VI.

DISCHARGE PLAN
Problem Diet Instructed folks to increase protein-rich foods for fast wound healing and increase fruits and vegetables intake for fast recovery. Encourage patient to increase fluid oral intake. Instructed folks of patient to increase intake of vitamins because they are prone to some vitamin deficiency such as iron, vit.A, and riboflavin. Hygiene Instructed folks to do daily wound dressing. Instructed patient to bath daily. Instructed patient to do daily oral care. Activity Instructed patient to avoid activities that could give pressure on the operation site. Medication Co-amoxiclav 375 mg/tab 3x a day until Nov.28, 2011. (8am-1pm-6pm) Appointment Check up after 1 week at OPD, 8:30 AM Community Support Instructed folks to communicate to their barangay health center for any unusualities claimed or noted. Home Hazard Appraisals Instructed folks of the patient to closely monitor the patient to avoid strenuous activities. Encourage patient not to play outside the house instead divert their interest to play board games. Level of Care Action of Plan Encourage patient to do exercises to strengthen muscles. Instructed patient to avoid factors that increases intra-abdominal pressure such as heavy lifting and straining. Divert the attention of the patient to board games instead of playing outside the house. Encourage patient to do deep breathing exercises if pain persist. Continue medication prescribed by the physician. Increase protein-rich food intake. Instructed patient to prevent wound from becoming wet to avoid growth of microorganism. Instructed patient/folks to prevent factors that can cause infection to the wound. Follow up check up is highly needed.

Preventive / Promotive

Acute pain at the incision site

Curative

Rehabilitative

IV. PROBLEM LIST

CUES Subjective: kasakit sa may tiyan ko nayon, as verbalized by patient. Objective: Pain scale of 5/10 Facial grimace Body malaise Not playful Cries sometimes Restlessness Irritable Immobilization due to surgery Other Pertinent Data: As verbalized by the mother: nurse, ga reklamo na sya bala nga ga sakit na ag gin operahan sa iya. kag kis-a ga hibi sya kung gab-e kay may bes nga ga sakit kuno kag gaka tandugan ya kung ma tulogan sya. PROBLEMS Pain at the incision site # 1 PHYSIOLOGIC ACTUAL POTENTIAL Acute pain at the incision site r/t surgery 2 Indirect Inguinal Hernia Risk for delayed surgical recovery r/t post operative surgical site infection 2 Indirect Inguinal Hernia BEHAVIORAL ACTUAL POTENTIAL Altered role performance: play r/t pain at the incision site 2 surgery Risk for disorganized infant behavior: temper tantrums r/t pain at the incision site 2 Indirect Inguinal Hernia

Body malaise Immobilization due to surgery

Altered activities of daily living (ADL) r/t body weakness 2 surgery

Risk for activity intolerance r/t body weakness 2 Herniotomy

Altered social interaction r/t body malaise 2 Indirect Inguinal Hernia

Risk for trauma r/t history of present illness 2 surgery

Lack of sleep Irritability Restlessness Anxiety

Disturbed sleep pattern r/t episodes of bearable pain and irritability 2 Indirect Inguinal Hernia

Risk for fall r/t lack of sleep and restlessness 2 surgery

Irritability r/t episodes of pain at the incision site 2 surgery

Risk for delayed development r/t lack of sleep 2 episodes of pain

B. NURSING CARE PLAN

General Objective: To promote safety through prevention of accidents, injury, or other trauma and through the prevention of the spread of infection. CUES Subjective: As verbalized by the patient: kasakit sa may tiyan q nayon. Ara naman, ga sakit luwat ma,(patient cries). Objectives: Pain scale of 4/10 Facial grimace Body malaise Not playful Cries sometimes Irritable Restlessness Immobilization due to surgery Anxiety Vital Signs: BP = 90/60 Temp. =36.6 PR = 65 RR = 19 Indirect inguinal hernia causes the Acute pain at abdominal viscera to protrude through the incision the inguinal ring site r/t surgery and follow the spermatic cord 2 Indirect extending down into the inguinal Inguinal canal, they emerge Hernia at the external ring and extend down into the scrotum. Within 24 hours of rendering care, the patient will be free from pain as evidence by: a. Verbalizes of no pain b. Doesnt cry because of pain; and c. Can freely move his body without complaining of any pain. Independent: Inspect wounds daily for changes Change the dressing at appropriate intervals Promote early mobility. Provide position changes Promote good nutrition with adequate protein-rich foods Provide adequate periods of rest After 24 hours or Promotes rendering care, the timely patient is free from intervention pain felt at the of plan of care incision site as evidenced by: To reduce microbial a. Verbalizes colonization of no pain b. Doesnt cry because of Promote pain circulation c. Freely and prevent moves his excessive body tissue without pressure complaining Promote of any pain. faster wound healing DIAGNOSIS RATIONALE SPECIFIC OBJECTIVE INTERVENTION RATIONALE EVALUATION

Correlation: The patient came with a chief complaint of left inguinal mass and then it was diagnosed as indirect inguinal hernia. Then, the patient had undergone a

To minimize impairment and promote

Lab. Results Hct = 0.32 (N= 0.42-0.56) Hgb = 104 (N= 130-180) RBC = 3.82 (N= 4.5-5.5x1012/L) WBC = 11.4 (N= 5-10x109 /L) Platelet = 401 (N=150-400x109/L) Neutrophils = 0.44 (N= 0.51-0.67) Lymphocytes=0.53 (N= 0.21-0.35) Eosinophils = 0.03 (N= 0.2-0.4) Other Pertinent Data: As verbalized by the mother: nurse, ga reklamo nab ala ag bata q nga ga sakit na kuno ang gn operahan sa iya. Kis-a gani daw indi na sya mah giho guid kay ga sakit kung mag hulag sya.

surgery: herniotomy to correct the hernia sac and to go back to its proper anatomical position. Normally, post operative patient suffer from acute pain because of the surgery and the disappearing effect of the anesthesia as well.

and sleep Health teachings regarding proper wound dressing aseptically Collaborative: Apply heat or cold compress as ordered

healing To promote better wound healing and prevent infection

Hot moist compress have a penetrating effect. Cold compress may reduce local edema and promote some numbing, thereby promoting comfort Reduce or eradicate pain

Administer medications for pain as ordered and as to its frequency, route and timing.

3.
Generic Name Brand Name Classification

DRUG STUDY
Mechanism of Action Indications Side Effects Nursing Responsibility

cefuroxime sodium PO, 500 mg IVTT q 6hr 9am-3pm-9pm-3am

Ceftin

Therapeutic: Antibiotic, broad spectrum Pharmacologic: Cephalosporins (2nd generation)

Inhibits bacterial cell wall synthesis, rendering cell wall osmotically unstable, leading to cell death.

Gram-negative organisms: H.influenzae, E.coli, Neisseria, P.mirabilis, Klebsiella; grampositive organisms: S.pneumoniae, S.aureus, S.pyogenes; serious lower respiratory tract, urinary tract, gonococcal infections, skin, septicemia.

CNS: headache, dizziness, weakness, fever, chills, paresthesia GI: nausea, vomiting, diarrhea, anorexia, pain, abdominal pain INTEG: rash, urticaria RESP: dyspnea.

Assess sensitivity to penicillin, or other cephalosporins MIO notify physician if urine output decreases, this may indicate nephrotoxicity Assess allergic reactions: rash, urticaria, pruritus, chills, fever Increase oral fluid intake For 10-14 days to ensure organism death and prevent superinfection. Instruct client to take with food to

mefenamic acid PO, 20 mg/tab, PRN

Ponstel

Therapeutic: Nonsteroidal antiinflammatory

Inhibits prostaglandin synthesis by decreasing an enzyme

Mild to moderate pain, inflammatory disease

GI: nausea, vomiting, anorexia, diarrhea, constipation, cramps,

Pharmacologic: Anthranilic acid derivative

needed for biosynthesis and interferes with prostaglandins at receptor sites; analgesics, antiinflammatory, antipyretic.

dry mouth CNS: dizziness, drowsiness, fatigue, tremors, insomnia, anxiety CV: tachycardia, palpitations, peripheral edema INTEG: purpura, rash, pruritus, sweating EENT: tinnitus, hearing loss, blurred vision

decrease GI symptoms Instruct client/folks to report changes in urine pattern, weight increase, edema, fever, blood in urine may indicate nephrotoxicity Avoid hazardous activities, dizziness or drowsiness may occur Instruct to client/folks to report diarrhea or skin rash: drug may be discontinued