abdominal hernia

abdominal hernia notes

1. Hernia is defined as a weakness in the abdominal muscle wall through which a segment of the bowel or other abdominal structure protrudes. 2. Hernias can also penetrate through any other defect in the abdominal wall, through the diaphragm, or through other structures in the abdominal cavity.

classifications of hernia

1. reducible 2. irreducible 2. strangulated

strangulated

1. trapping causes blood supply to be cut off: ischemia 2. can lead to necrosis and bowel perforation 3. symptoms include: sudden severe abd pain, vomiting, and distention

umbilical hernia notes

Congenital umbilical hernias occur in infancy. Acquired umbilical hernias directly result from increased abdominal pressure. These are more commonly seen in obese people.

femoral hernia notes

FEMORAL Hernias, like Inguinal hernias, develop in the groin area, but occur about 10 times more commonly in females than they do in males. These hernias develop at or very near the leg crease itself. It is often difficult to differentiate clinically between these and Inguinal Hernias on examination alone by those not experienced in hernia evaluation. These hernias are more prone to develop INCARCERATION and/or STRANGULATION as an early complication than are Inguinal Hernias.

abd hernia

Hernia Muscle weakness can be -Inherited: Congenital defect -Acquired: Lifting heavy objects, coughing, or obesity

non-surgical management

If a patient is not a good surgical risk -Truss: Uses pressure to keep abdominal contents from herniating -Inspect skin under truss daily -Put truss on before arising in the morning

classifications of hernia notes

In a reducible hernia, the contents of the hernial sac can be replaced into the abdominal cavity by gentle pressure or by laying flat. INCARCERATION The trapping of abdominal contents within the Hernia itself. The bulge cannot be reduced or pushed back. This could mean that intestine from within the abdomen is trapped in the hernia and the risk of injury to abdominal contents and intestine is increased. Surgical release and hernia repair are emergently necessary to avoid injury to the intestine STRANGULATION Injury to the blood circulation to the intestine caused by Incarceration

direct inguinal hernia

In contrast, this type of hernia passes through a weak point in the abdominal wall Most common in men older than 40 S/S: usually painless, round swelling close to pubis, which is easily reduced when supine Direct inguinal hernias mostly afflict adults especially middle-aged and elderly men.

incisional/ventral hernia

Occur at the site of a previous surgical incision Result from inadequate healing of the incision Caused by post-operative wound infections Inadequate nutrition Obesity

indirect inguinal hernia

Peritoneal sac with intestine pushes downward at an angle into the inguinal canal. S/S: pain with straining Soft swelling increases with intra-abdominal pressure, may decrease when lying down

teaching about a truss

Points to stress when teaching your client about wearing a truss: 1. inspect skin under the truss daily, can be prone to breakdown due to pressure and moisture. 2. put truss on before getting out of bed in the morning and 3. protect skin with a light dusting of powder.

femoral hernia

Protrude through the femoral ring More common in women than men S/S: lump in groin; severe pain, may become strangulated

umbilical hernia

Protrusion of bowel into umbilical ring Congenital: Infancy Acquired: Obesity, Intra-abdominal pressure: most commonly seen in obese individuals, Valsalva (straining)

post-op

Respiratory -Deep breathing and turning -Caution with coughing - too much pressure at incisional site Intake and Output -Monitor for post op difficulty voiding -Allow men to stand, more natural for voiding -urinary retention is most common complication after surgery -Encourage fluid intake pain: pain meds as ordered -ambulation: when awake and alert, discharge teaching, avoid straining and lifting, depending on type of repair this period can be as long as 6 wks

surgical intervention notes

Surgery is usually performed on an ambulatory care basis, unless there are co morbid conditions that would necessitate hospital admission. In same day surgery, anesthesia can be either local, regional, or general and the surgery is typically performed laporoscopically. The operation is called a herniorrhaphy. When a hernioplasty is also performed, the surgeon reinforces the weakened outside muscle wall with a mesh patch. More extensive surgery, such as a bowel resection or temporary colostomy, may be necessary if strangulation results in a gangrenous section of bowel.

indirect inguinal hernia notes

The most common groin hernia, the indirect inguinal hernia is a type of inguinal hernia which protrudes through the inguinal ring and is ultimately the result of the failure of embryonic closure of the internal inguinal ring after the testicle passes through it. The indirect inguinal hernia which is common in children - they may be present at birth - and young people. They are mostly seen in males but can also occur in females.

types of abd hernia

The most common types of abdominal hernias are indirect, direct, femoral, umbilical and incisional.

post op nursing considerations notes

The patient who has had laporscopic hernia repair is typically discharged from the surgical center in 3-5 hours. The patient should complain of soreness and discomfort rather than severe, acute pain following this type of surgery. Patients who have undergone surgery for hernias are told to avoid coughing. Deep breathing and ambulation are encouraged. With repair of an indirect inguinal hernia, the physician may suggest a scrotal support and ice bags to be applied to the scrotum to prevent swelling, which often contributes to pain. The nurse can also elevate the scrotum with a soft pillow which helps prevent and control swelling. In the immediate post-operative period, the patient may experience difficulty urinating. Encourage men to stand to allow for a more natural position for gravity to facilitate voiding and bladder emptying. You can turn the faucet on and allow the water to run in order to encourage voiding. Straight catheterization may be required if patient cannot void. Encourage a fluid intake of 1500 to 2500 ml's daily to prevent dehydration and maintain urinary function. Discharge Teaching: avoid straining and lifting for 1-2 weeks. May extend this period for up to 6 weeks, depending upon extent of surgery done.

surgical interv

Treatment of choice: Herniorrhaphy Usually outpatient surgery Unless patient has other health problems Complications from hernia -Bowel obstruction Laparoscopic procedure -If not strangulated

irreducible

incarcerated: loop of bowel is trapped, may cause intestinal obstruction and strangulation, requires immediate surgical intervention

reducible

loop of bowel can be popped back into its normal place