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Nursing Assessment:
1. Ask patient if hernia is enlarging and uncomfortable, reducible or irreducible; determine relationship to exertion and activities.
2. Assess bowel sounds and determine bowel pattern.
3. Determine if patient is exhibiting signs and symptoms of strangulation, such as distention, fever, nausea, and vomiting.
Nursing Diagnoses:
1. Chronic Pain related to bulging hernia (mechanical)
2. Acute Pain related to surgical procedure
3. Risk for Infection related to emergency procedure for strangulated or incarcerated hernia
Nursing Interventions:
Achieving Comfort
1. Fit patient with truss or belt when hernia is reduced, if ordered.
2. Trendelenburg's position may reduce pressure on hernia, when appropriate.
3. Emphasize to patient to wear truss under clothing and to apply before getting out of bed when hernia is reduced.
4. Give stool softeners as directed.
5. Evaluate for signs and symptoms of hernial incarceration or strangulation.
6. Insert NG tube for incarcerated hernia, if ordered, to relieve intra-abdominal pressure on herniated sac.
Relieving Pain Postoperatively
1. Have the patient splint the incision site with hand or pillow when coughing to lessen pain and protect site from increased intra-abdominal pressure.
2. Administer analgesics, as ordered.
3. Teach about bed rest, intermittent ice packs, and scrotal elevation as measures used to reduce scrotal edema or swelling after repair of an inguinal hernia.
4. Encourage ambulation as soon as permitted.
5. Advise patient that difficulty in urinating is common after surgery; promote elimination to avoid discomfort, and catheterize if necessary.
Preventing Infection
1. Check dressing for drainage and incision for redness and swelling.
2. Monitor for other signs and symptoms of infection: fever, chills, malaise, diaphoresis.
3. Administer antibiotics, if appropriate.
Patient Education and Health Maintenance
1. Advise that pain and scrotal swelling may be present for 24 to 48 hours after repair of an inguinal hernia:
A. Apply ice intermittently.
B. Elevate scrotum, and use scrotal support.
C. Take medication prescribed to relieve discomfort.
2. Teach to monitor self for signs of infection: pain, drainage from incision, temperature elevation. Also, report continued difficulty in voiding.
3. Inform that heavy lifting should be avoided for 4 to 6 weeks. Athletics and extremes of exertion are to be avoided for 8 to 12 weeks postoperatively, per provider instructions.
Evaluation: Expected Outcomes:
1. Hernia effectively reduced with truss or belt; patient comfortable
2. Verbalizes pain decreased to 2 or 3 level on 0-to-10 scale
3. No swelling present; afebrile, no drainage from incision
Book. Lippincott manual of nursing practice 8th ED. Page 664 - 665