It's best for care of hernia patient

1. PRESENTED BY
Ahmad Shahid
HERNIAS

2. Objectives
● By the end of this session learner will be able to:
● Review the anatomy and physiology of
gastrointestinal system(GIT)
● Discuss the causes, Clinical manifestation of Hernias
● Discuss the diagnosis, medical and surgical
management of the above mentioned disorder
● Apply nursing process including assessment,
planning, implementation and evaluation of care
provided to the clients with Hernias
● Develop a teaching plan for a client with Hernias

3. Hernia
● Definition:
Hernia is the protrusion of
an organ, tissue or the part
of an organ through the wall
of the cavity that normally
contains it.

4. Causes of hernia
● Weakness of the abdominal muscles.
● Increase intra abdominal pressure.
● Weakness of containing membranes or muscles is
usually congenital, or increases with age or due to
any risk factors.

5. Risk Factors
● Stretching of muscles during pregnancy.
● Obese people.
● Chronic constipation and straining during a bowel
movement or urination.
● Chronic hard coughing
● Improper heavy weight lifting .
● Tight clothing and incorrect posture.
Or because of scars from previous surgery.

6. Cont…
● Many conditions increase intra-abdominal
pressure, (ascites, COPD, benign prostatic
hypertrophy)
● Also, if muscles are weakened due to poor nutrition,
smoking, and overexertion.

7. Classification of hernia
1Hernia may be congenital or acquired:
congenital hernias: occur prenatal or in the
first year of life, and are caused by a
congenital defect.
Acquired hernias: develop later on in life.
2 Hernia may be complete or incomplete:
for example, the stomach may partially or
completely herniate into the chest.

8. Cont…
3- Hernia may be internal or external:
External ones herniate to the outside world,
whereas internal hernias protrude from their
normal compartment to another.

9. Cont…
4. Hernia may be Reducible or Irreducible:
• Reducible hernia: is one which can be pushed
back into the abdomen by putting manual
pressure to it.
• Irreducible hernia: is one which cannot be
pushed back into the abdomen by applying manual
pressure.

10. Pathophysiology of hernia:
● Defect or weakness in the muscular wall may
be congenital, acquired weakness or caused by
trauma.
● Increased the intra abdominal pressure as a result
of any risk factors that discussed before.
● As a results of weakness of the abdominal wall and
increased pressure, the abdominal contents can
protrude causing herniation

11. Types of hernia
● Hernias can be classified according to their
anatomical location into:
• Abdominal hernias and
diaphragmatic hernias.
Inguinal hernia:
An inguinal hernia is a protrusion of abdominal
cavity contents through the inguinal canal.

12. Types of hernia
1-Direct inguinal hernias:
It occur medial to the inferior epigastric vessels
when abdominal contents herniate through a weak
spot in the part of the posterior wall of the inguinal
canal.
2-Indirect inguinal hernias:
occur when abdominal contents protrude through
the deep inguinal ring, lateral to the inferior
epigastric vessels.

13. Types of hernia
(2) Femoral hernia:
Femoral hernias occur just below the inguinal
ligament, when abdominal contents pass into the
weak area at the posterior wall of the femoral canal.
(3) Umbilical hernia:
It is protrusion of intra abdominal contents through
a weakness at the site of passage of the umbilical
cord through the abdominal wall.

15. Types of hernia
1 Para umbilical hernia:
A type of umbilical hernia occurring in adults. It
develop around the area of the umbilicus.
2Congenital umbilical hernia
3- Acquired umbilical hernia
(4) Incisional hernia:
In an incisional hernia, the intestine pushes
through the abdominal wall at the site of previous
abdominal surgery

16. Types of hernia
5. Epigastric hernia:
It is a protrusion of the epigastric contents through
the abdominal wall. The protrusion occurs between
the linea Alba and the lower part of the rib cage in
the midline of the abdomen.

17. Clinical manifestation of hernia:
1) Bulging and painless swelling at first.
2) Pain
3) Nausea and vomiting
4) Constipation
5)Urinary Symptoms, frequency, urinary
burning, frequent infections.

18. Medical treatment
● Hernias that are not strangulated can be
mechanically reduced.
• Truss (firm pad) held by a belt to keep the hernia
in place or reduced.
• The patient is taught to apply the truss daily.
• Instruct the patient to inspect the skin under
the truss for any manifestation of skin
breakdown.
● If patient has preexisting medical conditions that
make surgery unsafe, doctor may not repair hernia
but will watch it closely.

19. Treatment
● Some hernias have very large openings in the
abdominal wall, and closing the opening is
complicated because of their large size. These kinds
of hernias may be treated without surgery, using
abdominal binders.
● Some doctors feel that the hernias with large
openings have a low risk of strangulation.
• An attempt to (push back) the hernia will
generally be made, often after giving medicine for
pain and muscle relaxation

20. Surgical treatment
A hernia repair is performed using a small incision
directly over the weakened area. The intestine is
then returned to the perineal cavity, the hernial sac
excised and the muscle closed tightly over the area.

22. Post operative care
● The nurse encourages the patient to void
immediately after surgery, because urinary
retention is a common problem.
• Give prescribed medication as ordered.
• The patient should be returned to general diet
as soon as he tolerates food.
• Encourage post operative ambulation as soon as
possible to prevent complications of immobility.
• Instruct the patient to avoid any risk factors
that facilitate hernial recurrence.

23. Nursing Management
Nurses Diagnosis
Nurses Intervention
Patient Teaching

24. References
● The Biologic Basis for Disease in Adults and
Children by Kathryn L. McCANCER SUE. E
HUETHER Valentina L. Brashers Neal S. Rote
Seventh Edition