Hernia

It include definition of hernia ,causes ,risk factor types of hernia and nursing management

1. HERNIA RAKCON Bsc (H)Nursing

2. INTRODUCTION Hernia is bulging of an organ or tissue through an abnormal opening. Typically hernia involves stomach and intestine i.e. abdominal cavity. It is generally due to congenital or acquired weakness of abdominal musculature.

3. Hernia is usually self diagnosable, and its symptoms include a bulge swelling or pain. This is treated by monitoring the condition and if required surgery can return tissue to its normal location and close the opening.

4. A hernia is the abdominal protrusion of an organ tissue or a part of an organ through the structure that normally contains it. DEFINITION

5. ON THE BASIS OF LOCATION INGUINAL HERNIA

6. Inguinal canal anatomy Anterior wall aponeurosis of external oblique (along and Entire length) - Internal oblique on lateral one third. Posterior Fascia transversalis - conjoint tendon in medial one third Roof arching fibres of internal oblique - Transverse abdominal Floor( interior) inguinal ligament - Lacunar ligament at the medial end

7. INGUINAL CANAL CONTENTS

8. THERE ARE TWO TYPES OF INGUINAL HERNIA Indirect inguinal hernia Origin : lateral to the inferior epigastric artery. Contents : sac of peritoneum (coming through internal ring through which omentum or bowel can enter) It is common in males because of the space allowed for the testicles to descend High risk in young people and 50 to 60 years of age. Direct inguinal hernia Origin : medially to inferior epigastric vessels. Contents: retroperitoneal fat (mainly), less commonly peritoneal sac containing bowel. It is common in elders It develops in weak areas giving to a congenital deficiency in number of fibres it contains.

9. FEMORAL HERNIA Defect is in transversalis fascia overlying the femoral ring at the entry to the femoral canal. The hernia passes through the femoral canal and present in the groin below and lateral to the pubic tubercle.

10. More common in females Higher risk of strangulation It begins as plug of fat in femoral canal that enlarges and gradually pulls the peritoneum and inevitably the urinary bladder into sac.

11. UMBILICAL HERNIA This occurs in children because of incomplete closure of the umbilical orifice. The majority close spontaneously during the first year of life PARA UMBILICAL HERNIA It occurs just above or just below the umbilicus and is more common in obese females . Predisposing factors include multiple pregnancies and obesity . The neck of the sac usually narrow and therefore there is a high risk of strangulation. The most common content is omentum the transverse colon and small intestine.

12. PARAUMBILICAL HERNIA

13. INCISIONAL HERNIA Occurs through a defect in the scar of previous abdominal incision. Caused due to post operative problem such as post-operative Wound infection, inadequate nutrition, extreme distension ,obesity and raised intra-abdominal pressure postoperatively (coughing ,straining Etc.)

14. HIATAL HARNIA Part of stomach protrudes up into chest. It is of two types - Sliding hernia: The gastro- esophageal junction itself slides through the defect into chest. Para- esophageal Hernia: Juncion remains fixed. Other portion of stomach moves up. More dangerous as allows stomach to rotate and obstruct.

15. ON THE BASIS OF SEVERITY Reducible hernia The contents of the sac in this type reduce spontaneously or can be pushed back manually. A reducible hernia imparts an expansible impulse on coughing. Irreducible hernia The content cannot be returned to the peritoneal cavity either because there are adhesions between the sac and contents or because of the narrow neck of the sac. irreducible hernia can be- I ncarcerated : no interference with blood supply Obstructed : hollow viscus is trapped within sac ,blood supply intact S trangulated : artery blood supply compromised

16. ETIOLOGY Caused by muscle weakness and strain. Develop quickly or over a long period of time Common cause of muscle weakness includes – Failure of abdominal wall to close properly in the womb which is congenital defect .

17. Factors that strain your body and may cause hernia specially if muscle are weak include: Being pregnant. Being constipation. lifting heavy weight fluid in the abdomen or asities gaining weight operated area coughing or sneezing

18. PATHOPHYSIOLOGY Defects in the muscular wall maybe congenital and due to weakened tissue or a wide space at the inguinal ligament or May be caused by trauma. Intra abdominal pressure increases with pregnancy ,obesity ,heavy lifting, coughing and traumatic injuries from blood pressure . when two of these factors coexist with some tissue weakness a hernia may occur. Increase pressure without a weakness is not likely to cause a hernia. Weakness in addition to being present from birth is acquired as part of the aging process. As clients age muscular tissue become infiltrated and are replaced by adipose and connective tissue.

19. CLINICAL MANIFESTATION Bulge or lump coughing fever pain discomfort when coughing or lifting weakness burning Gurgling itching sensation vomiting Swelling HOW HERNIA CAN BE DIAGNOSED Physical examination Ultrasound endoscopy x-ray

20. MANAGEMENT MEDICAL MANAGEMENT Truss is an appliance with a pad and belt that hold strongly over hernia. Parastomal hernia is managed with hernia support belt with velero . SURGICAL MANAGEMENT Recommended to correct hernia Herniorrhaphy Hernioplasty

21. TRUSS

22. Nursing Assessment Ask hernia is enlarging and uncomfortable reducible or irreducible Assess bowel sound Assess strangulation Assess intake and output by charting Assess for pain

23. NURSING DIAGNOSIS P RE-OPERATIVE DIAGNOSIS Diagnosis 1 : chronic pain related to bulging hernia. Goal : t o achieve comfort. Intervention : Provide trendelenburg’s position. Evaluate for signs of nausea, distension , fever , hernia strangulation Apply ice or cold compression Provide supportive belt or truss Insert NG tubes for incarcerated hernia.

24. DIAGNOSIS 2 Diagnosis : to risk of complications related to tear of muscles. goal : to avoid complications. Interventions : ask patient not to cough. Apply ice pack . Provide post operative care. Instruct pateint not to lift weight. In males use suspensory bandage.

25. DIAGNOSIS 3 Diagnosis 3 : constipation related to obstruction of intestinal flow by protusion of organ through the abdominal cavity Goal : to maintain a regular bowel pattern with absence of hard , dry & bloody stools Intervention : Assess the cause & duration of constipation Monitor the bowel sounds and provide test feeds Advice the client to drink plenty of fluids Advise the client to take fibre rich foods Advise the client to avoid straining while passing stools.

26. DIAGNOSIS 4 POST OPERATIVE NURSING DIAGNOSIS Diagnosis 4: for risk for fluid volume deficit related to postoperative States and dehydration. Go a l : client well experience adequate fruit volume . I interventions. Assess for nausea and vomiting Assess skin turgor , mucous membrane , last void assess vital signs maintain NPO status administer antiemetics monitor IV administration of nutrients.

27. DIAGNOSIS 5 Diagnosis 5: Deficient knowledge related to post-operative care goal : patient will obtain knowledge about preoperative care interventions : Provide clear information to patients relative . Instruct the patient avoid pushing lifting. Instruct the sponge bath till incision heal. Inform to keep i ncision during dressing until it peel off . apply diaper . Rea ssure parents that infants normally products without incident usual surgeries in infancy . Encourage relative to increase fluid intake & protein rich diet

28. DIAGNOSIS 6 ineffective breathing pattern related to cough Goal : t o help patient reduce cough and improve breathing pattern . Intervention : Pl ace patient to proper body alignment for maximum breathing pattern provide respiratory medications and oxygen per doctors order enc ourage small frequent meals. en courage frequent rest period and teach patient pace activity.

29. DIAGNOSIS 7 Acute pain related to surgical repair Goal:client will express feeling of comfortable and reduce pain. Intervention: Assess incision pain Adminster analgesic Maintain position of comfort Apply ice pack Change position Educate relatives

30. COMPLICATION Untreated hernia may grow & cause more pain Bowel obstruction cause constipation or nausea Swelling and pain in the surrounding area Strangulation can occur Parts of intestine get blocked and produce pain

31. PREVENTION

32. LIFESTYLE

33. HOME CARE

34. Health education

35. Research Laparoscopy limit to lower surgical infection for hernia surgery Published Date: May 15, 2019 A large retrospective study found that laparoscopic repair of umbilical hernias in patient with obesity resulted in lower rates of wound complications that open repair even though the laproscopic group had higher body mass index and rates of other key. Comorbidites , according to results reported at the annual meeting of the society of the AMERICAN GASTROINTESTINAL AND ENDOSCOPIC SURGEONS “In patient with obesity , even though our laproscopic umbilical hernia ( UHR) group had an overall higher BMI ; higher rates of diabetes , hypertension and current smoking status ; and larger operative times , they experienced decreased post-operative wound complications , compared to the open repair group”. said “ Kristen William of trihealth in Cincinnati . The retrospective cohort study evaluated 12,026 adult patients with BMI of more than 30 kg / m2 in the American College of surgeons National Surgical quality improvement Program ( ACNSQCP) database who had UHR in 2016 . Almost four times as many patients had open rather than laproscopic surgery.

36. SUMMARY AND CONCLUSION Today we all have discussed about hernia . In this we all get to know its definition ,classification, etiology , nursing management , prevention & health teaching of HERNIA.

37. BIBLIOGRAPHY