Professional Documents
Culture Documents
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LEARNING OUTCOMES
1. Define hernia
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or
is a protrusion of an organ through its
containing wall.
The term is applied to the herniation of a
muscle through its fascia covering it to a
herniation of the brain through a
fracture as well as protrusion of intra
abdominal organ through a defect in
abdomen
Before an organ is herniate through its wall there
must be a weakness in that wall. This may be a
normal weakness found in every one and related to
the abdominal wall configuration of that place
such as where a vessel or viscus enter and leave
the abdomen , Alternatively the weakness may be
due to congenital or acquired as a result of trauna
or disease.
There are few common varieties of hernia
Classification
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TYPE OF HERNIA
1.) Inguinal hernia
i.)Indirect inguinal hernia
ii.)Direct inguinal hernia(in contrast)
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ii.) Direct inguinal hernia(in contrast)
-it pass through a weak point in the fascia of
abdominal wall and at the medial to
the inferior epigastric artery
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The difference b/w direct and indirect
Direct Indirect
1-If the hernia held to 1-If it can be
be reduced by pressure controlled by pressure
only over the external over the internal ring
inguinal ring 2- reappearing indirect
2-direct hernia will hernia will seem to slide
project directly obliquely downward
forward along the line of the
canal
2.) Femoral hernia(protrude through the
femoral ring)
-femoral hernia is a protrusion of extra
peritoneal sac and sometimes abd. Content
through the femoral canal
The anatomical margin of this canal are the
inguinal pubic posteriorly ,the lacunar ligment
and pubic bone medially, and the femoral vein
laterally. It seems irreducibal
-Common in obese or pregnant women
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3.) Umbilical hernia(congenital/acquire)
-congenital-appear in infancy
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5.) Incisional/ ventral
hernia(occur at the site
of previous surgical
incision)
-results from inadequate
healing of the incision
-cause be postoperative
wound infection, inadequate
nutrition, and obesity
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4- Epigastric Hernia
An epigastric hernia is a protrusion of extra
peritoneal fat and some times peritoneal sac
through a defect in the linea alba b/w the
xiphesternam and umbilicus.
The patient complain of epigastric pain which is
exactly localized to the site of hernia
The pain is often related
to eating and they call it” indigestion
On examination it feels firm with no cough
impulse and cant reduced its impossible to
distinguish it from lipomata only the typical
position suggest it.
Obesity
constipation
pregnancy
Heavy
Smoking weight
Risk
factor lifting
Congenital
Muscle defect
weakness
Damage
from Chronic
injury or cough
surgery
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Causes/ Etiology
• a) Any condition that is increases
pressure on abdominal cavity :
- Combination of muscle weakness and
strain
- Obesity
- Heavy Lifting
- Persistant coughing or sneezing
- Pregnancy
- Straining during bowel movement or
urination
• b) Family History
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Pathophysiolog
y
Congenital
Defects in
muscular
Obesity walls
Hernia
Pregnancy Increased
Intra-
abdominal
Traum pressure
a
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Sign and symptoms
• Small to moderate size hernia don’t usually causes any
symptoms.
• Large hernia may be noticeable and cause same
discomfort.
- Pain when lifting heavy object
- Tenderness
- Bulging
• Severe symptoms
- Severe and sudden pain
- Nausea
- Vomiting
- Constipation
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Investigation
Physical examination
• health care provider may ask the patient to
stand and cough or strain so the health care
provider can feel for a bulge caused by the hernia
as it moves into the groin or scrotum. The health
care provider may gently try to massage the
hernia back into its proper position in the abdomen
Ultrasound
• A ultrasound may be ordered to diagnose
a hernia or to characterize the contents of
a hernia and determine its reducibility
Blood test
CBC
• Your doctor may recommend a complete blood
count to check for anemia due to blood loss
due to hiatal hernia
WBC
• detect inflammation, infection and
presence of tissue necrosis
MANAGEMENT
•Medical Pharmacology treatment
1.) Antibiotic
(used if the patient has strangulated
hernia)
i) IV cefoxitin (Mefoxin) 1 g 6-
8hourly
ii.) Cap.Ampicilin 250-500mg 6hourly
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Non-Surgical Management
• Truss (Inguinal hernia)
- a pad made with firm material that will held in place
over the hernia with belt to help keep the abdominal
contents from protruding into the hernia sac
Surgical Management
Herniorrhaphy(hernia repairs)
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Assessment
History
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Physical examination
1. Palpate the bulge area ( standing
and lying )
2. Check for the skin fragile
3. Type of hernia
Investigation
4. Ultrasound scan
5. X-ray abdomen
6. Barium swallow
7. MRI
8. Blood test 33
• Post herniarrhaphy pain
syndrome/ inguinodynia
• Hernia recurrence
• Wound Infection
• Ischemia
• Necrosis
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NURSING
DIAGNOSIS
&
HEALTH
EDUCATION
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NURSING DIAGNOSES
PRE-OPERATIVE FOR HERNIA REPAIR
1) Fear and anxiety related to
undergoing surgery
HIATAL HERNIA
Risk for aspiration related to reflux of
gastric content 36
Nursing Diagnosis : Fear and anxiety related to undergoing
surgery
Goal : Patient’s fear and anxiety had reduced
Intervention :
1) Assess patient’s level of anxiety either mild,
moderate ,severe or panic by interviewing the
patient to assess patient in an effective way to
provide nursing care
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4.) Encourage patient avoid lifting heavy
object or doing heavy exercise at least 6
weeks
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