ACUTE ABDOMINAL SECONDARY TO

PERFORATED HOLLOW VISCUS INCARCERATED

INGUINAL HERNIA

GROUP 3
Antiquerra, Dindo
Azares, Christine Camille
Bacolod, Mitzi Ann
Bertuldo, Aljean
Delara, Ellin
Dinglasan, Dorothy
Esquillo, Princess
Irao, Maryrose
Lumberio, Ramir
Monzon, Jaybe
Panamogan, Jossa
Prado, Diane Mae
INTRODUCTION

Mr. R, a 74-year-old male, was admitted to Provincial Hospital on April 14, 2023, as he
was experiencing abdominal pain, was vomiting, and had slightly reddish-colored urine. He was
constipated and unable to urinate adequately. Four days before admission, the patient complained
of feeling unwell and proceeded to hospitalization.

An incarcerated inguinal hernia is a condition where a portion of the intestine or abdominal

tissue becomes trapped within the inguinal canal, which is a narrow passage that runs from the
abdominal cavity to the scrotum in males. Incarcerated inguinal hernia usually causes swelling in
the groin region and some may show redness if bowel obstruction has occurred some additional
symptoms may include abdominal pain, nausea & vomiting, slightly reddish-colored urine, cold
clamming, constipation, and numbness/tingling of both upper and lower extremities. This can
lead to significant pain, discomfort, and potentially life-threatening complications if left
untreated. In males, the leading cause of incarcerated inguinal hernias is weak or damaged
abdominal muscles or tissues that allow a portion of the intestine or other tissue to protrude
through the inguinal canal. Other risk factors include obesity, physical activity, chronic coughing
or sneezing, pregnancy, and lifting heavy objects.

The treatment for an incarcerated inguinal hernia involves a surgical procedure known as
herniorrhaphy or hernioplasty. This involves repairing and strengthening the weakened muscles
or tissues in the groin area that have allowed the intestine or fatty tissue to bulge through. In
some cases, the surgeon may need to remove part of the intestine that is trapped in the hernia.
The surgery is usually done under general anesthesia, and recovery time can range from a few
days to several weeks depending on the complexity of the procedure and the patient's overall
health. If the hernia is causing severe pain or other complications, emergency surgery may be
necessary to prevent further damage to the intestine or other nearby organs.

Mr. R was discharged on April 20, the patient did not undergo the surgical operation as per
physician’s advice and recommendation. Due to the patient’s advanced age, the patient will
continue home medications and do preventive measures as his condition becomes fair and
tolerable.

PATIENT’S PROFILE

Name: Mr. R.
 Address: Brgy. Togoron, Monreal Masbate

Sex: Male

Age: 74 years old

Birthday: August 5, 1948

Birthplace: Brgy. Togoron, Monreal Masbate

Civil Status: Married

Religion: Roman Catholic

Nationality: Filipino

Occupation: Farmer/Carpenter

Date of Admission: April 14, 2023

Date of Discharge: April 20, 2023

Diagnosis:

Surgery (If any): None

Date of Surgery:

Patient's Health History:

History of Present Illness:

- Four days prior to admission, Patient had intermittent abdominal pain accompanied

with vomiting and blocked material.

- Four days prior to admission, patient noted to have abdominal distension, Patient had
bowel movement and flatulence.

Family Health History:

 MOTHER SIDE FATHER SIDE

No hereditary No hereditary

Past Medical History:

- No previous Hospitalizations.

Present Illness:

-The patient was admitted because of stomach pain, he has not been able to defecate
properly, he is also vomiting, and his urine has a slightly reddish color.

13 AREAS OF ASSESSMENT

1. Social status
Mr. R. is a 74-year-old male and was born on August 5, 1984. Residing in Brgy. Togoron,
Monreal, Masbate together with his wife and 7 children. He is a Roman Catholic. His occupation
is a carpenter and farmer. Mr. R has a drinking history.

2. Mental status

The patient is conscious, alert, and coherent; he is oriented to time, date, and place; he is
cooperative and responsive when answering questions.

3. Emotional status

Patient was scheduled for surgery operation upon admission: there were recognized anxieties or
worries, and no medications were utilized to change emotional reactions. The patient said that he
was thankful to his daughter for taking care of him.

4. Sensory and Perception

Hearing: The patient can hear and determine the sound with the use of snapping fingers and
clapping of hands beside the patient’s ear.

Sight: The patient can determine colors with the use of a color wheel. Can see the flashcard of

letters clearly.

Smell: The patient can smell odor and fragrance in the hallway.

Taste: The patient was on NPO and had NGT attached.

Touch: The patient can feel and identify what he touches. Like a pillow, shirt, plastic bottle, etc.

5. Motor stability

Motor strength is assessed. Can walk slowly because of abdominal pain and can slowly flex both
his arms and legs. His movements are limited, and he needs assistance and support when
assuming self-care needs.
6. Temperature status

Mr. R’s temperature is 98.6°F (37°C), which is within the normal range.

7. Respiratory status

Mr. M’s respiratory rate is 22 bpm.

8. Pain assessment

On the day of admission, the patient was able to state his feelings about pain in his abdomen
which were at the rate of 6 out of 10 indicating moderate pain.

9. Nutritional status

NPO as ordered.

BMI = kg/m2

Height: 164 cm

Weight: 64kg

BMI = 23.8 The patient's BMI falls within 18.5 and 25, which is considered to be a healthy
weight range.

10. Elimination

BEFORE AFTER

Stool

Color Dark brown Brown

Consistency Solid and hard Slightly solid and hard

 BEFORE AFTER

Urine
Color Slightly reddish but not Yellowish
painful
11. Reproductive status

The patient is not sexually active due to his age and illness. He has a wife and 7 children.

12. State of physical rest and comfort

BEFORE DURING

6-8 hours of sleep 4-5 hours of sleep

Prior to hospitalization, the patient stated that he rests and sleeps 6-8 hours a day. He
verbalized, “Sa amon balay nakaturog ako sin 6-8 ka oras.” However, during the assessment, he
stated that he was not able to sleep well at night because of loud noises. “Didi sa hospital 4-5 ka
oras nalang an turog ko kay maribok.”as verbalized by the patient.

13. State of Skin and Appendages

Mr. R’s skin is wrinkly due to his age, and dry, there are no wounds reported by the patient, he
has no lesions or rashes, and his skin was warm to the touch. His nail base is pale, with a
capillary refill time of 5 seconds.

DOTORS ORDER

DATE & TIME PROGRESS NOTES DOCTORS ORDER

APRIL 14, 2023  Admit patients to
surgery ward
 Management
 Inform the attending
Physician.
 Diet NPO
 IVF1 PNSS IL at 30
cc/hr IVF2 PLN 1L at
30 cc/hr
 Abdominal X-ray
supine and upright
 CBC  CBC +blood
typing  Na K+ BUN
 ECG
 Cefixime IV q 8
 Lactulose 10 ml STAT
 Metronidazole
500mg IV
 Omeprazole 40mg IV
 HNBB 10 mg IV
 TPN for abdominal
pain
 Insert Foley catheter
 NS q 1
 I&O shift
 Refer accordingly
APRIL 15, 2023  Cefazolin 2g q 8hrs
 Metronidazole 500mg
q 8hrs
 Omeprazole 40mg IV
 HNBB 10g 1wq 8hrs
IV OD Abdominal
Pain
 Digoxin 0.25 IV OD
APRIL 16, 2023  Insert NGT open
8:07 AM Drain
 Double line
 Right DLR IV at 60
drops per minute for5
hours then regulate
both lines
 at 20 drops after 5th
hours > Piperacillin &
Tazobactam 4.5gdm
IV q 8 hours
 Metronidazole
  Omeprazole drip
 Omeprazole 40mg
IVT q 12hrs
500mg IV q8
 Labs to be taken 3am
(CBC, CREA,
ELECTROLYTES,
Na, K, Protein)
 For Exploratory
Laparotomy
 Inform OR
APRIL 17, 2023 Bloody NGT output  Follow up lab
9:30 PM Melena results ASAP
TIC UGIB  Start omeprazole
drip 80mg
 omeprazole + 80
PNSS in Solucet x5
+ internal medicine
for Co-Management
DIC
 HNBB & Cefazolin
APRIL 17, 2023 With bloody output  Increase Omeprazole
12:22 PM NGT to 40 q12 IV 
 1 com omeprazole
drip
 Sucralfate 1g
dissolved ¼ glass q
vomiting QID
APRIL 18, 2023  NPO
10:00 AM  For H. Pylori
 Repeat CREA, CBC
 Sucralfate 1gm
 QID/NGT
APRIL 20, 2023  Postpone Surgery
 May Go Home
(MGH)
 1 com sucralfate 1g
PRN
 Tylenol
(Acetaminophen) – 1
or 2325 mg pills q4-
q6 PRN
 Motrin (Ibuprofen) –
200-400 ml (1-2
units) q6 PRN
ANATOMY AND PHYSIOLOGY
 The Digestive Process

Mouth - The digestive process starts in your mouth when you chew. Your salivary glands make
saliva, a digestive juice, which moistens food so it moves more easily through your esophagus
into your stomach. Saliva also has an enzyme that begins to break down starches in your food.

Esophagus - After you swallow, peristalsis pushes the food down your esophagus into your
stomach.

Stomach - Glands in your stomach lining make stomach acid and enzymes that break down
food. Muscles of your stomach mix the food with these digestive juices.

Pancreas - Your pancreas makes a digestive juice that has enzymes that break down
carbohydrates, fats, and proteins. The pancreas delivers the digestive juice to the small intestine
through small tubes called ducts.
Liver - Your liver makes a digestive juice called bile that helps digest fats and some vitamins.
Bile ducts carry bile from your liver to your gallbladder for storage, or to the small intestine for
use.

Gallbladder - Your gallbladder stores bile between meals. When you eat, your gallbladder
squeezes bile through the bile ducts into your small intestine.

Small intestine - The muscles of the small intestine mix food with digestive juices from the
pancreas, liver, and intestine, and push the mixture forward for further digestion. The walls of the
small intestine absorb water and the digested nutrients into your bloodstream. As peristalsis
continues, the waste products of the digestive process move into the large intestine.

Large intestine - Waste products from the digestive process include undigested parts of food,
fluid, and older cells from the lining of your GI tract. The large intestine absorbs water and
changes the waste from liquid into stool. Peristalsis helps move the stool into your rectum.

The End of the Process - The rectum stores solid waste until it is expelled via the

anus.

MALE REPRODUCTIVE SYSTEM

The male reproductive system is responsible for reproduction. It is made of the following parts:

Penis - the organ used for urination and sexual intercourse. It has spongy tissue which can fill
with blood to cause an erection. It contains the urethra, which carries both urine and semen.

Scrotum - this is a loose bag of skin that hangs outside the body, behind the penis. It holds the
testes in place.

Testes (or testicles) - these are a pair of egg-shaped glands that sit in the scrotum, on the outside
of the body. They produce sperm and testosterone, which is the male sex hormone.

Epididymis - this is a highly coiled tube that lies at the back of the testes. All sperm from the
testes must pass through the epididymis, where they mature and start to ‘swim’.

Vas deferens - this is a thick-walled tube joined to the epididymis. It carries sperm from the
epididymis up to the prostate gland and urethra.
Urethra - is to allow passage of urine and semen. The urethra connects the distal portions of the
urinary system, such as the urinary bladder, to the external environment and allows for urine
excretion from the body.

Prostate gland - this is a walnut-sized gland that sits in the middle of the pelvis. The urethra
runs through the middle of it. It produces fluid secretions that support and nourish the sperm.

Seminal vesicles - these are 2 small glands above the prostate gland that make up much of the
fluid in semen.

DISCHARGE PLAN
Prior to discharge

• Instructed the patient to take the following home medication as ordered by the physician.

• Follow-up appointments: The patient should have a follow-up appointment with their
healthcare provider to monitor their recovery and ensure that there are no complications.

• Consult the doctor for any problems and complications encountered.

Exercise/ activity

Inform patient with the following:

• Do not lift anything heavy. Heavy lifting can make your hernia worse or cause another hernia.

•Engage in moderate physical activities for inguinal hernia by strengthening the abdominal
muscles and reducing abdominal pressure (For ex: walking and deep breathing)

Treatment

Continue home medications such as Tylenol (acetaminophen) and Motrin (ibuprofen) for these
can relieve discomfort/relieve pain.

Health Teaching

• Maintain a healthy weight. If you are overweight, weight loss may prevent your hernia from
getting worse. It may also prevent another hernia.

• Do not smoke. Nicotine and other chemicals in cigarettes and cigars can weaken the abdominal
wall. This may increase your risk for another hernia.

• avoiding foods and drinks that irritate the stomach, like caffeine, chocolate, fatty foods and
alcohol.
Diet

• Drink liquids as directed. Liquids may prevent constipation and straining during a bowel
movement.

• Eat foods high in fiber. Fiber may prevent constipation and straining during a bowel movement.
Foods that contain fiber include fruits, vegetables, beans, lentils, and whole grains.

Spiritual

• Always be connected to God with a firm foundation of your Faith.

• Always Ask for His guidance and help.

* NOTE: The patient did not undergo surgical operation as per physicians’ advice. The
patient’s condition has improved and will continue home medication and preventive
measures as prescribed by the physician.

THEORETICAL FRAMEWORK
 The Self-Care Deficit Theory, developed by nursing theorist Dorothea Orem, is a theory
that explains the importance of self-care for individuals who are unable to take care of
themselves. It argues that individuals have the ability and responsibility to care for themselves
and that nursing should assist individuals in this process. According to the theory, self-care is an
essential component of good health and quality of life. It involves taking responsibility for one's
own health and well-being by engaging in activities such as maintaining a nutritious diet,
exercising regularly, getting enough sleep, and managing stress.

In this case, we give assistance to our patient to provide self-care and explain his situation
or condition which needs proper care and management. Four days prior to admission, Mr. R. was
constipated, He experienced sudden abdominal pain and had slightly reddish-colored urine.
During hospitalization, the patient complained of numbness and tingling in both of his upper and
lower extremities due to poor blood circulation. His sleeping pattern was disturbed because of
the loud noise. Since the patient is weak, nurses and his significant other assisted him, and the
fact that he is old and unable to perform self-care activities independently in promoting his well-
being.

Individuals who are unable to engage in self-care due to physical or emotional limitations
are said to have a self-care deficit. In such cases, nursing interventions are required to help
individuals achieve self-care. These interventions may include teaching patients how to care for
themselves, providing assistance with daily activities, and helping them develop strategies for
managing their health.

DEVELOPMENTAL TASK
 Erik Erikson's theory of psychosocial development is that individuals go through
different stages of development, each with a unique psychosocial crisis that must be resolved to
achieve a healthy personality. According to Erikson, the last psychosocial stage is Integrity vs.
Despair. This stage includes, “a retrospective accounting of one's life to date; how much one
embraces life as having been well lived, as opposed to regretting missed opportunities.

Mr. R's acceptance of his condition and his ability to reflect on his life choices indicate
that he has successfully navigated the final stage of Erikson's theory of psychosocial
development. At this stage, individuals strive for a sense of accomplishment and fulfillment and
seek to make peace with their past. Mr. R's engagement in activities that foster introspection and
reflection, such as sharing life stories and seeking closure on unresolved conflicts, demonstrates
his desire to attain a sense of closure and achieve a sense of integrity.

Moreover, Mr. R's happiness and contentment with his family's support indicate that he
has successfully created meaningful relationships in his life, which is a crucial aspect of
Erikson's theory of psychosocial development. In this final stage, individuals seek to form deep,
meaningful relationships to help them cope with feelings of loneliness and isolation. Mr. R's
close relationship with his family provides him with a sense of security and emotional support,
which helps him maintain a positive outlook on life.

Overall, Mr. R's engagement in activities that promote introspection, reflection, and the
formation of meaningful relationships suggests that he has successfully navigated Erikson's final
stage of psychosocial development and achieved a sense of fulfillment and contentment in his
life.

PATHOPHYSIOLOGY
 CAUSE: UNKNOWN

PRECIPITATING FACTOR: PREDISPOSING FACTORS

- Alcoholic - Age
- Over fatigue - Male
- Stress - Family History

GENERAL MANIFESTATION:
- A bulge in the area on either side of the pubic bone
- Burning/aching sensation at the bulge
- Pain or discomfort in groin area
- Pain and swelling around the testicles
- Weakness or pressure in the groin
- Enlarge Scrotum
- Heavy dragging sensation in the groin
PATIENT MANIFESTATION:
- Abdominal pain
- Constipation
- Numbness and tingling (Sensation at the upper and lower extremities)
- Nausea and vomiting
- Slightly Reddish colored urine

INGUINAL HERNIA
 Side Effects /
Drug Order Indications Contraindications Nursing Responsibilities & Precautions
Adverse Reactions
Perioperative Contraindicated in Weakness. tiredness.
Generic Name: prevention in patients hypersensitive drowsiness. Tingling Nursing Responsibilities:
Cefazolin contaminated to drug or other & numbness. Precautions:
surgery. cephalosporins.
Brand Name: •If large doses are given, therapy is pro-
Kefzol Infections of • Use cautiously in longed, or patient is at high risk, monitor
Ancef respiratory, biliary, patients hypersensitive patient for signs and symptoms of
and GU tracts; skin, to penicillin because of superinfection.
Classification: soft-tissue, bone, and the possibility of cross-
Antibiotics joint infections; sensitivity with other • Monitor patient for diarrhea and treat
septicemia; beta-lactam antibiotics. appropriately.
endocarditis caused
by Escherichia coli, Use cautiously in • Look alike-sound alike: Don't confuse
Route: Enterobacteriaceae, patients with a history drug with other cephalosporins that
IV gonococci, of colitis, seizure sound alike.
IM Haemophilus disorders, or renal
influenzae, Kleb- insufficiency.
Dosage / siella species, Precautions:
Frequency: Proteus mirabilis,
Staphylo coccus Instruct patient to report adverse
2grams q 8 aureus, reactions promptly.
hours Streptococcus •Tell patient to report discomfort at IV
pneumoniae, and injection site.
group A beta- • Advise patient to notify prescriber if a
hemolytic rash develops or if signs and symptoms
streptococci of super- infection, such as recurring
(Streptococcus fever, chills, and malaise, appear.
pyogenes)
 Side Effects /
Nursing Responsibilities &
Drug Order Indications Contraindications Adverse
Precautions
Reactions
Use metronidazole only Contraindicated in patients Trouble
Generic for the conditions for hypersensitive to drug or other sleeping. Nursing Responsibilities:
Name: which it's indicated nitroimidazole derivatives. The use of Lightheaded
Metronidazole because it may be disulfiram within 2 weeks of feeling. Monitor LFT results carefully
carcinogenic. Avoid metronidazole therapy and the use of in elderly patients. Observe
Brand Name: unnecessary use. alcohol or propylene glycol products patient for edema, especially
Flagyl R during treatment and for 3 days after if patient is receiving
treatment ends are contraindicated. corticosteroids; Flagyl IV
Classification: RTU may cause sodium
Antiprotozoals Adjust-a-dose (for all • Use cautiously in patients with a retention.
indications): For severe history of blood dyscrasia, CNS
Route: hepatic impairment disorder, or retinal or visual field Record number and character
IV (Child-Pugh class C), changes. of stools when drug is used to
PO reduce dose of treat amebiasis.
immediate-release tablets • Use cautiously in patients who take
and IV infusion by 50%. hepatotoxic drugs or have hepatic •Sexual partners of patients
Dosage / disease, alcoholism, or renal being treated for I. vaginalis
Frequency impairment. infection, even if
500 mg q 8 asymptomatic. must also be
hours treated to avoid reinfection.

Look alike-sound alike: Don't

confuse metronidazole with
metformin.

Precautions:

• Inform patient with

trichomoniasis of need for
sexual partners to be treated
simultaneously to avoid
reinfection.
Tell patient to avoid alcohol
and alcohol- containing drugs
during and for at least 3 days
after treatment course.
Tell patient that a metallic
taste and dark or red-brown
urine may occur.
Tell patient to report signs
and symptoms of candidal
overgrowth.
Tell patient to report all
adverse reactions mediately,
especially neurologic
symptoms seizures,
peripheral neuropathy).
 Side Effects / Nursing Responsibilities &
Drug Order Indications Contraindications
Adverse Reactions Precautions
Symptomatic GERD • Contraindicated in patients Headache.
Generic without esophageal hypersensitive to drug or its Abdominal pain. Nursing Responsibilities:
Name: lesions components and in patients Gastrointestinal Alert: May increase risk of CDAD.
Omeprazole receiving rilpivirine- disturbances. Evaluate for CDAD in patients who
Erosive Esophagitis containing products. develop diarrhea that doesn't improve.
Brand Name:
Losec Pathologic Alert: High-dose, long-term Long-term therapy may cause vitamin
Hypersecretory PPI therapy may be B12 absorption problems. Assess
Classification: conditions such as associated with an increased patient for signs and symptoms of
Antiulcer Zollinger-Ellison risk of hip, wrist, and spine cyanocobalamin deficiency (weakness,
Syndrome fractures. heart palpitations, dyspnea,
Route: paresthesia, pale skin, smooth tongue,
PO Duodenal Ulcer CNS changes, loss of appetite).
• Use cautiously in patients
Frequent Heartburn • Because risk of fundic gland polyps
with hypokalemia and
Dosage / respiratory alkalosis and in increases with long-term use,
Frequency: patients on a low-sodium especially beyond 1 year, use drug for
40mg diet. shortest duration appropriate to the
condition being treated.
• Risk of fundic gland polyps
increases with long-term use, Dosage adjustments may be necessary
especially beyond 1 year. in patients with hepatic impairment •
Periodically assess patient for
• Long-term administration osteoporosis
of bicarbonate with calcium
Monitor patient for signs and
or milk can cause milk-alkali
symptoms of acute interstitial
syndrome.
nephritis.

Precautions:
 Tell patient to swallow tablets whole
and, crush, or chew them not to open
Give patient instructions on how to
take oral suspension. Instruct patient to
take drug at least 30 to 60 minutes
before meals.

Caution patient to avoid hazardous

activities if dizziness occurs.
•Advise patient that Prilosec OTC isn't
intended to treat infrequent heartburn
(one episode of heartburn a week or
less), or for those who want immediate
relief of heart burn. ESTIST to omit to

• Inform patient that Prilosec OTC

may take 1 to 4 days for full effect,
although some patients may get
complete relief of symptoms within 24
hours.

•Teach patient to recognize and report

signs and symptoms of low
magnesium levels.

Side Effects / Nursing Responsibilities &

Drug Order Indications Contraindications
Adverse Reactions Precautions
Generic Name: Sucralfate is a Documented Dry Skin Give drug on an empty
Sucralfate medication used to treat hypersensitivity to Feeling fullness stomach, 1 hour before or 2
duodenal ulcers, sucralfate is an absolute No adverse effects hours after meals and at
Brand Name: epithelial wounds, contraindication as it can bedtime. Monitor pain; use
Carafate chemotherapy-induced cause an anaphylactic antacids to relieve pain.
mucositis, radiation reaction. Some of the
Administer antacids between
Classification: proctitis, ulcers in relative
Protectants Behcet disease, and burn contraindications include doses of sucralfate, not within
wounds. end-stage renal disease, 30 min before or after
Route: uncontrolled diabetes sucralfate doses. Measure and
NGT mellitus with record regular weight to
hyperglycemia, impaired monitor mobilization of
swallowing/gag reflex. edema fluid. Drug Levels and
Effects No data are available
Dosage / Frequency:
on sucralfate use during
1gm QID
breastfeeding; however, it is
virtually unabsorbed orally.
Most authorities consider
sucralfate acceptable to use
during breastfeeding. No
special precautions are
required, including following
application to the nipples in a
skin cream.

Side Effects / Nursing Responsibilities &

Drug Order Indications Contraindications
Adverse Reactions Precautions
 Digoxin is indicated in Digoxin is Dizziness and Monitor BP periodically in
Generic Name: the following conditions: contraindicated in the Nausea. patients receiving IV digoxin.
Digoxin 1) For the treatment of following conditions [5]: No adverse effects. Monitor ECG during IV
mild to moderate heart Acute myocardial administration and 6 hours
Brand Name: failure in adult patients. infarction. after each dose. Notify health
Lanoxin 2) To increase Hypersensitivity to the
care professional if
myocardial contraction drug. Ventricular
Classification: in children diagnosed fibrillation bradycardia or new
Digitalis Glycosides with heart failure. 3) To arrhythmias occur. Observe
maintain control IV site for redness or
Route: ventricular rate in adult infiltration; extravasation can
IV patients diagnosed with lead to tissue irritation and
chronic atrial fibrillation. sloughing. Notify health care
professional if bradycardia or
Dosage / Frequency: new arrhythmias occur.
0.25 q 8 hours Observe IV site for redness or
infiltration; extravasation can
lead to tissue irritation and
sloughing. Monitor intake
and output ratios and daily
weights. Assess for peripheral
edema, and auscultate lungs
for rales/crackles throughout
therapy.

Side Effects / Nursing Responsibilities &

Drug Order Indications Contraindications
Adverse Reactions Precautions
 Bacterial infections: Diarrhea from an Headache and
Generic Name: Bone and joint infection. infection with Nausea. Monitor signs of allergic
Piperacillin and Complicated Clostridium difficile No adverse effects. reactions and anaphylaxis,
Tazobactam appendicitis. GI bacteria. low amount of including pulmonary
infections. Gonorrhea. potassium in the blood. symptoms (tightness in the
Brand Name: Meningitis. Respiratory increased risk of
throat and chest, wheezing,
Zosyn tract infections. bleeding due to clotting
Septicemia. disorder. seizures. a cough dyspnea) or skin
Classification: significant drop in a reactions (rash, pruritus,
Penicillin Antibiotics certain type of white urticaria). Notify physician or
blood cell called a nursing staff immediately if
Route: neutrophil. Piperacillin these reactions occur. Watch
IV and tazobactam for for seizures; notify physician
injection is immediately if patient
Dosage / Frequency: contraindicated in develops or increases seizure
4.5gdm q 8 hours patients with a history of activity. Monitor signs of
allergic reactions to any pseudomembranous colitis,
of the penicillin's,
including diarrhea, abdominal
cephalosporins, or β-
pain, fever, pus or mucus in
lactamase inhibitors.
stools, and other severe or
prolonged GI problems
(nausea, vomiting, heartburn.
NURSING CARE PLAN

ACUTE ABDOMINAL SECONDARY TO PERFORATED HOLLOW VISCUS INCARCERATED INGUINAL HERNIA

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Abdominal Within 30 • Observe or monitor signs • Some people • After 30 minutes to
The Patient Pain related to minutes to 1 and symptoms associated deny the, 1 hour of Nursing
verbalized that, protrusion of hour of with pain such as BP, heart experience of pain Intervention the
"Sobrang sakit sa tissue through Nursing rate, temperature, color and when it is present. goals were met
ibaba san akon tiyan a weak spot in Intervention moisture of skin, Attention to
di ko aram kun the abdominal the Patient's restlessness, and ability to associated signs
panuhon". area. Pain Scale will focus. may help the nurse
decrease from • Assess pain characteristics in evaluating pain.
Objective: 6/10 to 1/10 or (quality, severity, location, • These data can be
Facial Grimace 0/10 onset, duration, used to identify the
Rated pain as 6/10 in precipitating and relieving extent of the pain
a pain scale of 0-10 factors). as well as serve as
• Watch for and baseline
immediately report signs of information.
incarceration and
strangulation.
• Administer I.V. fluids and
 analgesics for pain as
ordered (HnBB 10g 1wq
8hrs IV OD Abdominal
Pain).
• Don't allow the patient to
cough, but do encourage
deep breathing and frequent
turning.
• Apply ice bags to the
scrotum to reduce swelling
and relieve pain; elevating
the scrotum on rolled
towels also reduces
swelling.
• Administer analgesics as
necessary.
• In males, a jock strap or
suspensory bandage may be
used to provide support.

ACUTE ABDOMINAL SECONDARY TO PERFORATED HOLLOW VISCUS INCARCERATED INGUINAL HERNIA

 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Objective: Risk for Fluid • Within 30 • Assess the onset of • It gives details • After 30 minutes of
Vomiting (+) Volume Deficit minutes of symptoms, nausea, and about vomiting Nursing Intervention
• 5x PTA related to nursing vomiting. Record the and its significant the goals were met.
Nausea (+) vomiting intervention, quality, amount, and characteristics.
secondary to the patient presence of blood, bile, • Physical
stuck or trapped will vomitus, and odor. assessment
tissue inside experience • Check the skin elasticity, provides
hernia which cuts relief from mucous membranes, regarding
the blood flow. vomiting. fontanelles (for infants), hydration status; it
• The patient weight, last void, and involves
will show changes in behavior. extracellular
clinical signs • Obtain vital signs, losses, decrease in
of adequate including apical pulse. the level of
hydration. • Examine urine-specific activity, feeling of
• The gravity. Evaluate urine discomfort,
patient/parent color and amount every weight loss,
s will voiding or as per doctor’s decreased skin
recognize the order. turgor, and
reason for • If vomiting persists, concentrated
fluid maintain nothing per urine.
deficiency, Orem or NPO status as • To monitor
and the prescribed. cardiovascular
appropriate • Keep the patient on the response to
type of foods side or sitting when dehydration, signs
and liquids to vomiting. include weak
consume to • Start and monitor IV pulse and a drop
avoid administration as in blood pressure.
recurrence. prescribed by the Increased
physician. respiratory rate
• After nausea and may contribute to
vomiting subside, offer fluid loss.
clear liquids as tolerated. • Urine
For adults, an oral concentration and
rehydration solution can increase in
be given. For specific gravity
breastfeeding babies, can be indicators
frequent short feedings of dehydration.
can be done. • Gives rest to the
• Discuss with the parents gastrointestinal
the possible cause of tract to avoid
nausea and vomiting. getting more
Provide information nauseous and
regarding signs of triggers vomiting.
dehydration and when to • This is a safety
report them to the precaution to
physician. avoid aspiration
of emesis.
• To prevent and
treat nausea and
vomiting after
surgery.
• To provide fluid
replacement and
nutritional
support.
Monitoring IV
regulation is
important to
prevent fluid
overload.
• Fluid
replacement as
patient tolerated.
• Gives
 information for
urgent treatment
of dehydration.

ACUTE ABDOMINAL SECONDARY TO PERFORATED HOLLOW VISCUS INCARCERATED INGUINAL HERNIA

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Alterations of Within 1 to 3 • Checked the color of the • To check for the After 1 to 3 hours
The patient Sensory hours of skin of the affected arm. circulation. of nursing
verbalized that, Perception intervention • Measured capillary refill. • To check for the intervention the
"Naga binhod an (Numbness and the patient • Monitored vital signs. circulation in the patient had
akon kamot kag Tingling) related will be able • Teach the patient about affected area. identified awareness
tiil." to poor oxygen to identify passive exercises •To have baseline of sensory
awareness of •Encouraged patient to use perception. The
 circulation sensory relaxation techniques (deep data. goals were met.
Objective: perception. breathing exercises). •To enhance
Weak Pulse • Evaluate sensory circulation in the
Delay Capillary awareness: stimulus of affected area.
Refill (Nail Base is hot/cold, dull/sharp, smell, • To decrease
Pale, with a taste, hearing, and tension level
capillary refill time location/function of body • To assess degree
of 5 seconds) parts. of impairment
Cold Clammy Skin • Determine response to • To note whether
painful stimuli. response is
appropriate to
stimulus,
immediate or
delayed.
ACUTE ABDOMINAL SECONDARY TO PERFORATED HOLLOW VISCUS INCARCERATED INGUINAL HERNIA
ASSESSMENT DIAGNOSIS PLANNIN INTERVENTION RATIONALE EVALUATION
G
Subjective: Constipation Within 8 • Determine stool color, • Assist identifying After 8 hours of
The patient related to stuck hours of consistency, frequency and causative or nursing
verbalized that "Dili or trapped tissue nursing amount contributing factors intervention, the
ako nakaudo inside of hernia intervention • Auscultate bowel sounds and appropriate patient was able to
maayo." , the client • Educate patient on lifestyle intervention establish or return
will changes of constipation • Bowel sounds are to normal patterns
 establish or prevention (Diet, Hydration, generally decrease of bowel
Objective: return to and Avoid Alcohol) in constipation functioning.
Impaired Bowel normal • Older clients shout
Sounds patterns of at least drink up 2 L
(Hypoactive) bowel of water daily unless
Abdominal functioning contraindicated.
Tenderness • Adequate fluid
Facial Grimace intake makes the
Administered Oral stool softer and
Solution: (Lactulose easier to pass
10ml STAT) throughout the large
intestine.
• Assist patient with
being able to
successfully manage
and prevent
constipation
complications at
home in the future.
s

ACUTE ABDOMINAL SECONDARY TO PERFORATED HOLLOW VISCUS INCARCERATED INGUINAL HERNIA

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Fear related to • After 20 Independent: • This validates the After 20 minutes of
The Patient actual/perceived minutes of • Acknowledge your feelings the patient nursing intervention
verbalized that, threat to health nursing awareness of the patient's is having and the goals were met.
"nahahadlok ako sa as manifested by intervention, fear. communicates an
mangyayari saakon, tension the client • Stay with patient to acceptance of
dili ko aram kun will be able promote safety, especially those feelings.
makayanan ko" to determine during frightening • The presence of a
what the procedures or treatments. trusted person
patient is • Maintain a calm and increases the
Objective: fearful of by tolerant manner while patient’s sense of
Restlessness careful and interacting with patient. security and safety
Sweating thoughtful • Establish a working during a period of
Voice Quivering reasoning. relationship through feat.
continuity of care. • The patient's
• Orient to the environment feeling of stability
as needed. increases in a calm
• Provide safety measures and nonthreatening
within the home when atmosphere.
indicated (e.g., alarm system, • An ongoing
safety devices in showers or relationship
bathtubs). establishes trust
• Use simple language and and a basis for
brief statements when in- communicating
structing patient regarding fearful feelings.
diagnostic and surgical • This promotes
procedures. Explain what comfort and a
physical or sensory decrease in fear. If
sensations will be home environment
experienced, is unsafe, patient's
• Reduce sensory stimulation fears are not re-
by maintaining a quiet solved and fear
environment, whether in the may become
hospital or home situation. disabling
Remove unnecessary • When
threatening equipment. experiencing
• Assist patient in identifying excessive fear or
strategies used in the past to dread, patient may
deal with fearful situations. be unable to
These measures may be comprehend more
helpful or comforting. than simple, clear,
• As patient's fear subsides, and brief
encourage him or her to instructions.
explore specific events Repetition may be
preceding the onset of the necessary.
fear. • Fear may escalate
• Encourage rest periods. with excessive
• When patient must be conversation,
hospitalized or away from noise, and
home suggest bringing in equipment around
comforting objects from the patient. Though
home (e.g., music, pillow, staff or care giver
blanket, pictures). may be
comfortable
Collaborative: around "high-tech"
• A Refer the patient to or medical
programs especially designed equipment, the
to treat disabling fear such as patient may not be.
phobias. • This helps patient
focus on fear as a
real and natural
part of life that has
been and can
continue to be
dealt with
successfully.
• Recognition and
explanation of
factors leading to
fear are significant
in developing
alternative
responses.
• Rest improves
ability to cope.
ACUTE ABDOMINAL SECONODARY TO PERFORATED HOLLOW VISCUS INCARCERATED INGUINAL HERNIA
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Disturbed Sleep • After 20 Independent: Independent: After 20 minutes
The patient pattern related to minutes of • Instruct patient to follow as • This promotes of Nursing
verbalized that, environmental nursing consistent a daily sched- ule for regulation of the Intervention the
“Sa amon balay changes intervention retiring and arising as possible. circadian rhythm, client achieved
nakaturog ako sin the patient • Instruct to avoid heavy meals, and reduces the optimal amounts
6-8 ka oras." will be able alcohol, caffeine, or smoking energy required of sleep as
However, during to assess before retiring. for adaptation to evidenced by
the assessment, he past patterns • Instruct to avoid large fluid changes. rested appearance,
added that, “Didi of sleep-in intake before bedtime. • Though hunger verbalization of
sa hospital 4-5 ka normal • Increase daytime physical can also keep one feeling rested, and
oras nalang an environment activities as indicated. Instruct awake, gastric improvement in
turog ko kay : to identify to avoid strenuous activity digestion and sleep pattern.
maribok." factors that before bedtime. stimulation from
may • Discourage pattern of daytime caffeine and
Objective: facilitate or naps unless deemed necessary nicotine can
Sleepy interfere to meet sleep requirements or if disturb sleep.
Appearance with normal part of one's usual pattern. • This helps
pat • Suggest use of soporifics such patients who
as milk. otherwise may
• Recommend an environment need to void dur
conducive to sleep or rest (e.g., ing the night.
quiet, comfortable temperature, • This reduces
ventilation, darkness, closed stress and
door). Suggest use of earplugs promotes sleep.
or eye shades as appropriate. • Overfatigue may
• Suggest engaging in a cause insomnia.
relaxing activity before retiring • Napping can
(e.g., warm bath, calm music, disrupt normal
reading an enjoyable book, sleep patterns;
relaxation exercises). however, elderly
•Explain the need to avoid patients do better
concentrating on the next day's with frequent naps
activities or on one's problems during the day to
at bedtime. counter their
• Suggest using hypnotics or shorter nighttime
sedatives as ordered; evaluate sleep schedules
effectiveness. • Milk contains L-
• If unable to fall asleep after tryptophan, which
about 30 to 45 minutes, suggest facilitates sleep.
getting out of bed and engaging • Obviously, this
in a relaxing activity. will interfere with
For patients who are inducing a restful
hospitalized: state. Planning a
• Provide nursing aids (e.g., designated time
back rub, bedtime care, pain during the next
relief, comfortable position, day to ad- dress
relaxation techniques). these concerns
• Organize nursing care: may provide
• Eliminate nonessential permission to "let
nursing activities. go" of the worries
• Prepare patient for necessary at bedtime.
anticipated • Because of their
interruptions/disruptions. potential for
• Attempt to allow for sleep cumulative effects
cycles of at least 90 minutes. and gen- erally
limited period of
benefit, use of
hypnotic
medications
should be
thoughtfully
considered and
avoided if less
aggressive means
are effective.
Different drugs are
prescribed
depending on
whether the
patient has trouble
falling asleep or
staying asleep.
• Medications that
suppress REM
sleep should be
avoided.
• The bed should
not be associated
with wakefulness.
• These aids
promote rest.
• This promotes
minimal
interruption in
sleep or rest.
• Experimental
studies have
indicated that 60
to 90 minutes are
needed to
complete one
sleep cycle, and
the completion of
an entire cycle is
necessary to
benefit from sleep.