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Med Surg - Hernia

MM

Marielle Mateo

Transcript

Hernia

By: Marielle Mateo

Pathophysiology

  • If there is a defect in the muscular wall of the abdomen, the intestine may break through the defect
  • This protrusion is called a hernia or a rupture
  • The most common locations for a hernia are in areas where the abdominal wall is normally weaker and more likely to allow a segment of intestine to protrude
  • This include the center of the abdomen at the side of the umbilicus and the lower abdomen at the points where the inguinal ring and the femoral canal begin
  • A hernia may form at an old abdominal surgical incision

Pathophysiology & Etiology

Etiology

  • The most common contributing factors in the development of a hernia are straining to lift heavy objects, chronic cough, straining to void or pass stool, and ascites
  • Inguinal hernias are more common in men
  • Hernias are classified as reducible, in which the protruding organ can be returned to its proper place by pressing on the organ, and irreducible or incarcerated, in which the protruding part of the organ is tightly wedged outside the cavity and cannot be pushed back through the opening
  • If the protruding part of the organ is not replaced and its blood supply is cut off, the hernia is strangulated or incarcerated

Signs & Symptoms

  • If the hernia is not incarcerated, there will just be abnormal pouching, a "lump" or local swelling out from the abdominal wall or in the groin area (inguinal or femoral hernia)
  • Lifting of heavy objects, coughing, or any activity that puts a strain on the abdominal muscles may force the organ back through the opening, and the swelling reappears
  • Pain occurs when the peritoneum becomes irritated or when the hernia is incarcerated or strangulated
  • The flow of intestinal contents can be blocked by an incarcerated hernia, causing symptoms of intestinal obstruction
  • This is an emergency because when the blood supply is restricted, part of the intestine may die

Diagnosis: Lab Test

Diagnosis

  • Electrolyte: Blood test that measures the levels of electrolytes and carbon dioxide in the blood
  • Normal = 135 - 145 mEq/L
  • Abnormal = <135
  • Blood Urea Nitrogen (BUN): To measure the amount of urea nitrogen found in blood
  • Normal = 8 to 21 mg/dL
  • Abnormal = <8
  • Creatinine Levels: To see how well the kidneys functions
  • Normal:
  • Adult Male = 0.6 to 1.21 mg/dL
  • Adult Female = 0.5 to 1.11 mg/dL
  • Abnormal = <0.6 or <0.5

Diagnostic Test

Diagnostic Test

  • Diagnosis is made by physical examination
  • The patient is examined in a supine, sitting, or standing
  • A bulge may be seen or felt when the client coughs or bears down

  • Diagnostic test of hernia can be confirmed by:
  • CT Scan
  • MRI

Purpose & Preparations

Diagnosis: Purpose & Preparations

  • MRI
  • Purpose: To evaluate abnormalities in the liver or other abdominal structures
  • Preparation: Explain that there is no exposure to radiation. There is no food or fluid restrictions before the test. Remove all metal objects from the body, including dental bridges. Inform patient that he/she will be required to remain motionless during this study
  • CT Scan
  • Purpose: To visualize soft tissue and density changes when sonography is inconclusive to detect tumors, abscesses, trauma, cysts, inflammation, and bleeding
  • Preparation: Patient is kept NPO for 4 hrs when oral contrast is to be used. Verify presence of signed informed consent form for this procedure. Assess for allergy to iodine or shellfish. Explain the patient that he/she will be positioned supine on a special, narrow table, and their body will be in the circular opening of the scanner

Nursing Implications

Nursing Implications

  • MRI Scan:
  • Inform patient that they will be required to remain motionless during this study
  • A thumping sound will be heard during the test
  • There may be a tingling sensation in metal fillings
  • CT Scan:
  • Patient will have a strap over their waist to secure them to the table
  • Clicking noises will be heard from the machine
  • The test takes about 30 mins
  • An IV contrast agent that causes a transitory warm feeling may be given to enhance images
  • Patient will be asked to hold her breath at certain points in the test
  • The machine uses narrow x-ray beams

Treatment

Treatment

Medication

Surgical

  • Generic: ampicillin
  • Trade: Unasyn
  • Use: To treat or prevent different types of infections

  • Generic: gentamicin
  • Trade: Diogent
  • Use: Prevent to stop the growth of bacteria and infections of the blood

  • The surgical procedure used in the treatment of a hernia is called a herniorrhaphy
  • The defect in the muscle is closed w/ sutures
  • If the area of weakness is very large, a hernioplasty is done
  • In this procedure, some type of strong synthetic material is sewn over the defect to reinforce the area
  • The material used is a mesh product; it has potential for complications because a foreign object is being implanted
  • Studies show the recurrence of a hernia is significantly decreased w/ the mesh implant
  • The procedure can be done on an outpatient basis as an open or laparoscopic procedure
  • Local or regional anesthesia is used instead of general anesthesia for uncomplicated and minimally invasive cases

Holistic Treatment

  • If surgery is not possible because of age or high surgical risk, the patient may be fitted w/ an appliance called a truss (which reinforces the weakened cavity wall and prevents protrusion of the intestines)

Focused Assessment

  • Abdominal Assessment = Inspect for distention (bulge), auscultate bowel sounds, palpate, percussion
  • Fluid = Monitor electrolyte, fluid intake, and urine output
  • Identifying Pain Location = Rate pain, assess location, and describe description of pain
  • Inspection site = Monitor the size of bulge

Focused Assessment

Nursing Management

Nursing Management

  • Assess ABCS
  • Assess vital signs
  • Inspect, auscultate, percuss, and palpate the abdomen
  • Assess electrolyte and fluid I&O
  • Identify the location of pain
  • Educate to avoid spicy foods and lifting heavy items

NANDA 1

  • Risk for Injury:
  • Vulnerable for injury as a result of environmental conditions interacting w/ the individual's adaptive and defensive resources, which may compromise health
  • May be related to:
  • Intestinal obstruction
  • Possibly evidenced by:
  • Traumatic abdominal rupture
  • Desired outcomes:
  • Client will not experience injury

Nursing Diagnosis

  • Nursing Intervention:
  • Assess hernia site for any tenderness and other symptoms such as increased abdominal girth, loss of appetite, irritability, and defecation changes
  • Rationale:
  • Reveals partial or complete obstruction as a result of incarceration and strangulation

NANDA 2

  • Deficient Knowledge:
  • Absence or deficiency of cognitive information related to specific topic
  • May be related to:
  • Lack of knowledge about postoperative care
  • Possibly evidenced by:
  • Request for information about activity allowed, wound care, diet, bathing and comfort measures
  • Desired outcomes:
  • Patient's will obtain knowledge about postoperative care

NANDA 2

  • Nursing Intervention:
  • Assess patient's knowledge of hernia including its causes, surgical management; Assess patient's willingness and interest to execute treatment regimen
  • Rationale:
  • Promote efficient plan of instruction to ensure compliance

NANDA 3

  • Risk for fluid volume deficit:
  • At risk for experiencing vascular, cellular, or intracellular dehydration
  • May be related to:
  • Postoperative status (NPO status)
  • Dehydration
  • Possibly evidenced by:
  • Decreased urine output (less than 30mL/hr)
  • Desired outcomes:
  • Client will experience adequate fluid volume

NANDA 3

  • Nursing Intervention:
  • Assess skin turgor, mucous membranes, last void, and behavior changes
  • Rationale:
  • Provides information about hydration status; including extracellular fluid losses, decreased activity levels, malaise, weight loss, poor skin turgor, concentrated urine

FAMILY GUY: BRIAN'S HERNIA RUPTURED

Video / Reference

Reference

REFERENCE

ampicillin - davisplus.fadavis

deWit, S., Stromberg, H., Dallred, C. (022016). Medical-Surgical Nursing: Concepts & Practice, 3rd Edition [VitalSource Bookshelf version]. Retrieved from vbk://9780323243780

gentamicin - davisplus.fadavis

Martin, P., Martin, P., & Martin, P. (2019, April 10). 4 Umbilical and Inguinal Hernia Nursing Care Plans. Retrieved from https://nurseslabs.com/umbilical-and-inguinal-hernia-nursing-care-plans/

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