Assessment

522 Inguinal Hernia apparent when the patient coughs or strains. The swelling may subside on its own when the patient assumes a recumbent position or if slight manual pressure is applied externally to the area. Some patients describe a steady, aching pain, which worsens with tension and improves with hernia reduction.

PHYSICAL EXAMINATION. On inspection, the patient has a visible swelling or bulge when asked to cough or bear down. If the hernia disappears when the patient lies down, the hernia is usually reducible. In addition, have the patient perform a Valsalva's maneuver to inspect the hernia's size. Before palpation, auscultate the patient's bowel; absent bowel sounds suggests incarceration or strangulation.

You may be able to palpate a slight bulge or mass during this time and when the examiner slides the little finger 4 to 5 cm into the external canal that is located at the base of the scrotum. If you feel pressure against your fingertip when you have the patient cough, an indirect hernia may exist; if you feel pressure against the side of your finger, a direct hernia may exist. Palpate the scrotum to determine if either a hydrocele or cryptorchidism (undescended testes) is present.

PSYCHOSOCIAL. A delay in seeking healthcare may result in strangulation of the intestines and require emergency surgery. In the adult population, surgical intervention to correct the defect takes the patient away from home and the work setting and causes anxiety.

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