1. CHAPTER ONE
INTRODUCTION
Hernia is protrusion of an organ, part of an organ through a weak
point or aperture in the surrounding structures. In those affecting
the digestive system, a piece of bowel protrudes through a weak
point in either the musculature of the anterior abdominal wall or
an existing opening .It occurs when there are intermittent increases
in intra-abdominal pressure, most commonly in men who lift heavy
loads at work (Anne& Allison, 2017).
Taken as a group, herniorraphies (groin, umbilical, and epigastric)
are the most common operations performed by general surgeons.
The annual health care expenditure in the United States for
herniorraphy totals billions of dollars. Surprisingly, though exact
data on the numbers and types of hernia repairs are not currently
available in the United States.
2. CHAPTER TWO
REVIEW OF RELEVANT LITERATURES
• Pluta, Burke & Golub, (2018), states that a hernia develops when a
weakness that forms in the abdominal wall enables parts of the intestine
(bowel) or another organ to protrude through it. Among the most
common are umbilical hernia that occur at the navel and the inguinal
hernia that are seen in the groin areas. There are two types of inguinal
hernia, direct and indirect, that may look similar but have different
locations of the protruding intestine. Incisional hernias occurs when an
incision has been in the abdominal wall for an operation.
• The first symptom of hernia is usually a small bulging under the skin that is
generally painless but may produce discomfort and get larger during
strenuous activities or coughing. At this stage, the hernia is reducible
because its contents can be pushed back into the abdomen. However, if
the hernia grows it may become incarcerated (unable to be pushed
back).if blood stops flowing through an incarcerated bowel, this results in
strangulation which is accompanied by pain, often with nausea, vomiting,
or constipation.
3.
4. • CAUSES OF HERNIA
• The underlying cause of the abdominal wall
weakness are unknown. Outcomes include;
• Spontaneous reduction, i.e. the loop of bowel slip
back to its correct place when the intra-abdominal
pressure returns to normal
• Manual reduction, i.e. by applying gentle pressure
over the abdominal swelling.
• Strangulation, when reduction is not possible and
the venous drainage from the herniated loop of
bowel is obstructed, causing congestion, ischaemia
and gangrene (Anne & Allison, 2019).
5. • RISK FACTORS
• According to Tseng (2019), there are several risk factors that
may place an individual at risk of having hernias than others.
Some risk factors include the following:
• Age; fibrous tissues and muscles tends to weaken naturally
through time, so older adults and the elderly are more prone
to hernia than younger individual are.
• Gender; men are more prone to inguinal hernia than women
are.Pregnant women are more prone to umbilical hernia than
men are. Women in general are more prone to femoral hernia
than men are, due to a wider pelvic bone structure.
6. • CHAPTER THREE
• GENERAL MANAGEMENT OF PARAUMBILICAL HERNIA
• The general management of paraumbilical hernia involves
medical, surgical and nursing management.
• THE MEDICAL MANAGEMENT
• Although Mrs O.F. has been seen as early as 12th March, 2022
in surgical outpatient department (SOPD), but the condition
of Mrs O.F. on her visit on 6th of March 2022 prompted her
surgical consultant Dr A. to advise her on admission into the
ward for collaborative/Interdisciplinary management and
close monitor.
7. • THE SURGICAL MANAGEMENT
• This involves the pre-operative and post-operative management;
NURSING MANAGEMENT
• The nursing management of paraumbilical hernia
is done using the nursing process approach and
the components of which are as follows;
• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation
8. • CHAPTER FOUR
• INDIVIDUALIZED MANAGEMENT OF MRS. O.F
• DOCTOR’S PLAN OF ACTION
• Medical diagnosis
• Paraumbilical hernia.
• Medical plan:
• 12th March, 2022.
• Admit the patient in female surgical ward
• Do the following laboratory investigations; PCV, FBC, RVS,
Urinalysis, S/E/U/Cr, chest x-ray and abdominal scan.
9. • SUMMARY OF CASE STUDY
• Appropriate management and careful study of this case
was carried out from the female surgical ward in
Federal Medical Centre Owerri on Mrs. O.F, a 70year
old woman who was born into a Christian
monogamous family, happily married with children.
She was admitted into the ward on the 12th day of
March, 2022 with a medical diagnosis of paraumbilical
hernia, and she presented with abdominal
pain/swelling and waist pain (right leg involved).
• Due medical, nursing, dietary and laboratory
management were rendered to her from 12th March,
2022 to 15th March, 2022. She spent three days on
admission.
