HERNIA PATIENT

HERNIA PATIENT

1. HERNIA MR .ROMAN BAJRANG BASIC BS.C NURSING 2 ND YEAR RELIANCE INSTITUTE OF NURSING LIMTARA DHAMTARI

2. A hernia is protrusion of an organ or the muscular wall of an organ through the cavity that normally contains it . It is an abnormal protrusion of the intestine or other abdominal organ through a weakness or defect in the musculature in to another cavity . INTRODUCTION

3. “According to Brunner & suddarh ” The medical condition in which on organ inside the body for example the stomach pushes through the wall of muscle which surrounds it . “According to K. P. PARK” A hernia is an abnormal protrusion of avicus through the wall of a cavity which normally contains it . “According to BT basavanthappa ” A hernia is the protrusion of an organ through its contwning wall . DEFINITION

4. Hernia can occur at any age and either sex . Indirect inquinal hernias are the most the hypically occur in men . Direct hernia arefound mor community in older adult . Incisional or ventral hernia occar most after in dient . 75–80% are inguinal or femoral. 2% are incisional or ventral. 3–10% are umbilical, affecting 10-20% of newborns; most close by themselves by 5 years of age. 1–3% are other types. INCIDENCES

5. ANATOMY & PHYSIOLOGY OF ABDOMINAL WALL

6. In anatomy, the abdominal wall represents the boundaries of the abdominal cavity. The abdominal wall is split into the anterolateral and posterior walls . There is a common set of layers covering and forming all the walls: the deepest being the visceral peritoneum, which covers many of the abdominal organs (most of the large and small intestines, for example), and the parietal peritoneum- which covers the visceral peritoneum below it, the extraperitoneal fat , the transversalis fascia , the internal and external oblique and transversus abdominis aponeurosis , and a layer of fascia ,which has different names according to what it covers (e.g., transversalis , psoas fascia). In medical vernacular, the term 'abdominal wall' most commonly refers to the layers composing the anterior abdominal wall which, in addition to the layers mentioned above, includes the three layers of muscle: the transversus abdominis (transverse abdominal muscle), the internal ( obliquus internus ) and the external oblique ( obliquus externus ). Anatomy of the Abdominal wall

7. In human human anatomy the layers of the anterolateral abdominal wall are (from superficial to deep ) Skin Subcutaneous tissue Fascia Camper's fascia - fatty superficial layer. Scarpa's fasciau - deep fibrous layer. Muscle External oblique abdominal muscle Internal oblique abdominal muscle Rectus abdominis Transverse abdominal muscle Pyramidalis muscle Transversalis fascia Extraperitoneal fat Peritoneum Layers of anterolateral abdominal wall

8. There are many different kinds of hernias that are able to affect different arers of the body each hernia will be one of there types . Reducible . Irreducible . Stranguluted . TYPES OF HERNIA

9. REDUCIBLE HERNIAS

10. When the hernias is reducible it has the ability to be pushed back inside of the abdominal cavity . It may apperx as a new lump in the groin or other abdominal area . It may be reduced( pushed back in to the abdomen ) untess very large .

11. IRREDUCIBLE HERNIAS

12. When a hernias is irreducible it eans that you do not have the ability to push the mass back inside of the abdominal cavity . Many people perfer to treat the through surgery as soon as possible to avoid it becoming strangulated hernia . It may be an occasionally painful enlargement . Some may be chronic without pain . Signs and symptoms of bowel obstraction may occur , such as nausea and vomiting .

13. STRANGULATED

14. When the hernia is strangulated surgery is only the option this is when the hernia has become twisted with anintestine and is cutting off its blood supply cut off . This is an irreducible hernia in which the entrapped intestine has it blood supply cut off . Sometimes symptoms of bowel obstruction ( nausea and vomiting . This condition is a surgical emergency .

15. Hernia can be classified according to their anatomical location :- Inguinal hernia . Femoral hernia . Umbilical hernia . Incisional hernia . Hiatal hernia Other types of hernias include: Epigastric hernia . Ventreal hernia . Obturator hernia . Herniation of intervertebrrl disc . CLASSIFICATION OF HERNIA

16. A condition in which soft tissue bulges through a weak point in the abdominal muscles . The soft tissue is often part of the intestine its easy to see and feel the bulge , although not all are visible by the patient especially when obese . The intestine push through a weak or tear into the lower abdominal wall . 75% of all abdominal wall hernias . Occurs 25 % more often in men than women . In men, the inguinal canal is a passageway for the spermatic cord and blood vessels leading to the testicles. In women, the inguinal canal contains the round ligament that gives support for the womb. In an inguinal hernia, fatty tissue or a part of the intestine pokes into the groin at the top of the inner thigh. This is the most common type of hernia, and affects men more often than women. 2 type :- (1) Indirect inguinal hernia . (2) Direct inguinal hernia . 5 INGUINAL HERNIA

17. (1) INDIRECT INGUNAL HERNIA :- Muscle weakness at the inguinal ring causes failure closure of the deep inguinal ring . When icreased intra – abdominal pressure and contents to enter the channel . The protrusion passes through the dep inguinal ring and is located lateral to the inferior epigastric artery .

18. (2 ) DIRECT INGUNAL HERNIA :- It pass through a weak ponit in the fascia of abdominal wall and at the medial to the inferior astric artery .

19. A femoral hernia usually occurs when fatty tissue or part of your bowel pokes through into your grain at the top of uour inner thigh . 1 .It pushes through a weak spot in the swrounding muscle wall into an area called the femoral canal . 2. A plug of fats in the femorl canal enlarged and pull the peritoneum and often the urinary bladder into sac . 3. More frequently in women because of the wider of the femal pelvis . 4. Common in obese or preganat women . 5. Fatty tissue or part of the intestine protrudes into the groin at the top of the inner thigh. Femoral hernias are much less common than inguinal hernias and mainly affect older women. FEMORAL HERNIA

20. Part of small intestine passes through the abdominal wall near the navel , umbilical hernias are most comon in children . An umbilical hernia occurs when intestine , fat or fluid pushes through a weal=k spot in the belly . This causes abulge near the belly button , or navel . Fatty tissue or part of the intestine pushes through the abdomen near the navel (belly button). CONGENITAL :- Appear in infancy . ACQUIRED:- Increased in intaabdominal pressure common seen in obese or pregnant women . UMBILICAL HERNIA

21. HIATAL HERNIA A hiatal hernia develops in a small opening in the diaphragm through which the esophagus passes that allows the upper part of the stomach to move up into the chest . Part of the stomach protrudes up diaphragm into the chest . Part of the stomach pushes up into the chest cavity through an opening in the diaphragm (the horizontal sheet of muscle that separates the chest from the abdomen). 2 types histal hernia . ( 1) SLIDING HIATUS HERNIA :- the distal oesophagus and cardia slides inti the thorax with an intact gastro – oesophagel junction and therfore usually asymptomatic . (2) ROLLING HIATUS HERNIA :- most of the stomach rolls into the thorax , the stomach may also undergo a twist .

22. The intestine pushes through the abdominal wall at the site of previous abdomonal surgery . This types is most common in elderlg or overweight pepople who are inactive after abdominal surgery . Tissue protrudes through the site of an abdominal scar from a remote abdominal or pelvic operation. Incisonal / ventral hernia (occur at the site pf previous surgical incision ) results from inadequate healing of the incision . Cause be postoperative wound infection , indequate , nutrition , and obesity . INCISIONAL HERNIA

23. This types of hernia occurs as a result of a weaknessin the muscles of the upper – middle abdominal . Fatty tissue protrudes through the abdominal area between the navel and lower part of the sternum (breastbone). EPIGASTRIC HERNIA

24. A ventral hernia is a bulge of tissues through an opening of weakness with in your abdominal to move up into the chest . he intestine pushes through the abdomen at the side of the abdominal muscle, below the navel. VENTRAL HERNIA

25. The obturator hernia occurs when part the intestine passrs through the gap between the bones of the front of the pelvis . Organs in the abdomen move into the chest through an opening in the diaphragm. OBTURATOR HERNIA

26. HERNIATION OF INTERVERTEBRRL DISC The nucleus of disc protrudes into the annulus with subsequent never compression

27. pregnancy smoking Obesity Heavy wight lifting Muscle wekness Congenital defect constipation Risk factor Damage from injury or surgery Chronic cough

28. ETIOLOGY Any condition that increases the pressure in the intra – abdominal cavity may contribute to the formation of a hernia including the following . A ) Any condition that is increases pressure on abdominal cavity :- Combination of muscle weakness and strain . Marked Obesity . Heavy lifting . Presistant coughing or sneezing . Pregnancy . Straining during bowel movement or urination . Diarhea or constipation . Ascites – fluid in the abdominal cavity . Chronic obstructive pulmonary disese (COPD) . Poor nutrition . Smoking . B) family history of hernias .

29. congenital Pregnancy Trauma Obesity Defects in mascular walls Increased intr - abdominal pressure Hernia PATHOPHYSIOLOGY

30. Fever . Pain of discompart . Nausea and vomiting . Bowel obstruction . Tachycardia . Burning or aching at hernia site . Bulging . Tenderness . Constipation . Sever and sudden pain . CLINICAL MANIFESTATION

31. Physical examination . Complete blood count ( CBC) & WBC . MRI . Urinalysis . Uttrosonography . Upright chest radiogroph . CT scanning . Electolytes BUN and geatinine levels . X- ray abdomen . DIAGNOSTIC

32. Goal of management :- it is to improve symprons and the quality of life in general and to prevent , adverse envents the rate of surgical complication . General maneagement :- (1) open surgery – it is sugery in which a cut made into the body at location of hernia . (2) laparscopic surgery – it indude as some type of repairs in surgery . (3) rabotic hernia – like laparoscopic surgery uses a laparosocpe and is performed with small incisions . MANAGEMENTT

33. Propylatic antibiatics are given . Maintainence of intrrvenous fluids are administred . The patient is tough to apply truss daily . Hernias that are not strangalate can be mechaniclly reduced . Intrunt the patient to inspect the skin under the truss for any manifestation of skin break down . Neonates with intact omphalocel are usually in no distress unless associated with pulmonary hypoplasia . The baby should be cerefully examined to be detect any associated problems . Maintainense of intravenous fluids are administered . Prophylatic antibiotics are given . MEDICAL MANAGEMENT

34. ANTIBIOTIC (Used if the patient has strangulated hernia ) IV cefoxitin ( mefoxin ) 1g 6-8 hourly . Cap . Ampicilln 250 -500 mg 6 hourly . H2 RECETOR BLOCKER ( Used if the patient with hiatal hernia) Tab . Famotidine 40 mg dly . Tab . Ranitdine 150 mg BD . PHARMACLOGY MANAGEMNT

35. PPT ( Used if the patient with hiatal hernia ) Tab . Lansoprazole ( prevacid ) 15 -30 mg dly . Cap . Osomeprazole ( nexium ) 20- 40 mg dly . Cap . Omeprazole ( prilosec ) 20-40 mg dly . Tab . Pantoprazole ( controloc ) 20-40 mg dly . ANTIANXIMETY AGENTS ( indicated for patient who may experience significant anxiety before a surgery ) Tab . Dormicum 7.5-15 mg PRN. NONSTEROIDAL ANTI –INFLAMMATORY DRUGS (NSAIDs) ( for patients with mild to moderate pain ) Tab. Ibuprofen (Advil) 100 mg 6 hourly . Tab . Ketoprofen 50-75 mg 6 hourly .

36. NON – PHARMACOLOGICAL MANAGEMENT :- Avoid food that cause acid reflux or heartburn such as spicy food . Don’t lie down or bend over after a meal . Exercise . Stop smoking . Avoid gassy drinks . Avoid life heavy object .

37. Laparoscopic ( LEP) 9 SURGICAL MANAGEMENT Nissen fundoplication Herniohaphy ( hernia repairs)

38. Non – surgical management :- Truss( Inginal hernia) :- A pad made with firm material that will held in place over the hernia with belt to help the abdominal contents from protruding into the hernia sac .

39. NURSING MANAGEMENT Reduce the anxiety of patient . To provide clean environment . To improve the knowledge of the disease . To provide the psychological support of the patient .

40. Post herniarrhaphy pain syndrome / inguinodynia . Hernia recurrence . Wound infection . Ischemia . Necrosis . COMPLICATION

41. MEDICAL TREATMENT :- hernia that are not strangulated can be mechanically reduced . Truss ( firm pad ) held by a belt to keep the hernia in place or reduced . The hernia patient is taught to apply the truss daily . Instruct the patient to inspect the skin under the truss for any manifestation of skin breakdown . If patient has preexisting medical conditions that make surgery unafe , doctor may not repair hernia but will watch it closely . Some hernia have very large openings in the abdominal wall , and closing the opening is compliated may be treated without surgery ,using abdominal binders . Some doctors feel that the hernia with large openings have a low risk of strangulation . An attempt to ( push back ) the hernia will generally be made , often after giving medicine for pain and muscle relaxation . TREATMENT

42. SURGICAL TREATMENT :- A hernia repair is performed using a small incision directly over the weakened area . The intestine is then returned to the perineal cavity , yhe hernial sac excised and the muscle closed tightly over the area . Hernia in the ingunial region are usually repaired under spinal or local anesthesia . Some repair is difficult becsuse there is insufficient muscle to keep the intestines in place . So steel mesh grafts are used to reinforce the rea of herniation . Clients with difficult repairs are usually hospitalized for 1 to 2 days to prophylactic antibiotics . If the intestinal contents of the hernia had the blood supply cut off , the development of dead ( gangrenous ) bowel is possible in as little as six hours .

43. NURSING DIAGNOSES PRE –OPERATIVE FOR HERNIA REPAIR:- 1) Fear and anxiety related to undegoing surgery . POST - OPERATIVE FOR HERNIA REPAIR:- 2) Acute pain related to surgical intervention . 3) Risk of infection related to surgical site . HIATAL HERNIA :- Risk for aspiration related to reflux of gastric content .

44. HEALTH EDUCATION Intake output:- Drink safe water. Drink water 50ml/dl. Use chlorine in drinking water. Hygiene:- maintain person hygiene. Wash the hand before intake water and food. Excersize :- Active and pasive excersize . To protecte the injury. To maintain health. Rest and sleep:- Giving the active in patient to feel better in rest, sleep. Rest for 8-10 hour.

45. BIBLIOGRAPHY