DISCHARGE PLAN

Medication and Management

 Provide adequate sedation and analgesia to prevent straining or pain. The patient

should be relaxed enough to not increase intra-abdominal pressure or to tighten the involved musculature.
 Applying pressure at the apex, or first point that is felt may cause the herniated

bowel to "mushroom" out over the hernia opening instead of advancing through it.
 Consult with a surgeon if reduction is unsuccessful after 1 or 2 attempts; do not

use repeated forceful attempts.

 The spontaneous reduction technique requires adequate sedation/analgesia,

Trendelenburg positioning, and padded cold packs applied to the hernia for a duration of 20-30 minutes. This can be attempted prior to manual reduction attempts.
 Cefuroxime 500 mg 1 tablet TID  Celecoxib 200 mg 1 tablet BID  Instruct the client to continue with follow up medical care.  Advice the client not to miss the intake of medication given by the physician.

 Environment and Exercise

 Place the patient supine with a pillow under his or her knees.  Maintain a quiet, pleasant environment to promote relaxation and healing.  Encourage the client to continue exercises and instruct the family the need for

exercise this is to promote proper blood circulation and relaxation.

 Place the patient in a Trendelenburg position of approximately 15-20 for inguinal

hernias.
 Apply a padded cold pack to the area to reduce swelling and blood flow while

establishing appropriate analgesia.

 Place the ipsilateral leg in an externally rotated and flexed position resembling a

unilateral frog leg position.

 Place 2 fingers at the edge of the hernial ring to prevent the hernial sac from

riding over the ring during reduction attempts.  Firm, steady pressure should be applied to the side of the hernia contents close to the hernia opening, guiding it back through the defect  Three types of exercises are important: 1.Those to strengthen your pelvic floor. 2. Those to strengthen your pelvic floor and lower abdomen (transverse abdominal and oblique muscles). 3. Those to develop the links between your abdomen and your shoulders and rib cage. Strengthening these links will help to pull you up as your pelvic floor and lower abdomen are pushed up.  Walking (ideally 45 minutes per day) increases the interaction between these three target areas. Hernias are in part caused by our sedentary lifestyle. If a person drives to work and home again they may only walk in brief fragments of a few minutes here and there. Walk at a brisk and steady pace, thinking of your posture and breathing with awareness.

 Doing a massage of the hernia place with one hand. Doing small circles, first right
hand to the right and then left hand circles to the left. About one hundred times. Then massaging with both hands from down the belly upwards fifty times. Then I do bigger circles around my stomach, about 25 to 50 times, this I'm doing because the last few weeks I had stomach pain (probably because of stress and this helps.)

 Lifting legs and arms into the air and shaking them strongly several times. Letting
legs and arms fall relaxed down and repeating one time more the shaking.

 Treatment  A hernia repair requires surgery. There are several different procedures that can
be used for fixing any specific type of hernia. In the open surgical approach, following appropriate anesthesia and sterilization of the surgical site, an incision is made over the area of the hernia and carried down carefully through the sequential tissue layers. The goal is to separate away all the normal tissue and define the margins of the hole or weakness. Once this has been achieved, the hole

is then closed, usually by some combination of suture and a plastic mesh. When a repair is done by suture alone, the edges of the defect are pulled together, much like sewing a hole together in a piece of cloth. One of the possible complications of this approach is that it can put excessive strain on the surrounding tissues through which the sutures are passed. Over time, with normal bodily exertion, this strain can lead to the tearing of these stressed tissues and the formation of another hernia. The frequency of such recurrent hernias, especially in the groin region, has led to the development of many different methods of suturing the deep tissue layers in an attempt to provide better results.

 In order to provide a secure repair and avoid the stress on the adjacent tissue
caused by pulling the hole closed, an alternative technique was developed which bridges the hole or weakness with a piece of plastic-like mesh or screen material. The mesh is a permanent material and, when sewn to the margins of the defect, it allows the body's normal healing process to incorporate it into the local structures. Hernia repair with mesh has proved to be a very effective means of repair.

 After the hernia repair is completed, the overlying tissues and skin are surgically
closed, usually with absorbable sutures. More and more of hernia repairs are now being done using laparoscopic technique.

 Health teaching
 Explain what an inguinal hernia is and how it's usually treated.  Explain that elective surgery is the treatment of choice and is safer than waiting until hernia complications develop, necessitating emergency surgery.  Warn the patient that a strangulated hernia can require extensive bowel resection, involving a protracted hospital stay and, possibly, a colostomy.  Tell the patient that immediate surgery is needed if complications occur.  If the patient uses a truss, instruct him to bathe daily and apply liberal amounts of cornstarch or baby powder to prevent skin irritation.  Warn against applying the truss over clothing, which reduces its effectiveness and may cause slippage. Point out that wearing a truss doesn't cure a hernia and may be uncomfortable.

 Tell the postoperative patient that he'll probably be able to return to work or school and resume all normal activities within 2 to 4 weeks.  Explain that he or she can resume normal activities 2 to 4 weeks after surgery.  Remind him to obtain his physician's permission before returning to work or completely resuming his normal activities.  Before discharge, instruct him to watch for signs of infection (oozing, tenderness, warmth, redness) at the incision site. Tell him to keep the incision clean and covered until the sutures are removed.  Inform the postoperative patient that the risk of recurrence depends on the success of the surgery, his general health, and his lifestyle.  Teach the patient signs and symptoms of infection: poor wound healing, wound drainage, continued incision pain, incision swelling and redness, cough, fever, and mucus production.  Explain the importance of completion of all antibiotics. Explain the mechanism of action, side effects, and dosage recommendations of all analgesics.  Caution the patient against lifting and straining.

 Outpatient
 Nowadays, inguinal hernia surgery can easily perform as an outpatient procedure. However, stringent selection criteria, an optimized infrastructure and a close and standardized follow-up are mandatory prerequisites in order to obtain excellent results under secure conditions. Advice the outpatient client to go back in the hospital in a specific date to have a follow up check up and to consult the doctor for any problems or complications encountered.

 Diet  To facilitate healing of the hernia opening one has to take as much pressure off
the opening as possible. This means reducing the volume of intestinal contents using various means, such as COLON CLEANSING, FASTING,

INTRAVASCULAR (INTESTINAL) FAT REDUCTION, INTESTINE CONDITIONING SUPPLEMENTS. Protein, massive vitamin C, etc has also been used to facilitate muscle building.

 Spirituality
 Provide presence.  Support the clients religious practices and beliefs.  Refer the client for spiritual counselling.  Assist the client with prayer.