Hernia and its Nursing Managament.

1. PRESENTED BY
Mr. CHETAN R SANGATI
Assistant Professor, Dept of Medical Surgical
Nursing
HERNIA

2. INTRODUCTION
• A hernia is the abnormal exit of tissue or
an organ, such as the bowel, through the wall
of the cavity in which it normally
resides. Various types of hernias can
occur, most commonly involving the abdomen,
and specifically the groin. Groin hernias are
most commonly of the inguinal type but may
also be femoral. Other types of hernias
include hiatus, incisional, and umbilical
hernias.

3. DEFINITION
• A condition in which part of an organ
is displaced and protrudes through the wall of
the cavity containing it (often involving
the intestine at a weak point in
the abdominal wall).

4. INCIDENCE
• An inguinal hernia will affect nearly 25%
of men and less than 2% of women over
their lifetime. An indirect hernia occurs
more often on the right.

5. What are some of the different types
of hernias?
• Inguinal hernia. Inguinal hernias are the most
common type, accounting for 75% of all hernias.
They mostly affect men or people assigned male at
birth. They happen when part of your bowel
protrudes into your inguinal canal, a passageway that
runs down your inner thigh.

6. • Femoral hernia. A femoral hernia is a less-
common type of groin hernia that occurs in the
femoral canal, which runs underneath the
inguinal canal. Fatty tissue may poke through.

7. • Hiatal hernia. A hiatal hernia is another common
type of hernia that you acquire during your lifetime. It
happens when the opening in your diaphragm —
where your esophagus passes through — widens, and
the top of your stomach pushes up through the
opening into your chest.

8. • Congenital diaphragmatic hernia. A
congenital diaphragmatic hernia is a
serious birth defect in which the diaphragm
doesn’t close all the way during fetal
development. It can cause abdominal organs to
slip up into the chest cavity while the organs
are still growing the lungs.

9. • Incisional hernia. An incisional hernia occurs
when tissue protrudes through a former
incision in your abdominal wall that weakened
over time. It’s a common side effect of
abdominal surgery.

10. • Umbilical hernia. An umbilical hernia occurs
when part of your intestine pokes through an
opening in your abdominal wall near your
belly button. Most umbilical hernias are
congenital (present from birth).

11. • Ventral hernia. A ventral hernia is any hernia
that occurs through the front wall of your
abdomen. It includes umbilical hernias and
incisional hernias and an “epigastric hernia” is
a ventral hernia above the belly button.

12. • Perineal hernia. A perineal hernia occurs
when organs or tissue push through an
opening or weakness in your pelvic floor into
your abdominal cavity. These hernias are
relatively rare.

13. CAUSES
• A job that involves heavy lifting.
• A chronic cough or allergies that cause chronic
sneezing.
• Chronic constipation and straining at stool.
• A history of abdominal or pelvic surgery.
• Pregnancy, especially repeat pregnancies.
• Chronic obesity .

14. • A congenital condition, which occurs during
development in the womb and is present from
birth
• Aging
• Damage from an injury or surgery
• Strenuous exercise or lifting heavy weights
• Chronic coughing or chronic obstructive
pulmonary disorder (COPD)
• Constipation, which causes you to strain when
having a bowel movement
• Being overweight or having obesity
• Ascites

15. PATHOPHYSIOLOGY
• Due to various etiological factors
• Obstruction of the bowel
• There is no forward movement of food and
liquid and also venous and atrial supply
• Fluid collects in the abdominal sac and
eventually blood supply is impaired
• Bowel become dark and brownish color
• Perfusion occur at the site of constricted ring
• Peritonitis

16. CLINICAL MANIFESTATION
• Inguinal hernia signs and symptoms include:
• A bulge in the area on either side of your pubic bone,
which becomes more obvious when you're upright,
especially if you cough or strain
A burning or aching sensation at the bulge
Pain or discomfort in your groin, especially when
bending over, coughing or lifting
A heavy or dragging sensation in your groin
Weakness or pressure in your groin
Occasionally, pain and swelling around the testicles
when the protruding intestine descends into the scrotum

17. • Signs and symptoms of a strangulated
hernia include:
• Nausea, vomiting or both
• Fever
• Sudden pain that quickly intensifies
• A hernia bulge that turns red, purple or dark
• Inability to move your bowels or pass gas

18. DIAGNOSTIC EVALUVATION
• Barium swallow
• Your doctor may have you drink a liquid with barium in it before taking
an X-ray. This X-ray provides a clear silhouette of your upper digestive
tract. The image allows your doctor to see the location of your stomach. If
it’s protruding through your diaphragm, you have a hiatal hernia.
• Endoscopy
• Your doctor may perform an endoscopy. They’ll slide a thin tube in your
throat and pass it down to your esophagus and stomach. Your doctor will
then be able to see if your stomach is pushing through your diaphragm.
Any strangulation or obstruction will also be visible.

19. • CT Scans
• Your doctor may order a CT scan to check for
conditions that can cause abdominal pain and
swelling, such as appendicitis, which is an
inflammation of the appendix.
• MRI Scans
• Your doctor may recommend an MRI scan,
particularly if your pain gets worse when you
exercise. This is because, in some people,
participation in sports can cause a hernia that has
no visible bulge initially. An MRI scan can detect
a tear in the abdominal muscles.

20. • Ultrasound
• Your doctor may recommend an ultrasound if
you are a woman of childbearing age. This test
allows doctors to check for other pelvic
conditions, such as ovarian cysts or fibroids,
that can cause abdominal pain.
• BLOOD EXAMINATION
• Endoscopic evaluation

21. PHARAMACOLOGICAL
MANAGEMENT
• over-the-counter (OTC) antacids to neutralize
stomach acidex- sodium cabro, calcium
carbonate.
• OTC or prescription H2-receptor blockers that
lower acid production. ex- cimetidine, ranitidine.
• OTC or prescription proton pump inhibitors to
prevent acid production, giving your esophagus
time to heal. Ex- omeprazole, pantoprazole.

22. SURGERY
• Open surgical repair closes the hernia using
sutures, mesh, or both, and the surgical wound
in the skin is closed with sutures, staples, or
surgical glue.
• Laparoscopic repair is used for repeat
operations to avoid previous scars, and while
usually more expensive, is less likely to cause
complications such as infection.

23. • Open hernia repair (hernioplasty)
• In this procedure, which might be done with
local anesthesia and sedation or general
anesthesia, the surgeon makes an incision in
your groin and pushes the protruding tissue
back into your abdomen.

24. • Minimally invasive hernia repair
• In this procedure requiring general anesthesia,
the surgeon operates through several small
incisions in your abdomen. The surgeon may
use laparoscopic or robotic instruments to
repair your hernia.

25. • Nursing Interventions and Rationales
• Maintain a position of comfort. ...
• Provide support to the buttocks during lifting
or position changes. ...
• Encourage parents to change diapers
frequently.

26. • Place the patient in the Trendelenburg’s
position to reduce pressure on the hernia site.
• Apply truss only after the hernia has been
reduced. For best results, apply it in the morning
before the patient gets out of bed.
• Assess the skin daily and apply powder to prevent
irritation.
• Closely monitor vital signs and provide routine
preoperative preparation.
• Administer IV fluids and analgesics for pain as
ordered.
• Control fever with acetaminophen as ordered.

27. • THANK YOU……….