Medical 4-MS60-Interventions Noninflammatory Intestinal Disorders-Hernias
Terms
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- Define hernia?
-
<a weakness in the abdominal muscle wall through which a segment of bowel or other abdominal structure protrudes>
the problem appears to stem from INCREASED INTRA-ABDOMINAL PRESSURE! - <What are the most common >
-
indirect
<direct
femoral
umbilical
incisional or ventral> - Define indirect inguinal hernia?
- a sac formed from the peritoneum that contains a portion of the intestine or omentum....the most common type...most frequently seen in men because they follow the tract that develops when the testes descend into the scrotum before birth
- Where does an indirect inguinal hernia push down into?
- inguinal canal and at an angle
- In males, an indirect inguinal hernia often descends into the?
- scrotum
- Define direct inguinal hernia?
- pass through a weak point in abdominal wall...occur most often in older adults
- Define femoral hernia?
- protrudes through femoral ring...a plug of fat in femoral canal enlarges and eventually pulls the peritoneum and often the urinary bladder into the sac
- Define umbilical hernias?
- congenital or acquired; appear in infancy; acquired u.h. directly result from increased intra-abdominal pressure...not commonly seen in obese individuals...most common in obese or pregnant women
- Define incisional, or ventral, hernias?
- occur at the site of a previous surgical incision...these hernias result from inadequate healing of the incision, which is most often caused by postop wound infections, inadequate nutrition and obesity
- <Hernias may also be classified as? >
- <reducible, irreducible, or strangulated.>
- <Types of hernias depicted on powerpoint are?>
-
<hiatus
ventral or incisional
epigastric
umbilical
spigelian
inguinal
femoral> - When is a hernia reducible?
- when the contents of the hernial sac can be placed back into the abdominal cavity by gentle pressure
- When is a hernia irreducible (incarcerated)?
- when hernia cannot be reduced or placed back into the abdominal cavity...requires IMMEDIATE surgical evaluation.
-
When is a hernia strangulated?
there will be ischemia and obstruction of the bowel loop which can lead to necrosis of the bowel and possibly bowel perforation...and what are the signs of strangulation? -
when the blood supply to the herniated segment of bowel is cut off by pressure from the hernial ring (the band of muscle around the hernia)...
so if hernia is strangulated, what happens to the bowel loop?
abdominal distention, nausea, vomiting, pain, fever, and tachycardia - What are the most important elements in the development of a hernia?
- congenital or acquired muscle weakness and increased intra-abdominal pressure
- What are the most significant factors contributing to increased intra-abdominal pressure?
-
obesity
pregnancy
lifting of heavy objects - What does the patient with a hernia present with?
- complaint of a "lump" or protrusion felt at the involved site which may be associated with straining or lifting
-
When performing assessment of hernia patient, what positions should patient's abdomen be evaluated in?
because if the hernia is REDUCIBLE, it may DISAPPEAR when LYING FLAT!....what might the advanced practice nurse ask the patient to do to obs -
lying and then standing...and why is this?
strain or perform the Valsalva maneuver....the abdomen may also be AUSCULTATED for?
obstruction and strangulation -
How does the HCP PALPATE an inguinal hernia?
it could cause the strangulated intestine to rupture - examines ring and its content by inserting a finger in the ring and noting changes when patient coughs...the hernia is NEVER forcibly reduced and why is that?
- How does the HCP examine for a male groin hernia?
-
stand up...
use right hand for client's
right side and left hand
for client's left side....
the examiner invaginates the
loose scrotal skin with
the index finger, following
spermatic cord upward to
external inguinal cord..
then ask client to cough...
note any PALPABLE herniation -
A truss (pad) may be nonsurgical management for which kind of hernia?
only after the physician has reduced th ehernia if incarcerated...when does the patient apply the truss?
assess truss area daily and apply light layer of powder -
inguinal...when is a truss applied?
before arising...what skin care is advised for the truss area? - What is the preferred closed repair for the most common type of hernia?
-
ambulatory laparascopic surgery with local, regional, or general surgery...except in severe strangulation cases where gangrene occurs resulting in surgery for bowel resection or colostomy
<remain NPO midnight day of surgery> - <What is MIIHR?>
- <herniorrhaphy or minimally invasive inguinal repair (MIIHR) through a laparoscope....this type of surgery is successful because surgeon reinforces weakened area inside wall and patient has shorter recovery time..if this is inappropriate then a conventional open surgery is performed>
- <The most important thing to remind a patient preop to inguinal hernia repair is?>
- <remain NPO midnight to surgery time>
-
<What is the operative procedure for MIIHR?>
surgeon reinforces the weakened OUTSIDE muscle wall with a mesh patch -
<several small incisions..
identify defect...
cover weakened area with a mesh patch on the INSIDE of the abdominal wall...so what happens when a hernioplasty is performed? - <What is the operative procedure for a conventional inguinal hernia repair?>
- <an abdominal incision is made...places contents of hernial sac back into the abdominal cavity before closing the opening
- When is a MIIHR discharged from hospital?
- 3 to 5 hours postop
- What teaching does patient need postop?
-
check small incisions for:
redness
induration
heat
drainage
increased pain
(report to doctor right away if these occur)
soreness and discomfort is okay, but severe, acute pain following laparoscopy is not a good sign...
patient should avoid coughing
encourage deep breathing and
ambulation
scrotal support and ice bags
to scrotum to prevent
swelling
<elevate scrotum with a soft
pillow to prevent and
control swelling>...
<voiding may be difficult...
have patient stand to allow
for gravity>
allowing water to run may
stimulate urination...
increase fluids by 1500 to
2500 mL daily...a straight
catheter may be required
if client can't void.
avoid lifting for 1-2 weeks or longer
provide written instructions for the following:
fever
chills
wound drainage
redness
separation of incision
increasing incisional pain
keep wound dry and clean
with antibacterial soap
shower in a few days