🏥 Surgical Nursing Care Plan on Inguinal Hernia with Herniorrhaphy / Hernioplasty

Medical-Surgical Nursing | NANDA Surgical Nursing Care Plan Format

Surgical Nursing Care Plan | Practical File Ready

⚠️ Educational Purpose Only: This surgical nursing care plan is prepared for academic practical file work. Not for actual patient care or clinical decision-making.

📄 Page 1 — Student Information

Student Name	[Your Name]
Course	BSc Nursing / GNM / ANM
Subject	Medical-Surgical Nursing
Surgical Care Plan Topic	Inguinal Hernia with Herniorrhaphy / Hernioplasty
Format	NANDA-I Surgical Nursing Care Plan Format
Clinical Area	Male Surgical Ward / Operation Theatre / Post-operative Ward
Date of Submission	[Enter Date]
Clinical Instructor	[Instructor Name]

📄 Page 2 — Patient Identification Data

Name	Mr. Ramesh Choudhary
Age	48 Years
Sex	Male
Address	Jodhpur, Rajasthan
Occupation	Farmer / Labour Worker
Marital Status	Married
Religion	Hindu
Diagnosis	Right Inguinal Hernia
Surgical Procedure	Herniorrhaphy / Hernioplasty
Type of Surgery	Open Mesh Hernioplasty
Type of Anesthesia	Spinal Anesthesia
Type of Family	Nuclear Family
Family Size	5 Members
Ward Name	Male Surgical Ward
Bed Number	21
Date of Admission	19/05/2026
Date of Surgery	20/05/2026
Doctor Incharge	Dr. A. K. Rathore, MS General Surgery
Hospital Name	Government Medical College Hospital, Jodhpur

📄 Page 3 — Chief Complaints & Present Illness History

Chief Complaints

Swelling in right groin region — since 6 months.
Swelling increases on coughing, standing and lifting heavy weight.
Swelling reduces on lying down.
Dull aching pain in right groin — since 15 days.
Dragging sensation in lower abdomen.
Difficulty in heavy work due to groin discomfort.

History of Present Illness

Mr. Ramesh Choudhary, a 48-year-old male, was admitted to the male surgical ward with complaints of swelling in the right groin region for 6 months. Initially, the swelling was small and appeared only during coughing, standing for long time and lifting heavy objects. It disappeared on lying down.

Gradually, the swelling increased in size and was associated with dull aching pain and dragging sensation. The patient works as a farmer/labour worker and frequently lifts heavy loads, which increased the swelling and discomfort. There was no history of vomiting, abdominal distension, constipation with obstruction, fever or irreducible swelling.

On physical examination, a reducible swelling was present in the right inguinal region with positive cough impulse. The patient was diagnosed with right inguinal hernia. After routine investigations and pre-operative preparation, open mesh hernioplasty was planned.

Past Medical History

No history of diabetes mellitus.
No history of hypertension.
No history of tuberculosis, asthma or epilepsy.
History of chronic cough occasionally during winter season.
No history of chronic urinary obstruction.
No known drug allergy.

Past Surgical History

No previous major surgery.
No history of blood transfusion.
No previous hospitalization for hernia or abdominal surgery.

📄 Page 4 — Family History & Family Composition

Family History

The patient belongs to a nuclear family.
Total family members are 5.
No family history of inguinal hernia reported.
No family history of diabetes mellitus, hypertension, tuberculosis or hereditary disease.
Wife is healthy and works as homemaker.
Three children are healthy and studying.
Family is cooperative and supportive during hospitalization.

Family Composition

Name	Age/Sex	Education	Occupation	Relationship	Health Status
Mr. Ramesh Choudhary	48/M	8th Pass	Farmer / Labour Worker	Self / Patient	Right Inguinal Hernia with Hernioplasty
Mrs. Kamla Choudhary	44/F	5th Pass	Homemaker	Wife	Healthy
Master Mohan Choudhary	18/M	Class 12	Student	Son	Healthy
Miss Pooja Choudhary	15/F	Class 10	Student	Daughter	Healthy
Master Deepak Choudhary	10/M	Class 5	Student	Son	Healthy

Family Tree

👨

Mr. Ramesh Choudhary

Patient

Right Inguinal Hernia with Hernioplasty

♡

👩

Mrs. Kamla Choudhary

Wife

Healthy

👦

Master Mohan Choudhary

Son

Healthy

👧

Miss Pooja Choudhary

Daughter

Healthy

👦

Master Deepak Choudhary

Son

Healthy

Male Female Patient Highlighted

📄 Page 5 — Dietary, Personal, Socio-economic & Environmental History

Dietary History

The patient takes a mixed diet.
Usually takes 3 meals per day with tea and snacks.
Diet includes chapati, dal, vegetables, rice, milk and seasonal food items.
Occasional intake of spicy and oily foods.
Fluid intake is approximately 1.5–2 liters per day.
Appetite is normal before surgery.
Patient was kept NPO before surgery as per order.
Post-operatively, oral fluids and soft diet were started after bowel sounds returned and as advised.

Personal History

Sleep: 6–7 hours per night; disturbed before surgery due to anxiety and groin discomfort.
Appetite: Normal.
Bowel: Occasional constipation; no history of intestinal obstruction.
Bladder: Normal micturition; no burning, frequency or urinary retention before admission.
Habits: No alcohol intake; occasional tobacco chewing reported.
Activity: Performs heavy physical work and lifting due to farming/labour occupation.
Allergy: No known drug or food allergy.

Socio-economic History

The patient belongs to a lower-middle-class family.
Patient is the main earning member of the family.
Family income is mainly dependent on farming/labour work.
Family is cooperative and supportive during hospitalization.
Patient is worried about restriction of heavy work after surgery.

Environmental History

The family lives in a pucca/semi-pucca house with adequate ventilation.
Safe drinking water is available at home.
Sanitation facility is available.
Patient’s work environment involves lifting weight and prolonged standing.
Home environment is suitable for post-operative rest and recovery.

📄 Page 6 — Physical Examination

General Condition

Patient is conscious, oriented to time, place and person. He is cooperative and answers questions appropriately. Patient appears mildly anxious regarding surgery and future ability to do heavy work.

Vital Signs on Admission

Temperature: 98.6°F
Pulse: 84 beats/min
Respiration: 18 breaths/min
Blood Pressure: 122/78 mmHg
SpO₂: 99% on room air
Pain Score: 4/10

General Appearance

Built: Moderate
Nutrition: Moderate
Posture: Comfortable while lying; discomfort on standing and coughing
Facial expression: Mildly anxious
Skin: Warm, no cyanosis, no edema
Hydration: Adequate
Pallor/Icterus/Clubbing: Not present

Local Examination of Hernia

Swelling present in right inguinal region.
Swelling increases on coughing and standing.
Swelling reduces on lying down.
Cough impulse is positive.
Mild tenderness present over swelling.
No redness, no severe pain and no signs of strangulation.
Post-operatively, surgical incision dressing present in right inguinal region.

Systemic Examination

Abdomen	Soft, non-distended, bowel sounds present, right inguinal swelling present pre-operatively.
Cardiovascular System	S1 and S2 heard normally, no murmur, pulse regular.
Respiratory System	Chest clear bilaterally, normal vesicular breath sounds, no wheeze or crackles.
Central Nervous System	Conscious, oriented, GCS 15/15, no neurological deficit.
Skin	Skin intact pre-operatively; post-operatively surgical wound dressing present in right inguinal region.

📄 Page 7 — Vital Signs Monitoring Record

Date / Time	Temperature	Pulse	Respiration	BP	SpO₂	Pain Score
19/05/2026 — Admission	98.6°F	84/min	18/min	122/78	99%	4/10
20/05/2026 — Post-op	98.8°F	88/min	18/min	118/76	99%	5/10
21/05/2026 — POD 1	98.6°F	82/min	18/min	120/78	99%	3/10
22/05/2026 — POD 2	98.4°F	78/min	16/min	118/76	99%	2/10
23/05/2026 — Discharge	98.4°F	76/min	16/min	116/74	99%	1/10

Nursing Trend: Patient’s vital signs remained stable during pre-operative and post-operative period. Pain reduced gradually after hernioplasty and analgesic management.

📄 Page 8 — Diagnostic Investigations

Sr. No.	Investigation	Normal Value	Patient Value	Interpretation
1	Hemoglobin	13–17 g/dL	13.4 g/dL	Normal
2	Total WBC Count	4,000–11,000/mm³	8,600/mm³	Normal
3	Platelet Count	1.5–4 lakh/mm³	2.4 lakh/mm³	Normal
4	Random Blood Sugar	80–140 mg/dL	110 mg/dL	Normal
5	Blood Urea	15–40 mg/dL	30 mg/dL	Normal
6	Serum Creatinine	0.7–1.3 mg/dL	0.9 mg/dL	Normal
7	Serum Sodium	135–145 mEq/L	139 mEq/L	Normal
8	Serum Potassium	3.5–5.0 mEq/L	4.2 mEq/L	Normal
9	Urine Routine	No sugar/protein	Normal	No abnormality
10	ECG	Normal sinus rhythm	Normal sinus rhythm	Fit for surgery
11	Chest X-ray	Normal lung fields	No active lung lesion	Normal
12	USG Abdomen/Inguinoscrotal Region	No hernia sac	Right inguinal hernia with reducible bowel/omentum content	Suggestive of right inguinal hernia
13	Blood Group	-	B Positive	Recorded for surgical safety

📄 Page 9 — Medical & Surgical Management / Drug Chart

Medical Management

Patient was kept NPO before surgery as per anesthesia order.
IV line was secured and intravenous fluids were started to maintain hydration.
Analgesics were administered to relieve groin pain and post-operative wound pain.
Antibiotics were administered as prescribed to prevent wound infection.
Pre-operative investigations were reviewed before surgery.
Patient was advised to avoid coughing strain and heavy lifting.
Constipation prevention measures were explained to reduce straining.
Vital signs, pain score and surgical site condition were monitored regularly.

Surgical Management

Name of Surgery: Open Mesh Hernioplasty / Herniorrhaphy
Indication: Right Inguinal Hernia
Date of Surgery: 20/05/2026
Type of Anesthesia: Spinal Anesthesia
Operative Site: Right inguinal region
Operative Finding: Right inguinal hernia sac with reducible content
Procedure Done: Hernia sac identified, reduced/managed, posterior wall strengthened, polypropylene mesh placed and fixed, wound closed in layers and sterile dressing applied.
Drain: Not placed
Post-operative Status: Patient shifted to post-operative ward in stable condition.

Pre-operative Nursing Care

Verified patient identity, diagnosis and planned surgical procedure.
Checked informed written consent for surgery and anesthesia.
Maintained NPO status as ordered.
Recorded baseline vital signs and pain score.
Secured IV cannula and administered IV fluids as prescribed.
Administered prescribed pre-operative antibiotics.
Prepared right inguinal operative area as per hospital protocol.
Removed ornaments, dentures and valuables if present.
Encouraged patient to pass urine before shifting to operation theatre.
Explained post-operative bed rest, wound support, deep breathing and gradual ambulation.
Provided psychological support and reduced anxiety regarding surgery.
Completed pre-operative checklist and shifted patient safely to OT.

Post-operative Nursing Care

Monitored airway, breathing and circulation after spinal anesthesia.
Observed vital signs frequently during immediate post-operative period.
Checked return of sensation and movement in lower limbs after spinal anesthesia.
Observed surgical dressing for bleeding, soakage and discharge.
Assessed pain score and administered analgesics as prescribed.
Maintained IV fluids until oral intake was allowed.
Observed for urinary retention after spinal anesthesia.
Encouraged deep breathing exercises.
Assisted gradual ambulation as advised.
Advised patient to avoid coughing strain, constipation and heavy lifting.
Maintained aseptic technique during wound care.
Educated patient regarding wound care, activity restriction and follow-up.

Drug Chart

Drug Name	Dose	Route	Frequency	Purpose	Nursing Responsibility
Inj. Ceftriaxone	1 g	IV	BD	Antibiotic prophylaxis	Check allergy, administer slowly, monitor rash, diarrhea and IV site.
Inj. Pantoprazole	40 mg	IV	OD	Gastric protection	Administer before meals/early morning, monitor abdominal discomfort.
Inj. Ondansetron	4 mg	IV	SOS	Controls nausea and vomiting	Assess nausea, monitor headache and constipation.
Inj. Paracetamol	1 g	IV	TDS/SOS	Pain and fever relief	Monitor temperature, pain score and total daily dose.
Inj. Diclofenac	75 mg	IM	SOS	Post-operative pain relief	Give after food if oral/monitor gastric irritation, renal status and injection site pain.
IV Ringer Lactate	500 ml	IV	As ordered	Maintains hydration and electrolyte balance	Monitor flow rate, IV site, intake-output and signs of overload.
IV Normal Saline	500 ml	IV	As ordered	Fluid replacement	Check patency, monitor input-output and edema.
Stool Softener / Lactulose	As prescribed	Oral	HS/SOS	Prevents constipation and straining	Encourage fluids, monitor bowel pattern and abdominal discomfort.

📄 Page 10 — NANDA Nursing Diagnoses

Sr. No.	NANDA Nursing Diagnosis	Related To	Evidenced By / Risk Factors
1	Acute Pain	Surgical incision, tissue trauma and manipulation during hernioplasty	Pain score 5/10 post-operatively, verbal complaint of wound pain, guarding
2	Risk for Infection	Surgical wound, mesh placement and invasive procedure	Right inguinal surgical dressing, post-operative state
3	Impaired Physical Mobility	Pain, surgical wound and activity restriction after hernioplasty	Difficulty in walking initially, fear of pain, restriction of heavy lifting
4	Risk for Constipation	Reduced mobility, pain medication and fear of straining	Post-operative bed rest, analgesic use, history of occasional constipation
5	Deficient Knowledge	Lack of information regarding wound care, activity restriction, constipation prevention and recurrence prevention	Patient asks about heavy work, lifting weight and return to farming/labour work

Note: Main detailed nursing care plans are prepared for the first three priority diagnoses: Acute Pain, Risk for Infection and Impaired Physical Mobility.

📄 Page 11 — Nursing Care Plan 1: Acute Pain

Assessment	Nursing Diagnosis	Goal / Expected Outcome	Planning	Implementation	Evaluation
Subjective Data: Patient complains, “Operation wali jagah par dard ho raha hai.” Pain increases during movement, coughing and getting up from bed. Objective Data: Pain score 5/10 post-operatively. Right inguinal surgical dressing present. Patient shows guarding and slow movement.	Acute Pain related to surgical incision, tissue trauma and manipulation during hernioplasty as evidenced by verbal complaint of wound pain, guarding and pain score 5/10.	Short-Term Goal: Patient will report reduction in pain from 5/10 to 2/10 within 24–48 hours. Long-Term Goal: Patient will perform deep breathing, turning and gradual ambulation with minimal pain before discharge.	Assess pain location, intensity, duration and aggravating factors. Monitor vital signs regularly. Provide comfortable position. Administer analgesics as prescribed. Support wound during coughing and movement. Teach relaxation and gradual movement.	Assessed pain score using 0–10 pain scale every 4 hours. Observed facial expression, guarding and difficulty in movement. Positioned patient comfortably with support. Administered Inj. Paracetamol and Inj. Diclofenac as prescribed. Supported right inguinal wound area during coughing, turning and ambulation. Encouraged slow deep breathing and relaxation techniques. Assisted patient during first ambulation after surgery. Reassessed pain after analgesic administration.	Patient reported pain reduction from 5/10 to 1/10 within 48 hours. Patient was able to turn, sit and walk slowly with minimal discomfort before discharge.

Outcome: Goal achieved. Patient’s pain reduced and comfort improved.

📄 Page 12 — Nursing Care Plan 2: Risk for Infection

Assessment	Nursing Diagnosis	Goal / Expected Outcome	Planning	Implementation	Evaluation
Subjective Data: Patient asks, “Operation ke baad infection to nahi hoga?” Objective Data: Open mesh hernioplasty done. Right inguinal surgical dressing present. Mesh placed during surgery. Post-operative wound present.	Risk for Infection related to surgical wound, mesh placement and invasive procedure.	Short-Term Goal: Patient will remain free from signs of surgical wound infection during hospitalization. Long-Term Goal: Surgical wound will heal without redness, swelling, pus discharge, fever or wound gaping before follow-up.	Monitor temperature and signs of infection. Observe surgical dressing for bleeding, soakage and discharge. Maintain aseptic technique during wound care. Administer antibiotics as prescribed. Promote hand hygiene. Educate patient about wound infection warning signs.	Monitored temperature, pulse and wound condition regularly. Observed right inguinal dressing for bleeding, discharge, foul smell and soakage. Performed hand hygiene before and after patient care. Maintained aseptic technique during dressing and wound inspection. Administered Inj. Ceftriaxone as prescribed. Encouraged adequate fluid intake after oral intake was allowed. Encouraged protein-rich diet to support wound healing. Educated patient to avoid touching wound with unclean hands. Instructed patient to report fever, increased pain, redness, swelling or discharge from wound.	Patient remained afebrile. Surgical dressing was dry and clean. No redness, swelling, pus discharge or foul smell was observed. Patient understood infection prevention measures.

Outcome: Goal achieved. No signs of surgical wound infection were observed.

📄 Page 13 — Nursing Care Plan 3: Impaired Physical Mobility

Assessment	Nursing Diagnosis	Goal / Expected Outcome	Planning	Implementation	Evaluation
Subjective Data: Patient says, “Chalne par operation wali jagah me dard hota hai.” Patient is worried about when he can return to farming/labour work. Objective Data: Patient walks slowly after surgery. Right inguinal surgical dressing present. Heavy lifting restricted after hernioplasty.	Impaired Physical Mobility related to pain, surgical wound and activity restriction after hernioplasty as evidenced by slow walking, fear of pain and restriction of heavy lifting.	Short-Term Goal: Patient will sit, stand and walk with assistance within 24 hours as advised. Long-Term Goal: Patient will ambulate independently and follow activity restrictions before discharge.	Assess mobility level and pain during movement. Assist patient during first ambulation. Encourage gradual activity as tolerated. Teach wound support during movement. Prevent complications of immobility. Educate regarding avoidance of heavy lifting and straining.	Assessed patient’s ability to sit, stand and walk after surgery. Monitored pain before and after ambulation. Assisted patient during first ambulation to prevent fall and discomfort. Encouraged gradual walking in ward as tolerated. Advised patient to support surgical site while coughing, sneezing and getting up. Encouraged leg movements and deep breathing exercises. Explained to avoid heavy lifting, pushing, pulling and strenuous work until doctor permits. Educated patient to prevent constipation and straining during defecation.	Patient was able to sit, stand and walk independently with minimal pain before discharge. Patient verbalized understanding of activity restriction and avoidance of heavy lifting.

Outcome: Goal achieved. Patient’s mobility improved and patient understood post-operative activity restrictions.

📄 Page 14 — Discharge Summary

Patient Name: Mr. Ramesh Choudhary
Age/Sex: 48 Years / Male
Hospital Name: Government Medical College Hospital, Jodhpur
Ward: Male Surgical Ward
Date of Admission: 19/05/2026
Date of Surgery: 20/05/2026
Date of Discharge: 23/05/2026
Final Diagnosis: Right Inguinal Hernia
Surgery Performed: Open Mesh Hernioplasty / Herniorrhaphy under Spinal Anesthesia

Summary of Hospital Stay

Mr. Ramesh Choudhary, a 48-year-old male, was admitted with complaints of swelling in the right groin region for 6 months, which increased on coughing, standing and lifting heavy weight and reduced on lying down. He also complained of dull aching pain and dragging sensation in the right groin region.

On examination, a reducible swelling was present in the right inguinal region with positive cough impulse. Routine investigations were within normal limits. The patient was diagnosed with right inguinal hernia and open mesh hernioplasty was planned after pre-operative preparation.

Open mesh hernioplasty was performed on 20/05/2026 under spinal anesthesia. Post-operatively, the patient was monitored for pain, bleeding, infection, urinary retention, return of lower limb sensation after spinal anesthesia and vital signs. Patient’s condition improved gradually. Pain reduced, oral diet was tolerated and surgical dressing remained clean and dry.

Condition at Discharge

Patient is conscious, oriented and hemodynamically stable.
No fever at the time of discharge.
Pulse: 76/min, BP: 116/74 mmHg, Respiratory rate: 16/min.
SpO₂: 99% on room air.
Pain score: 1/10.
Right inguinal surgical dressing is clean and dry.
No redness, swelling, pus discharge or wound gaping present.
Patient is able to walk independently.
Patient tolerates oral diet.
No urinary retention present.
Patient and family understand discharge instructions.

Discharge Medications

Medication	Dose	Frequency	Purpose
Tab. Cefixime	200 mg	Twice daily for 5 days	Antibiotic
Tab. Paracetamol	500 mg	SOS after food	Pain and fever relief
Tab. Pantoprazole	40 mg	Once daily before breakfast for 5 days	Gastric protection
Lactulose Syrup	15 ml	At bedtime if constipation	Prevents constipation and straining
Multivitamin	1 tablet	Once daily	Recovery support

Follow-Up Advice

Follow-up in surgical OPD after 7 days for wound inspection.
Continue prescribed medicines as directed.
Keep surgical wound clean and dry.
Avoid heavy lifting, pushing, pulling and strenuous work until doctor permits.
Avoid constipation and straining during defecation.
Take adequate fluids and fiber-rich diet.
Report immediately if fever, severe pain, wound discharge, swelling, urinary retention or wound opening occurs.

📄 Page 15 — Health Education

1. Wound Care

Keep surgical wound clean and dry.
Do not touch wound with unwashed hands.
Do not remove dressing unless advised.
Observe wound for redness, swelling, discharge, foul smell or wound opening.
Visit hospital for dressing and follow-up as advised.

2. Medication Advice

Take antibiotics for the full prescribed course.
Do not skip or stop medicines without doctor’s advice.
Take pain medicine only as prescribed.
Take gastric protection medicine before breakfast if prescribed.
Use stool softener only as advised if constipation occurs.
Report allergy symptoms such as rash, itching, swelling or breathing difficulty immediately.

3. Diet Advice

Take a balanced diet rich in protein for wound healing.
Include dal, milk, curd, eggs if allowed, pulses, green vegetables and fruits.
Drink adequate water unless restricted.
Take fiber-rich foods to prevent constipation.
Avoid excessive spicy and oily foods during early recovery.
Avoid overeating if it causes abdominal discomfort.

4. Activity and Rest

Take adequate rest during recovery period.
Walk slowly at home as tolerated.
Avoid heavy lifting, pushing, pulling and strenuous work until doctor permits.
Avoid sudden bending and excessive stair climbing during early recovery.
Support surgical site while coughing, sneezing or getting up from bed.
Resume farming/labour work only after medical advice.

5. Prevention of Recurrence

Avoid lifting heavy weight without medical permission.
Treat chronic cough promptly.
Avoid constipation and straining during stool passage.
Maintain healthy body weight.
Use proper body mechanics while lifting after complete recovery.
Do regular follow-up as advised.

6. Warning Signs Requiring Immediate Medical Help

Fever above 100.4°F.
Severe pain or increasing swelling in operated area.
Redness, swelling, pus discharge or foul smell from wound.
Bleeding from wound site.
Wound opening.
Difficulty in passing urine.
Persistent vomiting or abdominal distension.
New bulge or swelling in groin region.

Patient Teaching Outcome: Patient and family verbalized understanding of wound care, medication, activity restriction, constipation prevention, recurrence prevention, follow-up and warning signs.

📄 Page 16 — Bibliography

Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, Latest Edition, Wolters Kluwer.
NANDA International Nursing Diagnoses: Definitions and Classification 2024–2026.
Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Latest Edition.
Bailey & Love’s Short Practice of Surgery, Latest Edition.
Indian Nursing Council recommended Medical-Surgical Nursing syllabus and clinical practical guidelines.
Hospital surgical nursing care protocols for pre-operative and post-operative care.

⚕️ Medical Disclaimer: This surgical nursing care plan is prepared for educational and academic purposes only for ANM, GNM and BSc Nursing students. It is not intended for actual patient care or clinical decision-making. Always follow hospital protocol, physician orders and standard nursing textbooks.