Week 12: Chp 58: Hernias

Question 1

What is a Hernia?

Answer 1

a protrusion of abdominal contents through an area of weakened muscle in the abdominal cavity
-typically occur because of weakened abdominal muscles accompanied by increased abdominal pressure

Question 2

Risk Factors for developing a Hernia

Answer 2

• obesity
• smoking
• excessive wound tension
• malnutrition
• pregnancy
• certain medication such as immunosuppressive agents

Question 3

Where does a hernia most frequently occur?

Answer 3

in the abdominal cavity; with the intestines protruding through an abnormal opening

Question 4

Reducible

Answer 4

if the contents can easily be placed back into the abdominal cavity manually or lying down, it is known as reducible

Question 5

Irreducible/ incarcerated hernia

Answer 5

if the contents cannot be placed back into the abdominal cavity
-it can become strangulated, affecting intestinal flow and/or blood supply

Question 6

Strangulated hernia

Answer 6

if the blood supply is obstructed and the patient may present with symptoms of an intestinal obstruction

Question 7

Common causes of Hernias

Answer 7

straining (straining to urinate or have a bowel movement), lifting heavy objects, sudden twists, pulls or muscle strains, weight gain, and chronic cough
-a weakened area of abdominal muscle due to a previous abdominal surgery

Question 8

Age-related changes

Answer 8

while people age, muscular tissue becomes infiltrated and replaced by adipose and connective tissue, which increased risk of development of a hernia

Question 9

Types of Hernias

Answer 9

• Inguinal
• Femoral
• Umbilical
• Ventral or Incisional

Question 10

Hernia: Inguinal

Answer 10

occurs in the groin, between the abdomen and thigh, intra-abdominal fat or part of the small intestine protrudes through weakened muscles of the lower abdomen through the inguinal canal
-typically present above the inguinal ligament and extend below it
>Indirect Inguinal Hernia
>Direct Inguinal Hernia

Question 11

Indirect Inguinal Hernia

Answer 11

congenital hernias
-develop in the womb
>male fetus; the spermatic cord and testicles normally descend through the inguinal canal into the scrotum; if the individual ring does not close normally after birth, the muscle is weak causing fat or intestine to slide through this weakness
>female fetus; the female organs or small intestine slides into the groin through the weakened abdominal muscles
-may not become obvious until later in life

Question 12

Direct Inguinal Hernia

Answer 12

• occurs only in males
• due to connective tissue degeneration that causes weakened muscles in adulthood
• fat or small intestine slides through the weakened muscle into the groin
• common symptom of groin hernias: feeling of heaviness or discomfort that is most noticeable when straining or lifting; the pressure is released when the patient stops straining or lies down
• if patient is experiencing significant pain, incarceration or strangulation should be suspected

Question 13

Hernia: Femoral

Answer 13

more common in females

• fat in the femoral canal enlarges and pulls contents from the peritoneum into the hernia sac
• 40% present as incarcerated or strangulated hernia and must be treated as an emergency
• typically present below the inguinal ligament

Question 14

Hernia: Umbilical

Answer 14

occur more frequently in women

• due to increased abdominal pressure, usually related to obesity or multiparity (giving birth to more than 1 child)
• typically the omentum or peritoneal fat that incarcerates (constricts blood flow) into the hernia
• can be congenital and appear in infancy

Question 15

Hernia: Ventral or Incisional

Answer 15

form from previous abdominal surgical incision

• may be due to inadequate healing from an infection, inadequate nutrition, smoking, immunosuppressive medications, connective tissue disorders, or obesity
• the highest incidence occurs with midline abdominal wound incisions, with upper abdominal incisions having higher incidence than lower abdominal incisions
• abdominal wound dehiscence can also lead to ventral hernia
• patient complains of a bulge in the abdominal wall along an old incision site

Question 16

Clinical Manifestations of a Hernia

Answer 16

typically present with a bulge or visible swelling, often associated when coughing or bearing down
-ache that radiates into the area of the hernia

Question 17

Clinical Manifestations of Strangulation Hernia

Answer 17

-abdominal distension
-nausea + vomiting
-pain
-fever
-tachycardia
>this is a medical emergency and the patient must be prepared for surgery immediately to prevent the development of gangrene

Question 18

How are Hernias Diagnosed?

Answer 18

based on physical examination alone, but if this is not definitive, a herniography (a radiographical examination of a hernia after the introduction of contrast medium), ultrasound, CT scan, or magnetic resonance imaging (MRI) can confirm diagnosis
-a CT or MRI may be needed to differentiate between inguinal and femoral

Question 19

Most common treatment of hernias

Answer 19

surgery

Question 20

What happens if the patient is a poor surgical risk?

Answer 20

a truss, or binder may be applied

Question 21

a Truss

Answer 21

a firm pad held in place against the hernia by a belt that reduces the hernia and prevents contents from protruding through the weakened muscle
-may be unilateral or bilateral, and the hernia must be reduced prior to the application of the truss

Question 22

The surgical procedure to repair a hernia is called?

Answer 22

herniorrhaphy

Question 23

When Mesh is used during surgical repair, the procedure is called what?

Answer 23

hernioplasty

Question 24

Hernioplasty

Answer 24

when mesh is used during surgical repair

• a synthetic or biological material called mesh, is placed to reinforce the area of weakness and prevent recurrence of the hernia
• the mesh reinforces the defective are and enhances a lower incidence of recurrence

Question 25

Herniorrhaphy

Answer 25

surgical procedure to repair a hernia | -may be performed through laparoscopic surgery or through an open laparotomy; has a shorter recovery time

Question 26

Surgical Management if the hernia is strangulated

Answer 26

- patient will be hospitalized | - temporary colostomy may be required in extensive surgeries

Question 27

Colostomy

Answer 27

surgically created opening on the abdomen in which the large intestine is connected for the elimination of fecal matter

Question 28

Post-op management

Answer 28

-similar to care of patients undergoing any other abdominal surgery -coughing is discouraged; coughing places pressure on the site of repair and increases the incidence of recurrence of hernia >the patient should be instructed to splint the surgical area when coughing to provide support

Question 29

Complications of hernias

Answer 29

-strangulation of the intestine; which impeded intestinal flow and the blood supply to the intestines; result in intestinal obstruction and/ or necrosis of bowel tissue

Question 30

Complications related to surgery with general anesthesia to correct hernias

Answer 30

nausea, vomiting, urinary retention, sore throat, headache - recurrence of hernia - wound infections; but are rare unless undergone an extensive surgery

Question 31

How to prevent complications such as pneumonia and venous thromboembolism (VTE) after surgery?

Answer 31

deep breathing and early ambulation

Question 32

Safety Alert: Strangulated hernia

Answer 32

patients with a strangulated hernia may present with clinical manifestations of an intestinal obstruction; this is an emergency and the patient must be prepared for immediate surgery to prevent gangrene from developing -strangulation S+S: abdominal distention, nausea, vomiting, pain, fever, and tachycardia

Question 33

The clinical manifestations of a hernia ae related to what?

Answer 33

their location and type of hernia >bulging or swelling at the site of the hernia >ache that radiates in the area of the hernia >feelings of fullness or pressure in the area of the hernia -strangulated hernia: painful engorgement of the hernia, nausea, vomiting, and abdominal distension

Question 34

Nursing Diagnoses

Answer 34

- acute pain r/t the surgical incision | - knowledge deficit r/t postoperative care and home care

Question 35

Nursing Assessments

Answer 35

- Vital signs - Pain - Intake and Output - Surgical Site

Question 36

Assessment: Vital Signs

Answer 36

increased heart rate and respirations may be indicative of pain and/or bleeding -elevated temperature may be indicative of infection

Question 37

Assessment: Pain

Answer 37

pain results from the surgical incision and manipulation of abdominal contents during the surgical repair -adequate pain management allows the patient to resume normal activities sooner

Question 38

Assessment: Intake and Output

Answer 38

urinary retention is a complication as a result of the effects of general anesthesia - if the surgery is performed in an outpatient setting, the nurse should have the patient urinate and measure this recording before discharge - if the patient is admitted to the inpatient facility, intake and output should be measured for 24 hours to ensure that the patient is not retaining urine

Question 39

Assessment: Surgical Site

Answer 39

the surgical site should be well-approximated | -swelling or drainage may be indications of early infection

Question 40

Nursing Actions

Answer 40

- deep breathing and early ambulation - administer pain medications as needed - give patient prescription for pain medication prior to discharge - apply ice pack to scrotum and elevate scrotum - begin diet with clear liquids, advancing diet as tolerated to patients preoperative diet

Question 41

Actions: deep breathing and early ambulation

Answer 41

promote lung expansion and prevent atelectasis and VTE

Question 42

Actions: Administer pain medications as needed

Answer 42

essential for the patient to recover to an optimal level and to prevent complications such as atelectasis and VTE -pain results from the surgical incision and manipulation of abdominal contents during the surgical repair; adequate pain management allows the patient to resume normal activities sooner

Question 43

Actions: give patient prescription for pain medication prior to discharge

Answer 43

patient will require pain medications at home, and this will promote the patient to return to normal activities of daily living

Question 44

Actions: Apply ice pack to scrotum and elevate scrotum

Answer 44

the ice pack and elevation are used to reduce swelling; a scrotal support may also be sued to reduce swelling and elevate the scrotum

Question 45

Action: Begin diet with clear liquids, advancing the diet as tolerated to patients preoperative diet

Answer 45

nausea and vomiting are common after anesthesia, and the patient should exercise steps to prevent nausea and vomiting

Question 46

Nurse Teachings

Answer 46

- coughing is discouraged - avoid heavy lifting for several weeks - pain management techniques - observe incisions for redness, swelling, heat, drainage, which indicate infection

Question 47

Teachings: Coughing is discouraged

Answer 47

coughing causes undue pressure on the surgical site and can possibly lead to recurrence of the hernia -if coughing is necessary, the surgical site should be splinted with pillows to prevent pressure on the site

Question 48

Teachings: Avoid heavy lifting for several weeks

Answer 48

heavy lifting can place undue pressure and straining on the surgical site and lead to reoccurrence of the hernia

Question 49

Teachings: Pain management techniques

Answer 49

the patient will be discharged with a prescription for pain medication - the nurse should teach the patient about the medication and to avoid driving or operating machinery while taking this medication - if the pain is unrelieved by the medication, this should be reported to the healthcare provider

Question 50

Teachings: Observe incisions

Answer 50

for redness, swelling, heat, and drainage, which indicate infection -report fevers, chills and increasing pain to their healthcare provider; these are clinical manifestations of infection and should be reported to healthcare provider ASAP

Question 51

Evaluating Care outcomes

Answer 51

- recovering from hernia repair return to previous level of functioning within 6 to 8 weeks after surgery depending on extent - stable vital signs, absence of infection, and normal bladder and bowel function

Question 52

What is the focused outcome of a patient who is a poor surgica candidate?

Answer 52

focus on patient comfort and ensuring a clear understanding of the clinical manifestations of strangulation

Question 53

The nurse correlates strangulated hernias with what finding?

Answer 53

impede blood flow to the intestines