................................................................................. 55

PATIENT AND FAMILY GAINED ADEQUATE KNOWLEDGE ABOUT HERNIA AND

ITS MANAGEMENT ................................................................................................................. 56

5.2 AMENDMENTS OF NURSING CARE PLAN ................................................................. 56

5.3 TERMINATION OF CARE ................................................................................................ 57

CHAPTER SIX ........................................................................................................................... 58

SUMMARY AND CONCLUSION ........................................................................................... 58

6.0 SUMMARY ........................................................................................................................... 58

6.1 CONCLUSION ..................................................................................................................... 58

APPENDIX .................................................................................................................................. 60

BIBLIOGRAPHY ....................................................................................................................... 64

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SIGNATORIES ................................................................................Error! Bookmark not defined.

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 CHAPTER ONE

ASSESSMENT OF PATIENT/ FAMILY

1.0 Introduction

Assessment is the systematic collection of data to determine the patient health status and any actual

or potential health problems (Smelter & Bare, 2014). It is the first step of the nursing process. It is

basically an ongoing activity involving gathering and organizing information about the patient’s

health status in order to generate a database that will form the bases for diagnosis and planning of

care. The data collected could be either subjective, objective or both. The data obtained through

discussions with patient or patient relatives, interviewing, observation, laboratory investigations,

patient’s folder, physical examination and relevant literature. The assessment entails the patient’s

particulars, family medical/surgical history, family socio-economic history, patient’s

developmental history, patient’s lifestyle and hobbies, patient’s past medical/surgical history, the

present medical/surgical history of the patient, admission process of the patient and family,

patient/family’s concept of his illness, literature review on the condition and validation of data.

1.1 Patient’s Particulars

Mr. A.R. is a 65-year-old man, born on 1st January, 1956 at Odumasi, in the East-Sunyani District
of Bono Region. He is married with four (4) children and stays with his wife at Odumasi, a suburb
of Sunyani in Bono Region in a house with number PLT 64 BLK G. He comes from Odumasi in
the Bono Region and speaks Bono and Twi language. Mr. A.R. is a Farmer, a Christian and
worships at the church of Pentecost Odumasi.

He is dark in complexion, about 1.5 height in metres and weighs 71kg. He is the second of four
children, three male and one female. The name of patient’s parents are Mr.A.K and Madam A.A.
Mr A. R. had his basic education at Odumasi Roman Catholic Junior High School. He was unable
to further his education due to financial constraints.

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1.3 Family’s Medical History

Mr. A.R. indicated that there is no known history of hereditary diseases such as hypertension,

diabetes mellitus, sickle cell anaemia, asthma or mental illness in his family. He also revealed that,

none of his family members have been hospitalized before but they occasionally suffer from minor

ailments such as, headache, abdominal pains and fever which they treat often mitigate with over

the counter medications purchased from the pharmaceutical shop and seek medical attention from

the hospital if symptoms persist. His siblings are alive and without any congenital abnormalities

or chronic diseases. None of their family members have been hospitalized before. His grandparents

are both deceased at very old age. Other siblings are doing well. Six (6) of his family members

died their natural deaths at the age of 80 years. According to patient there are no known allergies

in the family.

1.4 Family’s Socio-economic

Mr. A.R is a farmer, he grows maize, cassava, beans plantain. His wife also sells vegetables at
Odumasi market in Sunyani. Together with his wife, they care and provide for the needs of their
nuclear family. His income is enough for the family due to small family size.

He is also a beneficiary of the NHIS which also supports his family greatly during their sick
moments. Patient stated clearly that his family is one of a peaceful type. Due to their strong faith
as Christians, Mr. A.R. stated that they do not believe in taboos and myths, but respect people from
all religious backgrounds.

1.5 Patient’s Developmental History

According to Mr. A.R, he was born at term, spontaneously per vagina by traditional birth attendant
in their house at Odumasi and had no congenital abnormalities such as hydrocephalus, clubfoot,
cleft palate or cleft lip at both. He was breastfed exclusively for two months and was given

2
supplementary feeds for one and half years. He received immunization against the vaccine
preventable diseases and was circumcised two weeks after birth.

He went through normal developmental milestone without any complication. He developed teeth
at the fourth (4) month, crawled at the eighth (8) month and started talking when he was one year
old.

Secondary sex characteristics were developed at age fourteen. He started farming in his twenty
(20s) and married at age 27. Theory of psychosocial development which describes the human life
cycle as a series of eight ego developmental stages from birth to death, my patient falls in the
middle adulthood stage (Generosity vs Stagnation) (35 to 65) where the primary developmental
task involved contributing to society and helping to guide future generations. When a person makes
a contributing during this period, perhaps by raising a family or working towards the betterment
of society, develop sense of generativity; a sense of productivity and accomplishment of results.
In contrast, a person who is self-centered and unable or unwilling to help society move forward
develops a feeling of stagnation; a dissatisfaction with the relative lack of productivity. Mr. A. R
is a successful at this stage as he has been able to work towards the betterment of his society
through his hard work, kindness and generosity.

1.6 Patient’s Lifestyle and Hobbies

Mr. A.R. usually wakes up around 4:00am; he prays, empties his bowel, brushes his teeth and takes
his bath. He takes his breakfast and leaves for work (farm) around 8:00am. He usually returns
home around 4:00pm. He often takes his lunch at the farm.

He takes his supper with his family at home and watches television for a while. He goes to bed
around 10:00pm after brushing his teeth and taking his bath.

Mr. A.R is very active and has numerus friends. At his leisure time, especially on Sundays, he
visits friends and spend time with them.

His hobbies are listening to music, radio, visiting friends and relatives, playing draught and
watching soccer. His favorite food is banku, okro stew with tilapia.

1.7 Patient’s Past Medical History

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Medical history is a narrative or record of past events and circumstances that are or may be

relevant to the patient’s current state of health. Informally, an account of past diseases, injuries,

treatments and other strictly medical facts. (Cahil, 2015). According to him, before this episode

of sickness, he had not suffered any type of sickness or injury and has not been hospitalized

before. Mr. A.R. revealed that he had no particular health problem. He however suffers from

slight headache, fever and other minor ailments which were usually treated with drugs bought

from the chemical shop. Mr. A.R. has no known allergy. My patient has no history of serious

accident or any form of injury. My patient has no physical disabilities.

1.8 Patient’s Present Medical/Surgical History

Mr. A.R. indicated that had a sudden onset of swelling on the right inguinal region which was
very painful followed by abdominal pain, difficult breathing on and headache on 31st November,
2021. He took some pain medications given to him by some neighbor’s he complained to which
he could barely identify. However, symptoms persisted and was rather aggravating.

After all attempts to reduce pain and swelling failed, patient was rushed to Sunyani Regional
Hospital. He was diagnosed right inguino scrotal hernia and was to be prepared for surgery the
following day. On examination, Mr. A.R. was pale, had a swollen scrotum, abdominal pains,
constipation and fully conscious. He was admitted to the surgical Unit through the out-patient unit
by the doctor on duty.

1.9 Admission of Patient

On 1st December, 2021 at 3:35pm, Mr. A.R. was brought to the Male Surgical ward of Sunyani

Regional Hospital, through the Out-Patient department in a wheel chair accompanied by a relative.

He had history of coughing, fever, painful inguino-scrotal swelling, headache and straining during

urination. His admission was ordered by Dr. Marshall with a diagnosis of right inguino scrotal

hernia. His admission was confirmed by calling his name written on the folder handed to me and

4
he responded. I also read through his folder and his admission was stated clearly there by the

doctor. On arrival, patient was conscious and alert. He was made comfortable in an already

prepared bed. His particulars were recorded into the admission and discharge book as well as the

daily census sheet. I introduced myself as a final year student of the Holy Family Nursing and

Midwifery Training College, Berekum and the nurses around were also introduced. Mr. A.R. was

reassured that he would recover soon with the quality of care which will be rendered. I also assured

him of confidentiality of information about his health and personal life.

His vital signs were checked and recorded as:

• Temperature -36.8°C

• Pulse -80bpm

• Respiration -20cpm

• Blood Pressure -130/80 mmHg

His weight also checked and recorded as 71kilograms. The laboratory investigations that were
ordered on arrival included Full blood count (Hemoglobin level, white blood cell count and
differentials), Blood for grouping and cross matching.

In addition to that, the following treatment was prescribed by the doctor to prepare the patient for
surgery (Herniorrhaphy).

• Intravenous Normal Saline 2000mls for 48 hours

• Intravenous Ringers Lactate 1000mls for 24 hours
• Intravenous Dextrose Saline 1000mls for 24 hours
• Intravenous Amoxiclav 1.2g tid for 24 hours
• Intravenous Flagyl 500mg tds for 48 hours
• Intramuscular Pethidine 50mg 8 tid for 24 hours

5
His prescribed drugs were collected from the pharmacy and stat doses were given.

Intravenous infusions were given to rehydrate him and to provide nutrients to him while he was
on no oral feed.

I recorded her history in the nurse’s continuation sheet as well as the care rendered. All other forms

such as the vital signs sheet and medication sheet were filled and kept in the patient’s folder.

Daily routines such as visiting hours, time for medications and vital signs of the hospital were

explained to Mr. A.R. and his relatives. His relatives were orientated to the ward and areas such

as toilet and bathroom and the nurses’ post. Mr. A.R. was introduced to other patients on the ward.

Their belongings were packed in a bed side locker. Mr. A.R. and her family were assured of a

speedy recovery which would lead to their discharge when she fully recovers. I then introduced

myself again and sought for her consent to take her in writing my care study. I further explained

that the care study was a requirement by the Nursing and Midwifery Council of Ghana in order to

be awarded a license. He agreed and gave me his consent. An intravenous cannular was passed in

the dorsum of his palm. Due medications were served at the right time and a comprehensive care

plan was drawn for MR. A.R. Patient was educated on the condition to relieve anxiety.

1.10 Patient’s Concept of His Illness

Mr. A.R is of the view that his illness is as a result of the tedious work he did on the day before

the illness. Though patient and his relatives were very anxious of condition, they did not attribute

illness to any spiritual beliefs. They were looking forward to speedy recovery once he was

receiving treatment. I took this opportunity to educate them on the causes, signs and symptoms,

treatment, prevention and the need for the admission of Mr. A. R.

1.11 LITERATURE REVIEW ON HERNIA

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ANATOMY OF THE SCROTUM

According to Hammoud & Gerken (2021), the scrotum is a sac of skin that hangs from the body
at the front of the pelvis, between the legs. It sits next to the upper thighs, just below the penis.
The scrotum contains the testicles. These are two oval-shaped glands responsible for producing
and storing sperm. They also produce several hormones, the main one being testosterone. They
also produce several hormones, the main one being testosterone. The scrotum hangs outside the
body because it needs to maintain a slightly lower temperature than the rest of the body. This
lower temperature helps to maintain sperm production. Scrotal tissues help protect the structures
inside the testicles, where sperm and important hormones are produced.

In addition, the scrotum protects the testicles and major blood vessels, as well as tubes that
release sperm from the testicles into the penis for ejaculation.

7
Anatomy and function of the scrotum

The scrotum is a sack of skin divided in two parts by the perineal raphe, which looks like a line
down the middle of the scrotum.

The raphe joins the internal septum with the scrotum. The septum splits the scrotal sac into two
parts with similar anatomy.

Each side of the scrotum usually consists of a:

• Testicle. Each testicle produces hormones, the main one being testosterone, with the help
of parts of the brain like the hypothalamus and pituitary gland. They also contain tubules
and cells that produce sperm, or spermatozoa. Sperm are transferred from the testicle to
the epididymis.

• Epididymis. An epididymis is located on the top of each testicle. Each epididymis is a

tightly coiled tube. They store sperm created in each testicle until they’re mature, usually
for about 60 to 80 days. The epididymis also absorbs extra fluid secreted by the testicle to
help move sperm through the reproductive tract.

• Spermatic cord. Each spermatic cord contains blood vessels, nerves, lymph vessels, and
a tube called the vas deferens. This tube moves sperm out of the epididymis into
ejaculatory ducts. The blood vessels maintain the blood supply for the testicle, vas
deferens, and cremaster muscle. The nerves transport information from the spinal cord to
and from the scrotum, testicles, and cremaster muscle.

• Cremaster muscle. Each cremaster muscle surrounds one of the testicles and its
spermatic cord. The muscle helps to move the testicle toward and away from the body to
maintain the ideal temperature for sperm production. This is why the scrotum hangs
lower in warm conditions and closer to the body in cold weather.

All of these structures are surrounded by the scrotal wall. This wall is lined with smooth muscle
called the dartos fascia muscle. This muscle, along with the cremaster muscles, help to expand or
tighten the skin of the scrotum as it moves up and down.

8
DEFINITION

A hernia is the abnormal protrusion of an internal organ or part of an organ through an aperture
(opening) or a weakness in the walls of the cavity in which the organ is contained into another
cavity. (Cahil, 2015).

PARTS OF AN ABDOMINAL HERNIA

THE SAC:

According to Hammoud & Gerken (2021), it is an out pouch of the peritoneum. The neck of the
sac may be broad allowing internal organs to slip in and out of the sac. It may also be narrow and
surrounded by a dense fibrous tissue.

THE CONTENT:

This is what is in the hernia sac. It could be a loop of intestine, omentum, caecum, ovary or
occasionally the bladder.

THE RING:

The hernia ring is a ring of muscular or fibrous tissue that forms an opening into the sac through
which the viscus protrudes.

PATHOLOGICAL VARIETIES OF HERNIAS

Hammoud & Gerken (2021), outlined the pathological varieties of hernias according to the severity
of the protrusion.

These include;

1. REDUCIBLE HERNIA

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A reducible hernia is one that can easily return into the abdomen by mechanical when the patient
is placed in supine position or can be manually replaced by gently pushing the mass back into its
original cavity

2. IRREDUCIBLE HERNIA

An irreducible hernia is one that cannot be reduced by itself or by any manual method. This occurs
when adhesions form between the sac and its content, so that it cannot be pushed back and in which
intestinal flow may be obstructed completely.

3. STRANGULATED OR INCARCERATED HERNIA

An incarcerated hernia is one in which the protruding viscus is both irreducible and obstructed.
This condition eventually leads to obstructed blood flow to or from the strangulated incarcerated
hernias are considered to be surgical emergency. Immediate surgery is necessary to prevent
necrosis and gangrene formation of the viscus.

Inguinal, umbilical and femoral hernias are more likely to become strangulate than other hernia
because their sacs have smaller necks and tend to be surrounded by rigid rings of tissues. Also
over time, adhesions may develop between a hernia sac and its contents and result in an irreducible
or incarcerated.

TYPES OF HERNIA

1. INDIRECT INGUINAL HERNIA:

These herniations occur through the inguinal ring and follow the spermatic cord through the
inguinal canal. It is far more common in males because of the space allowed for the descent of the
testes. These hernias have a high incidence among infants and young persons after which the
incidence drops, then rises again among persons in their 50’s and then tapers off. These hernias
con become extremely large and they frequently descend into scrotum.

2. DIRECT INGUINAL HERNIA

These hernias pass through the abdominal wall in an area of muscular weakness and not through
a canal as the indirect inguinal and femoral hernias. It is more common in the elderly and is the

10
result of a gradually developed weakness in an area that is congenitally deficient in the number of
fibres present.

3. FEMORAL HERNIA

This occurs through the femoral ring and more common in females than in males. It begins as a
plug of fat in the femoral canal that enlarges and gradually pulls the peritoneum and almost
inevitably the urinary bladder, into the sac. There is a high incidence of incarcerated and
strangulation in this type.

4. UMBILICAL HERNIA

There are two types; congenital umbilical hernia and acquired umbilical hernia. Congenital
umbilical hernia is due to an abnormality of the muscular structure of the cord. Acquired umbilical
hernia is due to increased abdominal pressure which occurs in obesed persons and woman who
have had several pregnancies. It is due to defect of the umbilicus that has persisted from birth.

5. INCISION HERNIA

This type of hernia occurs at the site of a previous surgical incision. It is the result of inadequate
healing of the incision because of a post-operative problem such as infection, inadequate nutrition,
extreme distension, obesity or other factors. The incidence of this type of hernia is increasing
probably because of the higher number of surgical procedures being performed.

6. DIAPHRAGMATIC HERNIA

This occurs when the abdominal organs herniated through the diaphragm into thoracic cavity.

7. EPIGASTRIC HERNIA

Also called ventral hernia which occurs in the epigastric region due to weakness of the muscles
of the epigastric region.

8. HIATAL HERNIA (HIATUS HERNIA)

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Hiatal hernia occurs when a portion of the stomach protrudes into the thoracic cavity through a
defect in the diaphragm wall at the point where the esophagus passes through the diaphragm.

INCIDENCE

Inguinal hernia mostly affects men whiles femoral and umbilical hernia is more prevalent among
women (Cahil, 2015).

CAUSES

Abdominal hernias are caused by a combination or co-existence of factors such as:

1. a weak or defect in the muscle wall. The muscular wall defect may arise from congenital factors
including impairment of the collagen tissue and musculature integrity. Acquired muscular
weakness may develop as a result of trauma or with the ageing process.

2. Increase intra-abdominal pressures. This increase occurs under a number of circumstances and
with certain pathological states. These include;

▪ Pregnancy.
▪ Obesity.
▪ Bearing down as with chronic constipation.
▪ Straining associated with the use of incorrect techniques when lifting weights or other
heavy objects.
▪ Pushing or pulling.
▪ Ascites.
▪ Chronic cough.
▪ Enlargement tumor or lesion.

PATHOPHYSIOLOGY

Abdominal hernia develops by a combination of two factors; a weakness or defect in the muscle
wall. The muscular wall defect may arise from congenital factors including impairment of collagen
tissue and musculature integrity. Acquired muscular weakness may develop as a result of trauma
or with the aging process.

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Also, increase intra-abdominal pressure under a number of circumstances such as straining to lift
heavy object, straining on defecation and during forceful coughing or sneezing. A segment of the
intestine or abdominal organ moves into a weak area of the abdominal cavity. At first, the defect
in the abdominal wall is small as the hernia persists and the organs continue to protrude, the defect
grows larger.

Eventually the protruding organ may become trapped within the weakened pouch and adhesion
may develop between the hernia sac and it content resulting in an incarceration hernia.

If blood flows to or from the protrusion is obstructed the hernia is referred to as strangulation.
Immediate surgery is usually involved when there is a strangulation or incarceration so as to
prevent necrosis and gangrene.

SIGNS AND SYMPTOMS

1. Pain at site of strangulation.

2. Vomiting.

3. Swelling of the hernia sac which is tense.

4. Tenderness

5. Fever and chills

6. Pulse rate may be increased.

7. Anxious facial expression.

8. Constipation

9. If gangrene has developed there will be less pain

COMPLICATIONS

1. Irreducibility: this is when the hernia contents cannot be pushed back into the abdomen which
may be due to swelling or congestion of the protruded organ.

2. Intertrigo of the skin: abrasion due to two folds of skin rubbing each other.

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3. Strangulation: here the blood supply to the content becomes obstructed by constriction at the
neck of the sac so that the blood supply to the content is impaired. If the constriction is not relieved
urgently, the bowel becomes gangrenous and perforate. About 30% of femoral hernia and 5% of
inguinal hernia get strangulated.

4. Fistula formation: if part of the circumference of the bowel is in the sac become strangulated
and left untreated, it may lead to gangrene and perforate. As abscess form in the sac which later
raptures on the skin to form an enterocutaneous fistula

5. Reoccurrence of hernia.

6. Damage of spermatic cord in males.

7. Infections after surgery.

8. Oedema of the scrotum.

9. Retention of urine.

10. Bowel obstruction.

11. Hemorrhage.

12. Shock.

DIAGNOSTIC INVESTIGATIONS

1. Physical examination reveals the presence of a swelling which appears on coughing or straining
and disappears when the patient is supine.

2. Abdominal or pelvic x-ray reveals the protrusion of the viscus outside its normal cavity.

3. Laboratory studies which includes complete blood count, electrolytes, white blood cells count
will be elevated.

4. Computed tomography scan.

TREATMENT OR MANAGEMENT OF HERNIA

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(A) NON-OPERATIVE TREATMENT

MECHANICAL REDUCTION

This is carried out on reducible hernia; it involves manipulating the content back into place to
bring about temporary relief.

After that the patient may wear a truss to keep the abdominal content from protruding into the
hernia sac.

A truss is a firm pad, with a belt attached that is placed over the hernia to keep it from protruding.

Non-operative treatment does not cure the patient.

MEDICAL TREATMENT

There is no medical treatment for hernia. Until surgery is performed antibiotics and Intravenous

fluids are administered to prevent infections, fluid and electrolyte imbalance and dehydration.

Some of the drugs administered include;

1. Intravenous fluids such as normal saline, ringers’ lactate and dextrose saline.

2. Analgesic such as pethidine for pain.

3. Antibiotics such as metronidazole (flagyl) and ciprofloxacin

(B) SURGICAL TREATMENT

Surgery results in radical cure:

Procedures that may be use are:

HERNIOTOMY

This operation involves opening the hernia sac and reducing its content into the abdominal cavity.

HERNIORRHAPHY

15
It involves removal of the hernia sac after it has been dissected and free from the surrounding
structures and the content have been replaced in the abdominal cavity and the neck has been
ligated.

HERNIOPLASTY

In hernioplasty, the weaken areas is reinforce with synthetic sutures such as steel mesh, fascia, a
wire. It is an attempt to prevent reoccurrence.

SPECIFIC PRE-OPERATIVE CARE

OBSERVATIONS

(A) Assess the patient for upper respiratory tract infection, chronic cough, and sneezing or
constipation, it may be necessary to postpone the operation, because coughing or sneezing could
weaken the post-operative wound.

(B) Closely monitor vital signs and intravenous fluid administration.

(C) In emergency conditions of strangulated or incarcerated hernia, the nurse prepares the patient
as in any other acute surgical condition, the following points should however be taken into
consideration:

1. The patient is nursed in a recumbent position with the foot end of bed elevated.

2. Insert nasogastric tube promptly to empty the stomach and relieve pressure on the hernia sac.

3. Temperature, pulse, respiration and blood pressure are monitored half hourly.

4. Apply cold compresses to the site of the hernia to relax the muscles.

5. An intravenous line should be maintained to correct fluid and electrolyte imbalance.

6. The supra-pubic area should be shaved up to the anterior surface area of the thigh.

7. Specimen or samples should be obtained for laboratory investigations example, obtain urine to
test for sugar and albumin and also samples for analysis and grouping and cross-matching.

8. Reassure patient and his relatives by explaining procedure to them.

16
PATIENT EDUCATION

Reinforce the surgeon’s explanation of the surgery and its possible complications. An emphasis is
place on deep breathing exercise and leg movement.

Encourage early ambulation, but warm the patient against bending and lifting or other strenuous
activities.

SPECIFIC POST-OPERATIVE CARE

1. If general anesthesia is used oral fluid and food are restricted until peristalsis occurs.

2. For more extensive hernia repair, nasogastric suction may be use to prevent distension,
vomiting, and straining.

3. Check for retention of urine, the patient may face difficulty in voiding following spinal
anesthesia. Catheterization may be necessary to relief or avoid retention of urine.

4. Swelling of the scrotum on a rolled towel and apply ice-bags intermittently. A bandage or a
scrotal support may be applied for support and comfort.

5. The sutures are removed on the 7th and 9th day post operatively. Clips are removed on the 5th
day after operation. If a drain is in place, it is removed on the 2nd or 3rd day post-operatively.

6. Any elevation of temperature should be reported to the surgeon.

7. If the patient develops coughs, or sneeze, instruct him to splint the incision site with his hands
to lesser pain and protect the incision.

8. The nurse must encourage early ambulation but warn the patient against lifting.

NUTRITION

Intravenous fluids are administered as prescribed and monitor to ensure that drip is according to
prescribed rate by the surgeon to prevent dehydration pre-operatively and post operatively. Patient
is given nothing by mouth in the abdominal surgery until it is directed by the surgeon after the
certifying the presence of bowel sound or peristaltic movement, patient is then started with sips of

17
water and then patient is introduced to fluid diet e.g. plain tea then followed by light nourishing
diet e.g. light soup and eventually to normal diet.

Plan diet with patient taking into consideration her like and dislike, serve meal attractively, remove
unsightly scenes from the ward and providing snacks in between meals.

MEDICATION

Patient prescribed drugs are served both pre-operatively and post operatively. When serving drugs,
the nurse should take into consideration the following, the right of patient, the right of drug, the
right of dosage, the right of patient to refuse medication, the right route of drug administration.
Observe for the desirable effects and side effects of the drug and record should be encouraged to
take the full course of the drug.

WOUND CARE

Patient’s wound is observed for signs of bleeding and infection, any offensive odour, discharges
of pus or signs of wound gapping. Wound is dress aseptically from inside out to prevent wound
contamination. Also, alternative stitches are removed aseptically as directed by the surgeon.

The patient is educated to keep the wound dry and not to be touching it with the hand to prevent
wound infection. Also, the patient is encouraged to take in high protein diet with vitamin to
promote wound healing and repair worn-out tissues.

PERSONAL HYGIENE

Depending on the patient’s condition he is either assisted to bath when he can do so or given bed
bath. This help to remove dirt from the skin, improves circulation and muscles tone. It also
refreshes patient and enhances patient’s comfort. During bathing care must be taken to wash the
perineum. Also, during bathing, pressure areas such as the occipital, scapular, and sacrum should
be treated to stimulate circulation and prevent bed sores. The patient’s finger and toe nails are
soaked in water respectively to soften and trimmed them in order to prevent accumulation of dirt

18
and also causing injury to patient. Patient mouth is cared for by using tooth brush and paste or
chewing stick if the patient is conscious. Mouth care help to prevent oral infections e.g. halitosis,
gingivitis sores etc. it also enhances Patient appetite.

ELIMINATION

Serve Patient with bedpan on request and encourage patient to take more fluid and roughages to
prevent constipation. If the patient is unable to pass urine, the following measures are carried out;
open nearby taps to stimulate urination or apply warmth over the bladder and the perineum. If
these measures fail to induce micturition, pass catheter under aseptic technique. The amount,
colour, odour and any abnormalities found is documented in the nurse’s notes.

REST AND SLEEP

It is important the patient has a calm peaceful rest. Bed rest is provided to converse energy. This
can be ensured by providing comfortable bed free from creases and crump. There must be less
noise on the ward with all procedure organized in such a way to prevent interruption during sleep.
Ensure good ventilation and reduce the number of visitors.

POSITION

Patient is placed on the supine position to reduce pain and facilitate breathing after surgery. The
patient is allowed to assume a comfortable position which is not contra-indicated to his condition
to help prevent complication.

1.12 PATIENT EDUCATION BEFORE DISCHARGE

1. Warn the patient against lifting or straining.

2. Inform him that he will be able to return to work or resume normal duties within four weeks.

3. Remind him to take surgeon’s permission before returning to work or completely resuming his
normal activities.

4. Instruct him to watch for signs of wound infection such as oozing, tenderness, warmth and
redness of the incisional site or wound.

19
1.13 Validation of Data

All information provided by patient were compared with standards from literature, data from
patient’s folder as data obtained from patient’s relatives through series of interventions which
aided in arrival of the diagnosis of right inguino scrotal hernia.it is therefore considered valid for
the study.

CHAPTER TWO

ANALYSIS OF DATA

2.0 Introduction

Weller (2014), defined analysis as the critical examination and interpretation of the data
collected during the assessment of the patient. This is the second phase of the nursing process
where information gathered is interpreted, strength and weakness are identified and possible
interventions employed. It helps the nurse to identify the actual and potential health problem as
well as arrived at nursing diagnosis. This chapter comprises the following headlines;

1. Comparison of the data with standards

2. Patient/family strengths.
3. Health problems.
4. Nursing diagnosis
2.1 Comparison of The Data with Standards

20
This involves the comparison of information gathered from the patient with that of the standards
in the literature to help in gathering an empirical basis of the disease condition. These covers;
1. Diagnostic investigation.
2. Causes.
3. Clinical features.
4. Treatment.
5. Complications
Table 1: Comparison of the diagnostic tests carried out on Mr. A.R. with literature review.

Diagnostic Tests Per Literature Diagnostic Tests Conducted Mr. A.R.

Review

Physical examination Physical examination was done.

Abdominal X ray Abdominal X ray was not done

Full Blood Count Full Blood Count was tested

White blood Count White blood count was done

Computed temograhpic scan Computed temographic scan was not done

21
 TABLE 2: DIAGNOSTIC INVESTIGATIONS

DATE SPECIMEN INVESTIGATIONS RESULTS NORMAL INTERPRETATION REMARKS

1/12/21 Blood. Hemoglobin level 13g/dl Male =12-18g/dl Within the normal No treatment was given.
estimation Female= 11-16g/dl range.
1/12/21 Blood. Sickling Negative. Negative. Normal sickling status No treatment was given.

1/12/21 Blood. White blood cell 4.50 2.60-8.50 White Blood cell count No treatment was given.
count. [10^3/uL] [10^3/uL] was within normal
range
1/12/21 Blood Red blood cell count 4.51 4.50-5.50 Within normal range No treatment was given
[10^6/uL] [10^6/uL]

22
2.3 COMPARISON OF CAUSES OF PATIENT’S DISEASE CONDITION WITH

STANDARDS IN THE LITERATURE

With reference to the literature, hernia (inguino scrotal hernia) is caused by a combination factors,
which may include congenital defects, a weakened muscle of the abdominal walls, increased intra-
abdominal pressure as in constipation, lifting heavy objects with little precautionary measures and
so on.

Mr. A.R has the acquired type, which was brought about by lifting and pulling heavy objects at
the farm (work place) and also straining during defecation because of constipation.

TABLE 3: COMPARISON OF SIGNS AND SYMPTOMS OF PATIENT WITH

LITERATURE

Signs and symptoms as per literature Signs and symptoms presented by patient

1. Pain at the site of hernia especially at the 1. There was severe pain at the lower

early stage. abdominal region of Patient.

2. Vomiting 2. Patient did not vomit.

3. Swelling at the site of hernia. 3. There was swelling at the inguinal region.

4. Tenderness 4. Patient experienced tenderness at the

inguinal region.

5. Constipation. 5. Patient complained of constipation.

6. Pulse rate may be increased. 6. Patient had a normal pulse rate.

7. Fever and chills. 7. Patient had fever.

8. Anxiety. 8. Patient was anxious.

9. If gangrene has developed there will be less 9. Patient did not develop gangrene.
pain.

23
According to the table, patient presented with most of the clinical manifestations in the literature

review and this shows that my Patient had the condition.

2.4 SPECIFIC MEDICAL TREATMENT GIVEN TO THE PATIENT

The following medications were prescribed for patient;

PRE-OPERATIVE MEDICATION

1. Intravenous normal saline infusion two (2) litres for 48 hours.

2. Intravenous ringers lactate infusion one (1) litre for 24 hours.

3. Intravenous dextrose saline infusion one (1) litre for 24 hours.

4. Intravenous Ciprofloxacin 400mg bd for 72 hours.

5. Intravenous flagyl 500mg tds for 72 hours.

6. Intramuscular pethidine 50mg 8 hourly for 24 h

POST-OPERATIVE MEDICATION

1. Intravenous Ciprofloxacin 400mg bd for 72 hours.

2. Intramuscular pethidine 100mg one (1) litre for 48 hours.

3. Intravenous ringers lactate one (1) litre for 48 hours.

4. Intravenous normal saline infusion 1000mls for 24 hours.

5. Intravenous dextrose saline one (1) litre for 48 hours.

6. Intravenous flagyl 500mg tds for 72 hours.

7. Ciprofloxacin (Tab) 500mg bd x 7 days.

9. Flagyl (Tab) 200mg tds for 7 days.

10. Tablet paracetamol 500mg tds x 7 days.

24
Patient was given the following medications which do not correspond to those listed in the
literature review;

Table 4: Treatment outlined in the literature review compared with that given to the patient.

Treatment outlined in the literature Treatment given to Mr. A. R.

review

IV Ciprofloxacin 400mg bd intravenously x 72

Antibiotics hours

IV Flagyl 500mg tds x 72 hours

Tab Ciprofloxacin 500mg bd x 7 days

Tab Flagyl 200mg tds x 7 days

Analgesics/ Anti-inflammatory Intramuscular pethidine 100mg 8 hourly x 24

hours

Tab paracetamol 500mg tds x 7 days

Intravenous normal saline infusion two (2) litres

for 48 hours.
Intravenous ringers lactate infusion one (1) litre for
Intravenous fluids
24 hours.
Intravenous dextrose saline infusion one (1) litre
for 24 hours.

25
 TABLE 5: PHARMACOLOGY OF DRUGS PRESCRIBED FOR PATIENT

DATE DRUG DOSAGE/ROUTE OF DOSAGE/ROUTE CLASSIFICATIO DESIRED ACTUAL SIDE

NAME ADMINISTRATION OF N EFFECTS EFFECTS EFFECTS/REM
ACCORDING TO ADMINISTRATION ARKS
LITERATURE PRESCRIBED FOR
PATIENT
01-12-21 Normal Adults and children 2000mls for 24 hours Intravenous fluid To restore Patient’s Large doses may
saline dosage is highly intravenously. electrolyte sodium, sodium and give rise to sodium
Infusion. individualized expander and chloride and chloride level accumulation,
Route: Intravenous isotonic fluid level. was oedema and
replacement. maintained. potassium loss.
None was
observed.

01-12-21 Ringers Adults and children 1000mls for 24 hours Electrolyte solution To replace fluid Patient was Fluid overload,
lactate dosage is highly intravenously and isotonic and electrolyte rehydrated osmotic diuresis
Infusion. individualized. replacement. balance that and and
Route: Intravenous might be lost in electrolyte hyperglycaemia.
dehydration. balance None was seen.
maintained.

26
01-12-21 Dextrose Adults and children 1000mls for 24 hours Isotonic solution of Minimize Patient was Fluid overload,
saline dosage depends on fluids intravenously. glucose sodium glycogenisis, rehydrated osmotic dieresis
Infusion. and caloric requirement chloride and water. prevents and energy and
Route: Intravenous anabolism in was restored hyperglycaemia.
patient’s whose None was seen.
oral caloric
intake is
limited.
01-12-21 Injection Adult dose: 50 – 100 mg 100mg stat then 8 An opoid narcotic For analgesic Pain was Euphoria,
Pethidine Child dose:25-50mg hourly for 24 hours analgesic and sedative relieved. dizziness,
. Route: Intramuscular intramuscularly. effect. constipation,
vomiting. None
was observed.
1-12-21 Ciproflox Adult dose: 100-500mg 400mg bd for 72 hours Broad spectrum Inhibit Patient’s Headache,
acin Child dose:10-15mg/kg intravenously. antibiotic deoxyribonuclei condition dizziness,
Infusion. Route : intravenous Flouroquinolones c acid (DNA) improved. vomiting, fatigue.
replication in None was
susceptible observed.
bacteria
preventing cell
production.

27
1-12-21 Metronid Adult dose: 500 mg – 500mg tds for 72 Antibiotic/Antiprot Destroys Infection was Confusion,
azole 750 mg hours intravenously. ozoa bacteria and controlled. headache,
(flagyl) Child dose: protozoa. weakness,
Infusion. 30 – 50 mg constipation and
Route: Intravenous vomiting.
None was
observed

28
29
2.5 COMPLICATIONS DEVELOPED BY PATIENT

With reference to the complication stated in the literature review, Patient did not develop any
complications. However due to early detection and management he received, he had a successful
surgery and recovered well.

2.6 PATIENT /FAMILY STRENGTHS

Strength is a resource and ability that an individual has which can help him cope with the stress of
his condition (Weller, 2014). The following were the strengths of Mr. A.R;

1. Patient could describe the characteristics of pain (location and intensity)

2. Patient could verbalize his concerns about the surgery
3. Patient could verbalize the intensity of pain
4. Patient was willing to follow infection prevention measures.
5. Patient was willing to be assisted to attend to his personal hygiene
6. Patient expressed readiness to know more about hernia

2.7 HEALTH PROBLEMS

Health problems are any condition in which the patient requires nursing management to overcome
the said problem (Weller, 2014). It could be physical, social or spiritual. The following health
problems were identified upon assessing M.R A. R

1.(1/12/2021) Patient complained of pain in the inguinal region.

2.(1/12/2021) Patient complained of anxiety.

3.(2/12/2021) Patient complained of pain in the incision site.

4. (2/12/2021) Patient had an incisional wound.

5. (3/12/2021) Patient could not perform his personal hygiene.

6.(3/12/2021) Patient and family had insufficient knowledge about hernia.

30
2.8 NURSING DIAGNOSIS

This is based on the patient’s complaints and the observation made by the nurse. The following
diagnoses were made on patient;

1. (1/12/2021) Impaired comfort (inguinal pain) related to swelling and inflammatory process
at the inguinal region.
2. (1/12/2021) Anxiety (patient and family) related to impending surgery.
3. (2/12/2021) Impaired comfort (pain) related surgical incision.
4. (2/12/2021) Risk for infection as evidenced by break in the continuity of skin (surgical
incision).
5. (3/12/2021) Self-care deficit (bathing and grooming) related to confinement to bed.
6. (3/12/2021) Deficient knowledge (patient and family) related to the complex nature of
information about hernia and its management.

31
 CHAPTER THREE

PLANNING FOR PATIENT/FAMILY CARE

3.0 Introduction

Planning is third stage of the nursing process in which the nurse and the patient together consider
the goals to achieve in meeting the patient’s identified or potential problems in daily life and
produce an individual care plan (Weller, 2014). Plans for implementation are based on assessment
and diagnosis of the patient health status, strength and concerns. The nursing care plan facilitates
achievement of the patient goals. It communicates clearly the nature of the patient’s problem and
specifies the nursing interventions necessary for the patient.

3.1 Objectives and Outcome Criteria

1. Patient will be relieved of pain within six hours as evidenced by: (1/12/2021).
a. Patient verbalizing that inguinal pain has subsided.
b. Nurse observing that patient is relaxed with a cheerful facial expression.
2. Patient will be relieved of anxiety within twelve hours as evidenced by: (1/12/2021).
a. Patient reporting resolution of anxiety.
b. Nurse observing relaxed facial expression of patient and eagerness to undergo
surgery.
3. Patient will be relieved of incisional site pain within 24 hours as evidenced by: (2/12/2021).
a. Patient reporting a relief of pain.

b. Patient rating pain as 2 or below on the numeric pain rating scale.

4. Patient’s incisional wound will be healed devoid of infection within the period of
hospitalization as evidenced by: (2/12/2021).
a. Patient participating in wound care and infection prevention measures.

32
 b. Nurse observing that wound is healing by first intention without signs of
infection.

5. Patient will be assisted to bath within 24 hours as evidence by; (3/12/2021).

a. Patient looking well groomed.
b. Patient/ family gathering bathing supplies.

6. Patient and family will gain adequate knowledge about hernia and its management within 4
hours as evidenced by: (3/12/2021).

a. Patient and family practicing knowledge gained on hernia and its management.
b. Patient and family being able to answer correctly questions asked on the cause, clinical
features and management of hernia.

33
 TABLE 6: NURSING CARE PLAN FOR MR. A.R

DATE NURSING OBJECTIVE/ NURSING NURSING INTERVENTIONS DATE EVALUATION SIGN

AND DIAGNOSIS OUTCOME ORDERS AND
TIME CRITERIA TIME
1-12-21 Impaired Patient will be 1. Reassure patient 1. Patient and family were reassured that 1-12- Goals fully met A. G
4:00pm comfort relieved of and family. appropriate nursing care will be instituted 21 as patient
(inguinal pain within to relieve him of the pains. 9:00p verbalized that
pain) related five hours as 2. Put patient in a 2. Patient was placed in a recumbent m inguinal pain had
to swelling evidenced by: comfortable position in order to relieve the pains. subsided and
and a. Patient position. was relaxed with
inflammatory verbalizing 3. Apply cold 3. A wrapped cold compress was applied a cheerful facial
process at the that inguinal compress to the on the inguinal region every hour to expression.
inguinal pain has inguinal region. reduce pain sensation.
region. subsided. 4. Provide scrotal 4. The scrotum was supported by placing
b. Nurse support. wrapped cold compress under it to prevent
observing that vigorous movement and to ease the pain.
patient is 5. Employ 5. Diversional therapy such as
relaxed with a diversional therapy. conversation was used to help put
cheerful facial patient’s mind off the pain.
expression. 6. Serve prescribes 6. Injection pethidine 50mg as was
analgesics to relieve administered to patient.
pain.

34
DATE NURSING OBJECTIVE/O NURSING ORDERS NURSING INTERVENTIONS DATE EVALUATION SIGN
AND DIAGNOS UTCOME AND
TIME IS CRITERIA TIME
1-12-21 Anxiety Patient and family 1. Reassure patient and 1. Patient and relatives were assured that 2-12- Goal fully met as A. G
4:20pm (patient and will be relieved of relatives. everything possible will be done for him 21 patient reported
family) anxiety within 5 to have a successful surgery. 9:20p resolution of
related to hours as 2. Introduce patient and 2. Patient and his relatives were m anxiety and on
impending evidenced by: relatives to other patients introduced to MR. A.R who had observation
surgery a. Patient who have undergone the successfully undergone the herniorraphy patient had a
reporting similar surgery successfully. and was recovering. relaxed facial
resolution of 3. Educate patient and his 3. Patients and his relatives were expression of
anxiety. relatives on the benefits of educated that if the surgery is not done, patient and was
b. Nurse the surgery and the complications like intestinal obstruction, eager to undergo
observing relaxed complications that can occur peritonitis, and urine retention could surgery.
facial expression if the surgery is not done. occur hence the need for surgery.
of patient and 4. Allow patient and his 4. Patient and his relatives were allowed
eagerness to relatives to ask questions and to ask questions bothering their minds
undergo surgery. express their fears. and express their fears.
5. Answer their questions 5. Patients and his relatives’ questions
promptly in simple terms to were duly answered in simple terms to
their understanding. their understanding.

35
6. Provide a noise free 6. Volumes of ward television were
environment to reduce reduced to minimize noise and visitors
stimulation and ensure were restricted to ensure relaxation.
relaxation.

36
DATE NURSING OBJECTIVE/OUT NURSING NURSING INTERVENTIONS DATE EVALUATION SIGN
AND DIAGNOSIS COME CRITERIA ORDERS AND
TIME TIME
2-12-21 Impaired Patient will be 1. Assess patient’s 1. Patient level of pain was assessed 3-12-21 Goal fully met as A. G
2:00pm comfort (pain) relieved of incisional level of pain. using the numeric pain rating scale. 2:00pm patient reported a
related site pain within 24 Patient rated pain as 7 on a scale of 0 to relief of pain.
surgical hours as evidenced 10. and rated his pain as
incision. by: 2. Put patient in a 2. Patient was put in a recumbent 2 on the numeric pain
a. Patient reporting a comfortable position in order to relieve him of the rating scale
relief of pain. position. pain.
b. Patient rating pain 3. Monitor vital 3. Vital signs such as temperature,
as 2 or below on the signs. pulse, respiration and blood pressure
numeric pain rating were monitored.
scale. 4. Plan a diversional 4. Diversional therapy such as engaging
therapy for patient. patient in conversation and watching
television was employed to help divert
patient’s attention from the pain.
5. Encourage rest 5. Patient’s bed linen was straightening
and sleep to reduce and free of creases to enhance rest and
pain sensation. sleep in order to reduce pain sensation.
6. Serve prescribed 6. Injection pethidine 50mg was
analgesics. administered.

37
DATE NURSING OBJECTIVE/OU NURSING ORDERS NURSING INTERVENTIONS DATE EVALUATION SIGN
AND DIAGNOSIS TCOME AND
TIME CRITERIA TIME
2-12-21 Risk for Patient’s incisional 1. Observe wound site. 1. Patient’s wound was observed for 4-12-21 Goal fully met as A. G
2:30pm infection as wound will be swelling, drainage, and hemorrhage to 2:30pm patient
evidenced by healed devoid of assess for infection and none was seen. participated in
break in the infection within 2. Dress patient’s 2. A sterile trolley was set to dress wound care and
continuity of the period of wound aseptically. patient’s wound under strict aseptic infection
skin (surgical hospitalization as technique as ordered to prevent prevention
incision) evidenced by; infection. instructions and
Patient 3. Serve patient with 3. Patient’s diet was planned with him wound appeared
participating in highly nutritious diet to include food rich in protein, vitamins to be healing by
wound care and to facilitate wound and mineral salts to facilitate wound first intention on
infection healing. healing. assessment
prevention 4. Educate patient on 4. Patient was educated to keep wound without signs of
measures. how to promote dry and avoid touching it unnecessarily infection.
Nurse observing wound healing and to prevent wound infection.
that wound is prevent infection.
healing by first 5. Serve prescribed 5. Ciprofloxacin, Amoxiclav and flagyl
intention without antibiotics. were administered to prevent infection.
signs of infection.

38
DATE NURSING OBJECTIVE/ NURSING NURSING INTERVENTIONS DATE EVALUATION SIGN
AND DIAGNOSIS OUTCOME ORDERS AND
TIME CRITERIA TIME
3-12-21 Self-care Patient will be 1. Reassure patient 1. Patient and family were reassured 3-12-21 Goal fully met as A. G
6:00am deficit assisted to bath and family that patient’s bathing needs will be 8:00am Patient appeared
(bathing and within 2 hours catered for and with time patient will clean and well
grooming) as evidence by; bath himself unaided. groom in bed.
related to Patient looking 2. Educate patient 2. Patient was educated on the
confinement well-groomed on the importance importance of hygiene and that he will
to bed. and of personal be aided to attend to his personal
patient/family hygiene. hygiene needed.
gathering
bathing 3. Protect bed with 3. Patient’s bed was protected with
supplies. long mackintosh long mackintosh and assisted to bath in
and assist patient bed with warm water.
to bath.
4. Change 4. Patient’s bed linen was frequently
patient’s bed linen changed to prevent infection and
when soiled. enhance comfort.
5. Keep incisional 5. Patient’s surgical incision was kept
site clean and dry. clean and dry during bathing and the

39
 importance of some was explained to
6. Assist patient patient.
with grooming. 6. Patient was assisted to groom.

40
DATE NURSING OBJECTIVE/OUTC NURSING NURSING INTERVENTIONS DATE EVALUATION SIGN
AND DIAGNOSIS OME CRITERIA ORDERS AND
TIME TIME
3-12- Deficient Patient and family will 1. Provide a 1. A conducive environment with less 4/12/21 Goals fully met A. G
21 knowledge have adequate conducive noise was created to enhance 9:00am as;
9:00a (patient and knowledge about environment to learning. Radio and televisions were a. Patient and
m family) hernia and its enhance learning put off. family were seen
related to the management within 24 2. Assess patient and 2. Patient and his family level of practicing
complex hours as evidenced by: his family level of knowledge on hernia were assessed knowledge
nature of a. Patient and family knowledge on by questioning and misconception gained on hernia
information practicing knowledge hernia. about hernia was clarified in simple and its
about hernia gained on hernia and term. management.
and its its management. 3. Educate Patient 3. Patient and his family were b. Patient and
management b. Patient and family and his family on educated on the definition, causes, family were able
being able to answer hernia and its signs and symptoms, treatment, to answer
questions asked on the management. prevention and complications of questions asked
causes, clinical hernia. on the causes,
features and 4. Allow Patient and 4. Patient and his family were clinical features
management of hernia. his family to ask allowed to ask questions and management
questions. of hernia.

41
5. Answer questions 5. Answer questions in simple terms
in simple terms in in patient’s dialect to facilitate
patient’s dialect. understanding.

6. Evaluate patient 6. Patient and family were asked

and family’s questions on the causes, clinical
understanding by features and management of hernia.
question. They able to provide appropriate
answers to question posed.

42
 CHAPTER FOUR

IMPLEMENTATION OF PATIENT / FAMILY CARE PLAN

4.0 Introduction

Implementation of patient / family care plan started from the day of admission of patient and
continued till his discharge. It includes the routine nursing care such as checking of vital signs,
assisting patient to bath, eat, bed making etc. Its purpose is to provide technical and therapeutic
nursing care required to help the patient achieve an optimal level of health.

4.1 Summary of Actual Nursing Care

The nursing care of Mr. A.R started on the 1st of December, 2021 at the Male Surgical Unit Nursing
care was aimed at relieving him of his condition, to prevent infection and complete healing of
wound as well as maintenance of physiological function so that he could return home as a healthy
individual.

First Day of Admission (1st December, 2021)

On 1st December, 2021 at 3:35pm, Mr. A.R. Patient was brought to the Male Surgical ward of

Sunyani Regional Hospital through the Out-Patient department in a wheel chair accompanied by

a relative. He had history of coughing, fever, painful inguino-scrotal swelling, headache and

straining during urination. His admission was ordered by Dr. Marshall with a diagnosis of right

inguino scrotal hernia. Vital signs were checked and recorded as:

• Temperature- 36.8°C

• Pulse - 80bpm

• Respiration - 20cpm

• Blood Pressure- 130/80 mmHg

43
His weight also checked and recorded as 71kilograms. The laboratory investigations that were
ordered on arrival included Full blood count (Hemoglobin level, white blood cell count and
differentials), Blood for grouping and cross matching.

Blood sample was taken and specimen was labeled and sent to the laboratory to check haemoglobin
level to rule out anaemia, sickling to rule out sickle cell disease, grouping and cross matching
against one pint of blood and also to know the blood group and rhesus type of patient.

In addition to that, the following treatment was prescribed by the doctor to prepare the patient for
surgery (Herniorraphy).

• Intravenous Normal Saline 2000mls for 48 hours

• Intravenous Ringers Lactate 1000mls for 24 hours
• Intravenous Dextrose Saline 1000mls for 24 hours
• Intravenous Amoxiclav1.2g tid for 24 hours
• Intravenous Flagyl 500mg tds for 48 hours
• Intramuscular Pethidine 50mg tid for 24 hours

His prescribed drugs were collected from the pharmacy and stat doses were administered.

At 4:00pm a nursing diagnosis of impaired comfort (inguinal pain) related to swelling and
inflammatory process at the inguinal region was made and an objective set to relief patient of
pain within five hours. The following nursing actions were carried out: patient and family was
reassured that appropriate nursing care will be instituted to relieve him of the pains, patient was
placed in a recumbent position in order to relieve the pains, a wrapped cold compress was
applied on the inguinal region every hour to reduce pain sensation, the scrotum was supported by
placing wrapped cold compress under it to prevent vigorous movement and to ease the pain.
Diversional therapy such as conversation was used to help put patient’s mind off the pain.
Injection pethidine 50mg was administered as prescribed.

At 4:20pm Patient expressed concerns about the upcoming surgery. A nursing diagnosis of
Anxiety (patient and family) related to impending surgery was made. An objective was set to help
relief patient of anxiety within five hours. Nursing interventions carried executed include: patient
and relatives were assured that everything possible will be done for him to have a successful

44
surgery, patient and his relatives were introduced to MR. A.R who had successfully undergone the
herniorraphy and was recovering, patients and his relatives were educated that if the surgery is not
done, complications like intestinal obstruction, peritonitis, and urine retention could occur hence
the need for surgery, patient and his relatives were allowed to ask questions bothering their minds
and express their fears, patients and his relatives’ questions were duly answered in simple terms
to their understanding, volumes of ward television were reduced to minimize noise and visitors
were restricted to ensure relaxation.

His vital signs such as temperature, pulse respiration and blood pressure were taken and recorded
as in appendix.

His prescribed drugs were collected from the pharmacy and stat doses were given. Intravenous
infusions were given to rehydrate him and to provide nutrients to him.

PRE-OPERATIVE CARE OF PATIENT

Psychological Preparation:

Patient and his relatives were assured of a competent health staff. Procedures were explained to
patient and his relatives to reduce fear and anxiety.

It was observed that patient and relatives were anxious about the impending surgery and did not
know anything about hernia or herniorrhaphy. They were however assured that patient is in safe
hands of competent health staff who will take good care of him.

The disease process including the causes, signs and symptoms and treatment were explained to
patient and relatives in simple terms and they were then allowed to express their fears and problems
and these were explained in simple terms promptly.

The spiritual needs of the patient were also met by inviting his relatives to pray for him to go
through the surgery successfully.

Physical Preparation:

To prevent post-operative complications, patient’s skin was assessed for any abnormalities such
as rashes, keloids, scars or incision of previous operations of which none was seen. He was

45
instructed not to take anything by mouth. Food and fluids were withheld orally for about 8hours
to prevent vomiting and aspiration during the period of administration of the anaesthetic agents.

Patient operation site was prepared by shaving with particular attention to the perineal area to
help prevent wound infection.

Soap and water were used to clean the area after shaving and savlon used to rinse the area and
finally, methylated spirit was applied to minimize microorganisms in the area. After which the
area was covered with a sterile dressing towel.

Patient was taught how to do deep breathing exercise to prevent hypostatic pneumonia by
breathing deeply in and deeply out during the exercise. He was again taught to support his wound
with his palms when coughing or sneezing to prevent wound gaping.

Patient and his relatives were given the reasons for signing the consent form. Results for the
various laboratory investigations were received. A theatre nurse and anesthetist came to introduce
themselves to him and his relatives on the same day around 7pm and also assess him for fitness
for the surgery.

At 9:00pm the objective that was set to relief patient of pain was evaluated and goal was fully met
as patient as patient verbalized that inguinal pain had subsided and was relaxed with a cheerful
facial expression.

At 9:20pm the goal that was set to help relief patient of anxiety was evaluated and goal was fully
met as patient reported resolution of anxiety and on observation patient had a relaxed facial
expression of patient and was eager to undergo surgery.

Around 10:00pm a low and dim environment was provided for the patient to have adequate sleep.
He was then handed over to the night nurse after all procedure has been recorded.

Second Day of Admission (2nd December, 2021)

Immediate Pre-Operative Care

Patient woke up at 5:00am, made his quiet time, said his prayers and at 5:30am took his bath.

After bathing, his vital signs were checked and recorded as in appendix.

46
At 6:30am, he was encouraged to eliminate his bladder and bowel if he feels the urge to do so.

The site of the operation was inspected and was cleaned and disinfected again, the site was then

wrapped with a sterile towel. Afterwards, patient was given a theatre gown to wear and then the

theatre staffs were alerted that the patient was ready for the surgery.

At 9:00am patient was sent to the theatre on a stretcher with his folder and was handed over to

the receiving theatre staff. An operation bed was prepared to receive him. Time and his state of

condition were written in the nurses 'note

Immediate Post-Operative Care

The objective of immediate post-surgical nursing care is to assist the patient to recover from
anesthetic agent as quickly, safely and comfortable as possible. After recovering from anesthesia,
patient was brought to the male surgical ward at 11:35am for observation and continuity of care
after he has prescribed the following drugs;

• Intravenous normal saline infusion 1000mls for 24 hours.

• Intravenous dextrose saline 1 litre for 48 hours.
• Intravenous Amoxiclav 1.2g tid for 24 hours.
• Intravenous Paracetamol 1g tid for 24 hours.
• Injection pethidine 50mg tid for 48 hours.

Patient was received into an already prepared operation bed and was placed in a recovery position
and incisional site was observed for heamorrhage. His vital signs were checked and recorded as
follows;

Temperature : 36.2 degrees Celsius

Pulse : 76 beat per minute

Respiration : 20 cycles per minute

Blood pressure : 100/70 millimeter of mercury.

47
The subsequent vital signs were strictly monitored quarter hourly for an hour, half hourly for an
hour, hourly for four hour and four hourly for 24 hours.

At 2:00 pm Patient complained of pain at the incisional site hence a nursing diagnosis of
impaired comfort (pain) related surgical incision was formulated and a goal was set to relief
patient of incisional site pain within 24 hours. Nursing interventions include: Patient’s level of
pain was assessed using the numeric pain rating scale. patient rated pain as 7 on a scale of 0 to
10. Patient was put in a recumbent position in order to relieve him of the pain. Vital signs such as
temperature, pulse, respiration and blood pressure were monitored. Diversional therapy such as
engaging patient in conversation and watching television was employed to help divert patient’s
attention from the pain. Patient’s bed linen was straightening and free of creases to enhance rest
and sleep in order to reduce pain sensation. Injection pethidine 50mg was administered

At 2:30pm, Due to the presence of surgical incision a nursing diagnosis of Risk for infection as
evidenced by break in the continuity of skin (surgical incision) was made. An objective was set
to ensure patient’s incisional wound heal devoid of infection within period of hospitalization.
The following nursing interventions were carried out: Patient was reassured of the available
measures to help prevent wound infection, Patient’s wound was observed for swelling, drainage,
and hemorrhage to assess for infection and none was seen, Patient’s diet was planned with him to
include food rich in protein, vitamins and mineral salts to facilitate wound healing, Patient was
educated to keep wound dry and avoid touching it unnecessarily to prevent wound infection,
Prescribed Ciprofloxacin, Amoxiclav and Flagyl were administered to prevent infection

At 9:00pm, patient was made comfortable in bed and handed over to night staff.

Third Day of Admission (1st Day Post-Operatively) (3rd December, 2021)

Patient woke up around 6:00am. His vital signs were checked and recorded as in appendix.

At 6:30am A nursing diagnosis of self-care deficit (bathing and grooming) related to

confinement to bed was formulated. A goal was set to assist patient to bath within 2 hours. The
following nursing interventions were executed: Patient and family were reassured that patient’s
bathing needs will be catered for and with time patient will bath himself unaided, patient was
educated on the importance of hygiene and that he will be aided to attend to his personal hygiene

48
needed. patient’s bed was protected with long mackintosh and assisted to bath in bed with warm
water, patient’s bed linen was frequently changed to prevent infection and enhance comfort,
patient’s surgical incision was kept clean and dry during bathing and the importance of some was
explained to patient, patient was assisted to groom.

A sterile trolley was set to dress patient’s wound under strict aseptic technique as ordered to
prevent infection.

At 8:00am the objective that was set to assist patient to bath within 2 hours was evaluated and
goal fully met as patient was looking clean and well groom in bed.

At 9:00am upon interaction with patient and relatives, it was noticed that they had insufficient
knowledge on Hernia. Therefore, a nursing diagnosis of Deficient knowledge (patient and
family) related to the complex nature of information about hernia and its management was
formulated and a goal was set to help patient and family will gain adequate knowledge about
hernia and its management within 24 hours. Nursing actions include the following: A conducive
environment with less noise was created to enhance learning. Radio and televisions were put off,
Patient and his family level of knowledge on hernia were assessed by questioning and
misconception about hernia was clarified in simple term, Patient and his family were educated on
the definition, causes, signs and symptoms, treatment, prevention and complications of hernia,
Patient and his family were allowed to ask questions, Answer questions in simple terms in
patient’s dialect to facilitate understanding, Patient and family were asked questions on the
causes, clinical features and management of hernia. They able to provide appropriate answers to
question posed.

At 2:00pm the objective set to relief patient of incisional site pain was evaluated and goal was
fully achieved as patient reported a relief of pain and rated his pain as 2 on the numeric pain
rating scale

Fourth Day of admission (Day of discharge) (4th December, 2021)

Mr. A. R’s condition was very good on this day. He spent the night perfectly and woke up well
relaxed. He was assisted to maintain his personal hygiene and he took his breakfast. His vital signs
were checked and recorded as in appendix.

49
Patient’s wound was observed for swelling, drainage and haemorrhage to assess for infection and
none was seen. His wound was found to be clean and was healing by first intention.

Mr. A.R and family were to be discharged as written by physician during ward rounds. Patient and
family were happy to go home without complications and in a very good condition.

At 9:00am, the objective that was set to help patient and family gain adequate knowledge about
hernia and its management within 24 hours was evaluated and goal was fully met as patient and
family was seen practicing knowledge gained on hernia and its management on observation and
they were able to answer questions asked on the causes, clinical features and management of
hernia.

At 2:30pm the goal that was set to ensure patient’s wound heal within period of hospitalization
was evaluated and goal was fully met as patient participated in wound care and infection
prevention instructions and wound appeared to be healing by first intention on assessment
without signs of infection.

His folder was sent to the accounts office for assessment and payment of his bills. Patient and his
family were educated on how to take his prescribed drugs. They were asked to report for review
on 10th December, 2021. Mr. A.R general condition at the time of discharge showed an immense
improvement. They were seen off and bid goodbye at the taxi rank at 4:25pm. I returned to the
ward, stripped off the bed linen, disinfected the items and remade the bed for the next admission.

PREPARATION OF PATIENT / FAMILY FOR DISCHARGE AND REHABILITATION

Preparation of Mr. A.R and family for discharge and rehabilitation started on the day of admission
and continued until the day of discharge. A cordial and therapeutic relationship was established
with patient and family members, who were encouraged to cope with the admission since it was
only a temporary measure after which patient would be discharged home to continue life
independently. Patient was assisted to have his bath with warm water as he preferred. Afterwards,
his mouth was cared for using a tooth paste and tooth brush. These were done twice daily
throughout his hospitalization to maintain his personal hygiene and promote circulation as well as
relax him and improve his personal image.

His vital signs were checked and recorded as in appendix.

50
All other treatments were ordered to be continued as prescribed by patient’s doctor. They were
educated on the causes, clinical features, management and prevention of the condition. The need
for a well-balanced diet and proper personal and environmental hygiene were stressed to them as
the best way to live a healthy life. Home visits were also discussed with them; this was to ensure
continuity of care and to make the necessary changes where applicable.

4.2 FOLLOW UP / HOME VISITS / CONTINUITY OF CARE

First Home Visit (3rd December, 2021):

When patient was on admission, a visit was paid to his house with his wife madam A.B on 3rd
December, 2021. It was a planned visit with the aim of assessing patient’s home environmental
condition upon which health education was given. Their house is a compound house, well
ventilated with two (2) windows in a room. Built with cement blocks and roofed with aluminum
roofing sheets. There are four (4) rooms, two bath rooms and toilet (water closet) facility. They
had good sources of electricity and water supply from national grid and number of community
boreholes.

The community also enjoys the services of Sunyani Regional Hospital. Waste being produced in
the house was disposed at the community waste disposal area. The opportunity was taken to
educate the family on the need to observed strict personal and environmental hygiene. They were
also educated on some of the possible dangers of their method of disposal and the preventive
measures they can employ to safeguard possible disease outbreaks. There was no venerable person
in the house. Time was allowed for questions and they were promised of a visit again after the
discharge of Mr. A.R.

Second Home Visit (10th December, 2021)

On the second visit, patient and family were doing well with no complications and complain. The
wound was almost healed. The family and patient were encouraged to maintain their personal and
environmental hygiene. It was also emphasized that patient should not lift heavy objects. Patient
and family were eventually reminded that should any complication arise, they should not hesitate
to come to the hospital for early treatment. Periodic medical checkups were also encouraged.

51
The family members and the patient expressed their gratitude for the care given and wished me all
the best in life. I left the house around 5: 30 pm.

Day of Review (12th December, 2021)

On the day of review, patient was assisted to collect his folder and accompanied to the consulting
room. The doctor examined him and encouraged him to continue taking his prescribed drugs.
Patient had no complains on examination. He was advised not to lift heavy objects and also practice
good lifting techniques. Again, he was advised to report to the hospital if he is not feeling well.
His vitals were checked and recorded as;

• Temperature -36.30 C
• Pulse -78bpm
• Respiration -20cpm
• Blood Pressure -120/80mmhg

Third Home Visit (15th December, 2021)

This was on Wednesday 15th December, 2021 at 4.30pm. When I arrived at the house, I was
warmly welcomed by the family and was given a seat. They were all very happy to see me again
in their house and were very happy about MR. A. R condition. He did not complain of any ill
health. His wound was completely healed with stitches been removed. I explained to the family
that MR.A. R condition was good but he can report to the Hospital if any problem arises.
I told them that I will not be visiting them frequently since our interaction had come to an end but
promised to pass by anytime, I am in their vicinity.
I thanked them for their support and co-operation throughout the interaction, asked permission and
took leave of them.

52
 CHAPTER FIVE

EVALUATION OF CARE RENDERED TO PATIENT AND FAMILY

5.0 INTRODUCTION

Evaluation determines the progress made by patient with comparison to the specific goals and
objectives. It helps to judge the effectiveness of the nursing process.

5.1 STATEMENT OF EVALUATION

Patient was relieved of pain

On 1/12/2021 at 4:00pm based on patient’s complaints a nursing diagnosis of impaired comfort

(inguinal pain) related to swelling and inflammatory process at the inguinal region was made and
an objective set to relief patient of pain within five hours. The following nursing actions were
carried out: patient and family was reassured that appropriate nursing care will be instituted to
relieve him of the pains, patient was placed in a recumbent position in order to relieve the pains,
a wrapped cold compress was applied on the inguinal region every hour to reduce pain sensation,
the scrotum was supported by placing wrapped cold compress under it to prevent vigorous
movement and to ease the pain. Diversional therapy such as conversation was used to help put
patient’s mind off the pain. Injection pethidine 50mg was administered as prescribed.

53
At 9:00pm on the same day, the objective that was set to relief patient of pain was evaluated and
goal was fully met as patient as patient verbalized that inguinal pain had subsided and was relaxed
with a cheerful facial expression.

Patient and family were relieved of anxiety

On 1/12/2021 at 4:20pm Patient expressed concerns about the upcoming surgery. A nursing
diagnosis of Anxiety (patient and family) related to impending surgery was made. An objective
was set to help relief patient of anxiety within five hours. Nursing interventions carried executed
include: patient and relatives were assured that everything possible will be done for him to have a
successful surgery, patient and his relatives were introduced to MR. A.R who had successfully
undergone the herniorraphy and was recovering, patients and his relatives were educated that if
the surgery is not done, complications like intestinal obstruction, peritonitis, and urine retention
could occur hence the need for surgery, patient and his relatives were allowed to ask questions
bothering their minds and express their fears, patients and his relatives’ questions were duly
answered in simple terms to their understanding, volumes of ward television were reduced to
minimize noise and visitors were restricted to ensure relaxation.

On 1/12/2021 at 9:20pm the goal that was set to help relief patient of anxiety was evaluated and
goal was fully met as patient reported resolution of anxiety and on observation patient had a relaxed
facial expression of patient and was eager to undergo surgery.

Patient was relieved of incisional site pain

On 2/12/2021 at 2:00 pm Patient complained of pain at the incisional site hence a nursing
diagnosis of impaired comfort (pain) related surgical incision was formulated and a goal was set
to relief patient of incisional site pain within 24 hours. Nursing interventions include: Patient’s
level of pain was assessed using the numeric pain rating scale. patient rated pain as 7 on a scale
of 0 to 10. Patient was put in a recumbent position in order to relieve him of the pain. Vital signs
such as temperature, pulse, respiration and blood pressure were monitored. Diversional therapy
such as engaging patient in conversation and watching television was employed to help divert
patient’s attention from the pain. Patient’s bed linen was straightening and free of creases to

54
enhance rest and sleep in order to reduce pain sensation. Injection pethidine 50mg was
administered

On 3/12/2021 at 2:00 pm, the objective set to relief patient of incisional site pain was evaluated
and goal was fully achieved as patient reported a relief of pain and rated his pain as 2 on the
numeric pain rating scale.

Patient’s incisional wound healed devoid of infection

On 2/12/2021 at 2:30pm, Due to the presence of surgical incision a nursing diagnosis of Risk for
infection as evidenced by break in the continuity of skin (surgical incision) was made. An
objective was set to ensure patient’s incisional wound heal devoid of infection within period of
hospitalization. The following nursing interventions were carried out: Patient was reassured of
the available measures to help prevent wound infection, Patient’s wound was observed for
swelling, drainage, and hemorrhage to assess for infection and none was seen, Patient’s diet was
planned with him to include food rich in protein, vitamins and mineral salts to facilitate wound
healing, Patient was educated to keep wound dry and avoid touching it unnecessarily to prevent
wound infection, Prescribed Ciprofloxacin, Amoxiclav and Flagyl were administered to prevent
infection

On 4/12/2021 at 2:30pm the goal that was set to ensure patient’s wound heal within period of
hospitalization was evaluated and goal was fully met as patient participated in wound care and
infection prevention instructions and wound appeared to be healing by first intention on
assessment without signs of infection.

Patient was assisted with self-care activities (bathing and grooming)

On 3/12/2021 at 6:00am A nursing diagnosis of self-care deficit (bathing and grooming) related
to confinement to bed was formulated. A goal was set to assist patient to bath within 2 hours.
The following nursing interventions were executed: Patient and family were reassured that
patient’s bathing needs will be catered for and with time patient will bath himself unaided,
patient was educated on the importance of hygiene and that he will be aided to attend to his
personal hygiene needed. patient’s bed was protected with long mackintosh and assisted to bath
in bed with warm water, patient’s bed linen was frequently changed to prevent infection and

55
enhance comfort, patient’s surgical incision was kept clean and dry during bathing and the
importance of some was explained to patient, patient was assisted to groom.

On 3/12/2021 at 8:00am the objective that was set to assist patient to bath within 2 hours was
evaluated and goal fully met as patient was looking clean and well groom in bed.

Patient and family gained adequate knowledge about hernia and its management

On 3/12/2021 at 9:00am upon interaction with patient and relatives, it was noticed that they had
insufficient knowledge on Hernia. Therefore, a nursing diagnosis of Deficient knowledge
(patient and family) related to the complex nature of information about hernia and its
management was formulated and a goal was set to help patient and family will gain adequate
knowledge about hernia and its management within 24 hours. Nursing actions include the
following: A conducive environment with less noise was created to enhance learning. Radio and
televisions were put off, Patient and his family level of knowledge on hernia were assessed by
questioning and misconception about hernia was clarified in simple term, Patient and his family
were educated on the definition, causes, signs and symptoms, treatment, prevention and
complications of hernia, Patient and his family were allowed to ask questions, Answer questions
in simple terms in patient’s dialect to facilitate understanding, Patient and family were asked
questions on the causes, clinical features and management of hernia. They able to provide
appropriate answers to question posed.

On 4/12/2021 at 9:00am, the objective that was set to help patient and family adequate
knowledge about hernia and its management within 24 hours was evaluated and goal was fully
met as patient and family practiced knowledge gained on hernia and its management on
observation and they were able to answer questions asked on the causes, clinical features and
management of hernia.

5.2 AMENDMENTS OF NURSING CARE PLAN

Upon careful analysis of evaluation of nursing care given to MR. A. R all goals were fully met.
This can be attributed to the expert nursing and medical care rendered to him during his stay on
the ward and the cooperation from the patient and his family.

56
5.3 TERMINATION OF CARE

Termination of care is a therapeutic process that helps patient and the nurse to end their
relationship. It is gradual process which started from the day of admission to the last home visit
Throughout hospitalization M.R. A.R and family were made aware that the care is for a period of
time after which the nurse- patient relationship will eventually be terminated; patient and family
were educated on their personal and environmental hygiene, exercise, eating of a well-balanced
diet and was advised not lift heavy objects.
The patient and his family showed appreciation for the services I rendered and asked for
continuation of the relationship. The termination left no ill effect on the patient and family, since
they were educated from the beginning. The actual termination of the interaction occurred on the
last home visit thus, 15th December, 2021. Since there was no health facility patient was handed
over to his daughter (a student nurse) to continue with care at home.

57
 CHAPTER SIX

SUMMARY AND CONCLUSION

6.0 SUMMARY

Mr. A.R a sixty-five-year-old man of 4 children and a residence of Odumasi, a suburb of Sunyani
in the Bono Region was admitted through the Out-Patient unit of Sunyani Regional Hospital to the
male surgical unit on the 1st of December, 2021 with a diagnosis of right inguino-scrotal hernia.
He underwent herniorrhaphy the following day and was transferred to male surgical ward B1 for
continuity of care.

Some of the nursing problems identified on patient were pain at the inguinal region, anxiety, pain
at the incisional site, and knowledge deficit.

The following drugs were prescribed for patient and were served accordingly; intravenous normal
saline, dextrose saline, ringers’ lactate, injection pethidine, intravenous ciprofloxacin, intravenous
flagyl, paracetamol. Nursing diagnoses were employed to achieve the objectives and goals.

Patient and family were educated on the disease, its possible causes, treatment and preventive
measures.

M.R A. R was finally discharged on 4th December 2021 and came for review on 10th December
2021.

Home visits were made to his home whilst he was still on admission and also after discharge to
assess and insure a therapeutic home environment.

6.1 CONCLUSION

In conclusion, the patient and family care study has not only broadened my knowledge in hernia
disease but also helped me put the knowledge I have acquired for the three-year nursing course
into practice. It has also helped me to understand comprehensive nursing care that has to be given
to individual patient and also improved my interpersonal relationship with patients.

58
I suggest that if possible, all patients who come on admission should be given such specialized and
individualized nursing care so as to promote recovery and positive self-image of patients.

59
 APPENDIX

TABLE FIVE: FLUID INTAKE AND OUTPUT CHART

DATE/ FLUID INTAKE AMOUNT DATE/ FLUID OUTPUT AMOUNT

TIME TIME
1/12/21 Intravenous Normal 500mls 1/12/21 Urine 1000mls
4:00pm Saline 8:30pm
1/12/21 Intravenous Ringers 500mls
6:05pm Lactate
1/12/21 Intravenous Dextrose 500mls 1/12/21 Urine 800mls
8:45pm Saline 10:00pm
1/12/21 Intravenous Normal 500mls
10:50pm Saline
1/12/21 Intravenous Ringers 500mls 1/12/21 Urine 700mls
3:45pm Lactate 3:10pm
1/12/21 Intravenous Dextrose 500mls
5:55pm Saline
1/12/21 Intravenous Normal 500mls 1/12/21 Urine 700mls
8:30pm Saline 6:15pm

TOTAL INTAKE=3500mls

TOTAL OUTPUT=3200mls

BALANCE=300mls

60
DATE/ FLUID INTAKE AMOUNT DATE/ FLUID OUTPUT AMOUNT
TIME TIME
2/12/21 Intravenous Normal 500mls 2/12/21 Urine 1000mls
5:45am Saline 5:00am
2/12/21 Intravenous Ringers 500mls
7:05am Lactate
2/12/21 Intravenous Dextrose 500mls 2/12/21 Urine 800mls
9:45am Saline 9:00am
2/12/21 Intravenous Normal 500mls
12:00pm Saline
2/12/21 Intravenous Ringers 500mls 2/12/21 Urine 800mls
2:45pm Lactate 1:10pm
2/12/21 Intravenous Dextrose 500mls
4:50pm Saline
2/12/21 Intravenous Normal 500mls 2/12/21 Urine 1000mls
6:30pm Saline 5:40pm
2/12/21 Intravenous Ringers 500mls
8:00pm Lactate
TOTAL INTAKE=4000mls

TOTAL OUTPUT=3600mls

BALANCE=400mls

Vital signs of Mr. A.R.

61
Date Time Temperature (0C) Pulse Respiration Blood
(bpm) (cpm) pressure
(mmHg)

3:35pm 36.8 80 20 130/80

1/12/21
6:00pm 36.7 83 22 120/80

10:00pm 36.5 70 21 120/60

6:00am 37.3 92 22 110/70

11:35am 36.9 86 27 110/80

2/12/21
2:00pm 36.5 74 25 120/60

6:00pm 36.3 81 24 120/80

10:00pm 36.7 70 21 110/70

6:00am 37.5 92 21 120/70

3/12/21
10:00am 36.7 72 22 120/70

2:00pm 36.9 89 20 110/80

6:00pm 37.1 79 23 120/80

10:00pm 37.2 80 22 110/80

6:00am 37.5 95 23 120/70

10:00am 37.1 79 21 120/70

4/12/21
2:00pm 36.9 74 20 110/70

62
SYMBOLS/ABBREVIATIONS MEANING

Bds Twice daily

Tds Three times daily

Qid Four times daily

O
C Degrees Celsius

Bpm Beat per minute

Cpm Count per minute

Ml Milliliters’

Mg Milligram

Kg Kilogram

Tabs Tablet

MmHg- Millimeters of mercury

G/dl Grams per decimeter in hemoglobin level

T Temperature

P Pulse

R Respiration

63
 BIBLIOGRAPHY

1.Bare, G.B and Smeltzer, C.S (2014), Brunner and Suddath Textbook of Medical and

Surgical Nursing. 20th edition, J.B Lippincott Company, Philadelphia, U.S.A.

2. Cahil M. (2015), Handbook of Medical Surgical Nursing, 19th edition, Springhouse Corporation,

Pennsylvania, U.S.A.

3. Stephen, R.A et al (2014), Nursing Drug Handbook, 34th edition, Springhouse Corporation,

Pennsylvania, U.S.A.

4.Hammoud M. and Gerken J (2021), Textbook of Inguinal Hernia.1st edition Institute for Quality

and Efficiency in health care, Germany.

5. Weller F.B (2014), Bailliere’s Nurses Dictionary, 34th edition, Bailliere Tindal, London, U.K.

6. Client’s folder number:0922/18.

64
65