Nursing care of patients with Hernia

Nursing care of patients with Hernia
Adult Health Nursing

1. Abdelrahman Alkilani , RN. BSN. MSN- Year 1 Nursing Care of Patients with Hernia

2. Define Hernia. Enumerate the different types of Hernias. State the clinical manifestations of Hernias Discuss the pathophysiology of Hernia State the complications of Hernias. Describe the diagnostic tests required for patients with Hernia Describe the medical and surgical management provided for patients with hernia. Explain the nursing management of patients with Hernia. Objectives

3. It is the protrusion of an organ or part of an organ through the wall of the cavity that normally contains it. It is classified by location. Hernia

4. Inguinal hernia Umbilical hernia Incisional or ventral hernia Hiatal hernia Types of Hernia

5. Pathophysiology Often are congenital, caused by improper closure of the tract that develops as the testes descend into the scrotum during fetal development. Or acquired defects that result from weakness of the posterior inguinal wall Inguinal hernia

6. Indirect inguinal hernia Are caused by improper closure of the tract that develops as the testes descend into scrotum before birth. A sac of abdominal contents protrudes through the internal inguinal ring into the inguinal canal. It often descends into the scrotum. often not evident until adulthood, when increased intra-abdominal pressure and dilation of inguinal ring allow contents to enter the channel . Inguinal hernia

7. Inguinal hernia Direct inguinal hernias Are acquired defects that result from weakness of the posterior inguinal wall. Usually affect older adults

8. Clinical Manifestations May produce no manifestations May cause a lump, swelling, or bulge in the groin, particularly with lifting or straining. May cause sharp pain or a dull ache that radiates into the scrotum. A palpable mass may be present in the groin, although it may be felt only with increased intra-abdominal pressure (as occurs during coughing ). Inguinal hernia

9. Umbilical hernia Pathophysiology Pregnancy and obesity contribute to the development of umbilical hernias in adults May be congenital and evident during infancy, or acquired as the tissue closing the umbilical ring weakens, allowing protrusion of abdominal contents. More common in women.

10. Clinical manifestations May cause sharp pain on coughing or straining or a dull, aching sensation. Umbilical hernia

11. Pathophysiology Occurs at a previous surgical incision or following abdominal muscle tears Contributing factors include poor wound closure, postoperative infection, age or debility, obesity, and excess incisional stress caused by vigorous coughing. Incisional or ventral hernia

12. Clinical manifestation Characterized by a bulge at the incisional site, often noted when the client pulls to a sitting position from lying position. Incisional or ventral hernia

13. Pathophysiology Sliding hiatal hernia, the gastroesophageal junction and the fundus of the stomach slide upward through the esophageal hiatus. Contributing factors include: weakened gastroesophageal -diaphragmatic anchors shortening of the esophagus or increased intra-abdominal pressure . Hiatal hernias

14. Pathophysiology In a paraesophageal hiatal hernia, the junction between the esophagus and stomach remains in its normal position below the diaphragm while a part of the stomach herniates through the esophageal hiatus. Further classified as type II, III, or IV. Depending on the extent of herniation, with type IV having the greatest herniation. Hiatal hernias

15. Clinical Manifestations Sliding hernia: 50% of patients with sliding hernia are asymptomatic. Heartburn Regurgitation Dysphagia   Paraesophageal hernia: Sense of fullness after eating or chest pain, or there may be no symptoms. Reflux usually doesn’t occur, because the gastroesophageal sphincter is intact. Hiatal hernias

16. If the content of hernia cannot be returned to the abdominal cavity, it is said to be incarcerated . Incarceration increases the risk of complications, including obstruction and strangulation . Complications

17. Obstruction occurs when the lumen of the bowel contained within the hernia becomes occluded. A strangulated hernia develops when blood supply to bowel and other tissues in the hernia sac is compromised, leading to a necrosis. The affected bowel can infarct , leading to perforation with contamination of the potential cavity Complications

18. Diagnosis is made by physical examination The client is examined in a supine or standing position A bulge may be seen or felt when the client coughs or bears down. Diagnosis of hiatal hernia can be confirmed by: X-ray Barium swallow Fluoroscopy Diagnostic tests

19. Surgical repair, or herniorrhaphy , is the usual treatment for hernia Abdominal wall defect is closed by suturing or with wire or mesh over the defect. If incarceration has occurred or strangulation is suspected, the abdomen is explored at the time of surgery and any infarcted bowel restricted. Medical and surgical management

20. Hiatal hernia: Frequent, small feedings that can pass easily through the esophagus. The patient is advised not to recline for 1 hour after eating, to prevent reflux or movement of the hernia The patient is advised to elevate the head of bed on 4-8 inches blocks to prevent the hernia from sliding upward. Surgery is indicated in about 15% of patients. May require emergency surgery to correct torsion (twisting) of the stomach or other body organ that leads to restriction of blood flow to that area . Medical and surgical management

21. Assessment Nursing diagnosis Goal Interventions Outcome Bulging at hernia site Risk of ineffective tissue perfusion related to hernia and the possibility of obstruction and strangulation Complications will be avoided next 24 hours Watch for and immediately report signs of incarceration and strangulation There is no signs of complications within 24 hours Nursing process

22. Assessment Nursing diagnosis Goal Interventions Outcome Patient is complaining of pan 5 on score Acute pain relate to swelling and pressure The patient will express feelings of comfort. Watch for and immediately report signs of incarceration and strangulation. Administer I.V. fluids and analgesics for pain as ordered. Place the patient in Trendelenburg's position to reduce pressure on the hernia site Pain was relieved from 5 to 2 on score Nursing process

23. Assessment Nursing diagnosis Goal Interventions Outcome patient said that he often have oral regurgitation after meals Risk of aspiration related to reflux of gastric content Client will be able to state the steps in preventing aspiration after 2 hours of nursing interventions Instruct to take small frequent meals Encourage not to take meal 2 hours before bed time Patient has no episodes of oral regurgitation after 2 hours of interventions Nursing process

24. Assessment Nursing diagnosis Goal Interventions Outcome Patient has repeated doubts regarding surgery Fear and anxiety related to hospitalization Pt to be free from anxiety with 2 hours of interventions explain the procedure to the patient in simple terms introduce the patient to similar patients who had undergone the surgery Pt is relieved of fear and anxiety as he state it. Nursing process

25. It is the protrusion of an organ or part of an organ through the wall of the cavity that normally contains it. Inguinal hernia, Umbilical hernia, Incisional or ventral hernia, and Hiatal hernia Main manifestation is bulging or pain. Incarceration leads to obstruction or strangulation Diagnosed mainly with physical exam Surgical repair is the treatment Nurses play a significant role in care of patients with hernia. Summary

26. Write about 2 pages about the risk factors of each type of hernia which we covered in our session? To be submitted on Tuesday 17th Nov, 2015 . Assignment

27. Smeltzer , Bare, Hinkle, and Cheever. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, (2013). Priscilla LeMone , Medical surgical Nursing (fourth edition). Pearson international edition. References

28. Thanks