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Nursing 172 > Week 12: Chp 58: Hernias > Flashcards

Week 12: Chp 58: Hernias Flashcards

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1
Q

What is a Hernia?

A

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

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2
Q

Risk Factors for developing a Hernia

A
  • obesity
  • smoking
  • excessive wound tension
  • malnutrition
  • pregnancy
  • certain medication such as immunosuppressive agents
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3
Q

Where does a hernia most frequently occur?

A

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

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4
Q

Reducible

A

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

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5
Q

Irreducible/ incarcerated hernia

A

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

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6
Q

Strangulated hernia

A

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

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7
Q

Common causes of Hernias

A

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

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8
Q

Age-related changes

A

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

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9
Q

Types of Hernias

A
  • Inguinal
  • Femoral
  • Umbilical
  • Ventral or Incisional
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10
Q

Hernia: Inguinal

A

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

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11
Q

Indirect Inguinal Hernia

A

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

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12
Q

Direct Inguinal Hernia

A
  • 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
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13
Q

Hernia: Femoral

A

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
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14
Q

Hernia: Umbilical

A

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
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15
Q

Hernia: Ventral or Incisional

A

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
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16
Q

Clinical Manifestations of a Hernia

A

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

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17
Q

Clinical Manifestations of Strangulation Hernia

A

-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

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18
Q

How are Hernias Diagnosed?

A

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

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19
Q

Most common treatment of hernias

A

surgery

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20
Q

What happens if the patient is a poor surgical risk?

A

a truss, or binder may be applied

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21
Q

a Truss

A

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

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22
Q

The surgical procedure to repair a hernia is called?

A

herniorrhaphy

23
Q

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

A

hernioplasty

24
Q

Hernioplasty

A

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
25
Q

Herniorrhaphy

A

surgical procedure to repair a hernia

-may be performed through laparoscopic surgery or through an open laparotomy; has a shorter recovery time

26
Q

Surgical Management if the hernia is strangulated

A
  • patient will be hospitalized

- temporary colostomy may be required in extensive surgeries

27
Q

Colostomy

A

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

28
Q

Post-op management

A

-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

29
Q

Complications of hernias

A

-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

30
Q

Complications related to surgery with general anesthesia to correct hernias

A

nausea, vomiting, urinary retention, sore throat, headache

  • recurrence of hernia
  • wound infections; but are rare unless undergone an extensive surgery
31
Q

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

A

deep breathing and early ambulation

32
Q

Safety Alert: Strangulated hernia

A

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

33
Q

The clinical manifestations of a hernia ae related to what?

A

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

34
Q

Nursing Diagnoses

A
  • acute pain r/t the surgical incision

- knowledge deficit r/t postoperative care and home care

35
Q

Nursing Assessments

A
  • Vital signs
  • Pain
  • Intake and Output
  • Surgical Site
36
Q

Assessment: Vital Signs

A

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

37
Q

Assessment: Pain

A

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

38
Q

Assessment: Intake and Output

A

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
39
Q

Assessment: Surgical Site

A

the surgical site should be well-approximated

-swelling or drainage may be indications of early infection

40
Q

Nursing Actions

A
  • 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
41
Q

Actions: deep breathing and early ambulation

A

promote lung expansion and prevent atelectasis and VTE

42
Q

Actions: Administer pain medications as needed

A

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

43
Q

Actions: give patient prescription for pain medication prior to discharge

A

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

44
Q

Actions: Apply ice pack to scrotum and elevate scrotum

A

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

45
Q

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

A

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

46
Q

Nurse Teachings

A
  • coughing is discouraged
  • avoid heavy lifting for several weeks
  • pain management techniques
  • observe incisions for redness, swelling, heat, drainage, which indicate infection
47
Q

Teachings: Coughing is discouraged

A

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

48
Q

Teachings: Avoid heavy lifting for several weeks

A

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

49
Q

Teachings: Pain management techniques

A

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
50
Q

Teachings: Observe incisions

A

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

51
Q

Evaluating Care outcomes

A
  • 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
52
Q

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

A

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

53
Q

The nurse correlates strangulated hernias with what finding?

A

impede blood flow to the intestines

Nursing 172 (120 decks)

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