Question

Jack Lane, a 54-year-old male client who teaches history at the local high school, is seen at the outpatient surgical center for a left inguinal herniorrhaphy via a laparoscopic approach. The client was moving to a different house and developed the hernia while lifting heavy objects 1 week ago. When the client is standing, the nurse sees bulging in the left inguinal area, which decreases when he is lying flat. The vital signs include T, 99° F; BP, 120/78 mm Hg; HR, 80 beats/minute; RR, 22 breaths/minute. The client had preadmission testing, and the nurse notes that the CBC with differential is within normal limits (WNL), and the electrolytes, renal function, and coagulation profile are also WNL. The electrocardiogram (ECG) copy is on the chart, and the reading is a normal ECG. The results of the chest X-ray are WNL. The physician’s history and physical is also on the chart, and the nurse notes that the client has no previous medical or surgical history. The client is an active runner and has participated in marathons. The client is 5 feet 8 inches in height and weighs 160 lb. He follows a heart-healthy diet, being proactive because he has a family history of cardiovascular disease. He does not smoke cigarettes or use tobacco products, has a rare alcoholic drink socially, and does not use any recreational drugs. The client stated that he was told about the surgical procedure by his surgeon, to not eat or drink anything the night before the surgery or the morning of the surgery, and to report to the surgical center. The client asks the LPN/LVN to provide preoperative education of the hernia repair and what to do at home once he is discharged.

a. What preoperative nursing management and client education are needed?

b. What discharge instructions should the nurse provide?

Answer 1

a) Pre operative nursing management and client education for the patient named Mr. Jack Lane undergoing inguinal herniorrhaphy includes

start nil orally from midnight on the day before surgery

regualr monitoring of vital signs. here the vitals , ECG and Xray has done already and the reports can be shown to physician to get medical fitness

slight temperature shows 99 F can be controlled

writen consent from patient and family members stating that willing for surgery and anesthesia.

Shaving the part from nipple to thigh to avoid infection

Administer pre operative medications as per doctors order.

Administer prophylactic antibiotics to prevent further infection

undergo various blood test necessary for surgery

help the patient in bath and cleaning

preoperative enema to clear bowel

catheterize the patient

Cross match and arrange blood , blood may needed during surgery

The client education include sessation of alcohol , pain management and what to expect from surgery

Psychological support is important to relieve anxiety related to upcoming surgery.

2) Discharge instructions

avoidance of oily and spicey foods

keep the surgical site wound dressed and dont allow to get wet

surgical wound dressing should done alternatively

dont lift any object which is heavy

walk as often

drink 6-8 glasses of water to avoid dehydration

constipation is one of the complication occurs in many abdominal surgeries to avoid such condition eat fruits, vegetables and whole grains

practicemild post op exercise as per physician order

use laxatives or mild stool softners.

Follow up