Question

Case Study #2: Caring for Clients With Disorders of the Lower Gastrointestinal Tract

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

The necessary physical examination is conducted and if there is an existing medical history of some disease then, relevant test of will be conducted to determine that. Blood test and ECG are the most common preoperative tests.

The following client education are needed -

• The client must not have anything a night before surgery. (food and water)
• He must have a good bath before coming to surgery.
• Don't have aspirin, ibuprofen or any other blood thinner as long as one week before surgery.
• Don't put on any body perfume or deodrant before surgery.
• Don't have to shave anything.(Neither the site nor the pubic hair)

The nurse should provide the following discharge instructions -

• No heavy work for at least 24 hours.
• Eat healthy food like fruits, vegetables ,whole grain and drink a lot of water to avoid constipation.
• Don't bend much or lift heavy weight.
• The bandage must be kept dry and must not be removed for atleast 48 hours.
• Always wash the site with mild soap and soft water. Try to keep it dry all the time. Don't apply lotion or cream.
• In case of tear, bleeding, sweeling or severe pain, contact healthcare immediately.