Hernia medical surgical nursing notes pdf Jitendra bhargav SlideShare

Hernia medical surgical nursing notes pdf Jitendra bhargav SlideShare

1. HERNIA

INTRODUCTION:- A hernia occurs when there is a weakness in the layers of the
abdominal wall. The pressure from inside the abdomen then pushes the lining of the
abdominal wall, the peritoneum, out through this area of weakness, leading to a bulge
under the skin.
DEFINITION:- body मE iकसी भी organ या structure का अपनी cavity या loca?on से हट कर
other cavity मE $वेश (protrusion) hernia कहलाता है। ये समा?यतः दो $
कार के होते है ज
?मजात
एवं ज?म के प?चात उ?प?न।
OR
यह ऐसी CONDITIONS होती है िजसमे ORGANS या BODY PART अपनी NORMAL जगह से
MISPLACED
हो जाता है और दूसरे
ORGANS
या दूसर
# CAVITY PROTUDE या MOVE कर जाता है
इस CONDITION को HERNIA कहते है

2. VARIETY OF HERNIA :-
1.REDUCIBLE HERNIA :-
 Sac reduce spontaneously can be pushed back manually
 It impact an expansile impulse in coughing
2.IRREDUCIBLE:-
 Content can’t be returned to peritoneal cavity
CLASSIFICATION OF HERNIA :-











CLASSIFICATION
INTERNAL
DIAPHRAGMATIC
E
SOPHAGEAL
HERNIA
PARAESOPHGEAL
EXTERNAL HERNIA
COMMON HERNIA
INGUINAL HERNIA
FEMORAL HERNIA
UMBLICAL HERNIA AND
INCISIONAL HERNIA
RARE HERNIA
SPIGELIAN HERNIA
GLUTEAL
HERNIA
OBTURATER AND LUMBAR HERNIA

3. Hiatus Hernia:-यह एक असामा?य ि?थ?त है िजसमE stomach
का कुछ भाग
diaphragm से
होते हुए
thoracic cavity) मE $वेश कर जाता है जैसे- sliding hernia, rolling hernia
2. Inguinal Hernia – इसमE abdominal organ अlधक तर intes?nal का भाग inguinal ring को
पार कर नीचे tes?cle मE आ जाता है। यह दो $कार होता है - ascending inguinal hernia
descending inguinal hernia.
 ascending inguinal hernia:- इसमE tes?cles abdominals cavity मE आ जाते है.
 descending inguinal hernia:- इसमE intes?ne inguinal ring को पर करके tes?cles cavity
मE आ जाते है

4. 1. Incisional hernia or ventral hernia :- surgery के प?
चात्
wound न भरने या
abdomen क' muscle’s के incision क' जगह week
रहने एवं अ
?यlधक intra- abdominal
दबाव के कारण intes?nal hernia?on होता है।
यह most common elderly overweight और surgical procedure same place पर बार -बार
करने से infec?on और poor nutri?on के कारण proper wound healing नह#ं होता है
Femoral hernia : intes?ne का एक sec?on ( loop) femoral canal मE $वेश कर
जाता है femoral ring क' muscles के week होने से होता है, यह female मE male
क'
तुलना म
E अlधक है

5. Umbilical hernia :- Congenital condi?on है िजसमे abdomen के umbilical के आसपास क'
muscle के week होने, अlधक obesity से abdominal cavity मE pressure बढ़ जाने, pregnancy या
ल?बे समय तक coughing चलने के कारण umbilical hernia होता है।
6.Epigastric hernia: These occur when fa?y ?ssue pokes through abdomen between
navel and lower part of breast bone.

6. 7. Diaphragma?c hernias :- These occur when organs in the abdomen move into
chest through opening in the diaphragm. It can affect babies if their diaphragm does not
develop in womb.
8. Muscle hernia: These occur when part of a muscle pokes through the abdomen.
They can also occur in leg muscles as a result of a sport injury
9. Spigelian hernia: These occur when a part of na- vel pokes through abdomen at
the side of five ab dominal muscle below n
Causes:-
 Weak muscles of diaphragm)
 गभाव?था (Pregnancy)
 मोटापा (Obesity)
 Age
 Excessive exercise
 भार# वजन उठाना (Heavy liLing
weight)
 लगातार खाँसी रहना (Chronic cough)
 पेशीय रोग होना
 पेट मE चोट लगना (Trauma)
 Past surgical history
 Severe malnutri?on

7. SIGN AND SYMPTOMS:-
 ह?न[या क' जगह दद[ होना
 अंग भाग का बाहर उभरना
(Protrusion)
 चलने iफरने मE सम?या
 सांस लेने मE परेशानी (Dsypnoea)
 Epigastric pain
 उ?ट# होना (Vomi?ng)
 भोजन ?नगलने मE परेशानी
 Oesophagus मE जलन होना (Burning
in oesophagus)
 बेचैनी (Restlessness)

बुखार आना (
Fever)

भूख न लगना (
anorexia, nausea, vomi?ng)
Other CLINICAL MANIFESTATION (According to Classifica?on)
1.In Sliding Hernia
 Heart burn up to 30 to 60 min. aLer meal
2. In Rolling Hernia
 Dyspnoea
 Pain like anginal pain
 Pain increase in supine posi?ve and decreases in standing and si?ng
posi?on
 Vomi?ng..
3. In Strangulated Hernia
 Pain
 Swelling of hernial sac
 Fever.
 Vomi?ng
 Peritoneal irrita?on

8. PATHOPHYSIOLOGY
Due to e?ological factors (coughing ,Obesity, )
↓
Defect in the muscular wall
↓
Weakness ?ssue
↓
Increased intra-abdominal pressure
↓
When two these factor coexist .with ?ssue weakness
↓
The person may acquire a hernia (protrusion of organ ?ssue)

DIAGNOSTIC EVALUATION:-
 History collec?on
 Physical examina?on
 Chest X-ray
 Barium meal test

Complica?ons:-
 Hernia recurrence
 Urinary reten?on
 Bowel obstruc?on
 Li?re's hernia: hernia of meckel's diver?culum
 Nausea and Vomi?ng
 Sudden and severe pain
 Weakness or pressure in the groin
 Adhesion
 Bowel perfora?on

9. Management:-
Medical Management:-
 Antacid for heart burn, e.g., Magnesium hydroxide.
 An?eme?c for vomi?ng.
 Prokine?c agents, e.g., Metoclopramide (which induces movement,
especially intac?vity).
 An?histamine.Vasopressin - To control bleeding.
Surgical Management:-
 Herniorrhaphy – इसमE surgery through herniated organ को वापस अपने ?थान
पर readjust कर ?दया जाता है iफर hernia क' suture क' द# जाती है।

10. Manual reduc?on of hernia) herniated organ व इसके parts को readjust कर ?दया
जाता है।







 Nissen Surgery: Suturing of Hitus part.
 Hernioplasty: The surgical opera?on to repair a hernia.

11. Nursing Management:-
 Place the pa?ent in trende lenburg's posi?on to reduce pressure on hernia site.
 Instruct to take small frequent meals
 Encourage not to take meals 2 hours before going to bed
 Explain the surgical procedures to pa?ent and family
 Administer IV fluids and analgesics for pain control.
 Avoid heavy weight liLing to avoid unnecessary increase intraabdominal
pressure.
 Surgery से 8-10 hrs
पूव
[ से pa?ent को Nil by Mouth रखE।
 Pa?ent को सज[र# ?े क' ?वचा को तैयार करना चा?हए।
 सज[र#
हेतु
gलhखत सहम?त $ा?त करE।
 lचiक?
सक आदेशानुसार रोगी को सभी दवाईयां
$दान करनी चा?हए।
 Pt के ?ब?तर के gसरे वाले ?ह?से को लगभग 6-8 इंच ऊपर रखना चा?हए।
 Pt क' Bowel sound को auscultate करE।
 Pt को कम वसा तथा उ??च फाइबर आहार लेने क' सलाह देनी चा?हये।
 Pt को food धीरे-धीरे व चबा-चबा कर खाने क' सलाह देनी चा?हये।
Nursing Diagnosis
 Splint incision when coughing or sneezing Ice bags to scortal area to reduce
swelling Scortal and support.
 Imbalanced nutri?on less than body requirement related to difficulty in
swallowing. Acute pain related to dysphagia, inges?on of abrasive agent, a tumour
or reflux.
 Deficient knowledge related to treatment and rehabilita?on. Anxiety related to
change in health status and disease process.
HEALTH EDUCATION
 Avoid smoking and alcohol
 Avoid obesity.
 Avoid intake of heavy meal
 Avoid ?ght clothing around abdomen
 Avoid to take bed rest just aLer taking meal