Week 5 - Hernia and Hemorrhoids Flashcards
what is a hernia
- protrusion of a viscus (usually intestines or tissue) thru an abnormal opening or a weakened area in the wall of the cavitity in which it is normally contained
what is a reducible hernia
- if the hernia can be pushed back into the abdominal cavity
what is an irreducible hernia
- if the hernia cannot be pushed back into the abdominal cavity
- either by manipulation or when they lie down
what is a strangulated hernia
- when the hernia is irreducible and the intestinal blood flow and blood supply are obstructed
what does a strangulated hernia result in
- acute intestinal obstruction and ischemia
- necrosis & gangrene if not immediate care
= needs surgery
what are types of hernia (4)
- inguinal
- femoral
- umbilical
- incisional (or ventral)
where does a hernia commonly occur
- over the involved area when the pt stands or strains
what are symptoms of a strangulated hernia (4)
S&S of bowel obstruction
- vomitting
- crampy abdominal pain
- distension
- and severe pain
what are symptoms of a hernia
- pain to area of hernia
what can be used to diagnose a hernia
- history
- physical exam
what is the treatment of choice for hernias and why?
- surgery
- to prevent the complication of strangulation
what is the surgical repair of a hernia called
- herniorrhaphy
what may be needed to treat a strangulated hernia (2)
- bowel resection of involved area
- temporary ostomy
what may be used to keep a hernia in place
- a truss
what is a truss and what does it do
- a firm pad placed over the hernia and held in place w a belt
- keeps hernia from protruding
when should a truss not be used
- if the hernia is not reducible
what nursing care is involved w a truss
- check for skin irritation caused by the rubbing and pressure of the truss
what is a hernoplasty
- surgical reinforcement of the weakened area w fascia or mesh
describe post-op care for hernia (6)
- may have difficulty voiding = observe for bladder distension and I&Os
- scrotal edema may occur
- coughing not encouraged
- DB should be done
- if pt needs to cough or sneeze, splint w pillow
- position to decrease P on suture line
what is scrotal edema
- painful complication of an inguinal hernia repair
what can be used to relieve discomfort of scrotal edema
- use of scrotal support
after discharge, what is imp to teach the pt r/t hernia surgery
- may be restricted from heavy lifting or activities for 6-8 weeks (however some surgeons dont put limits on activities)
what are hemorrhoids
- varicosities in the lower rectum or anus caused by congestion in the veins
hemorrhoids may be..
- internal (occur above internal sphincter)
- external (occur outside external sphincter)
what can cause hemorrhoids(6)
things that increase P
- straining to defecate
- pregnancy
- prolonged constipation
- heavy lifting
- prolonged standing & sitting
- portal HTN
what are symptoms of internal hemorrhoids (4)
- may be asymptomatic
- if become constricted, experience pain
- bleeding
- chronic, dull, aching discomfort
what are symptoms of external hemorrhoids (7)
- reddish blue color
- seldem bleed or cause pain unless a vein ruptures
- if blood clot, get inflamed and painful
- intermittent pain
- pain on palpation
- itching
- burning
- bleeding w defecation
(textbook kinda contradicts itself abt the pain and bleeding??)
what can be used to diagnose hemorrhoids
- digital exam, anoscopy, sigmoidoscopy for internal
- visual inspection and digital exam for external
describe collaborative care for hemorrhoids (5)
directed towards causes and symptoms
- constipation prevention
- surgery
- nonsurgical procedures
- anti-inflamm, astringents, and anaesthetics to relieve discomfort
- sitz baths for pain
what interventions can be used to prevent constipation r/t hemorrhoids (3)
- increased fluids
- high fibre
- stool softeners
what are some nonsurgical procedures for treatment of hemorrhoids (4)
- band ligation
- infrared coagulation
- cyrotherapy
- laser treatment
describe how band ligation works for treatment of hemorrhoids
- thru an anoscope, the hemorrhoid is identified and then ligated w rubber band
- the constrictive effect impairs circulation, tissue becomes necrotic, seperates, and sloghs off
what is infrared coagulation for hemorrhoids
- used to treat bleeding internal hemorrhoids
what is cyrotherapy for treatment of hemorrhoids
- involves rapid freezing of the hemorrhoid
what us laser treatment for treatment of hemorrhoids
- used to treat internal hemorrhoids
what surgical procedure is used for treatment of hemorrhoids
- hemorrhoidectomy
what is a hemorrhoidectomy
- surgical excision of hemorrhoids
when is surgery indicated w hemorrhoids? (4)
- if there is prolapse
- excessive pain
- excessive bleeding
- large hemorrhoids
describe discharge teaching for a pt with hemorrhoids (10)
- how to prevent constipation
- avoid prolonged standing or sitting
- proper use of OTC drugs available for hemorrhoidal symptoms
- seek medical care if severe symptoms of hemorrhoids (excessive pain, bleeding, prolapse)
- use of sitz baths to reduce discomfort and swelling
- importance of diet
- care of anal area
- avoid constipation & straining
- hemorrhoids may recurr
- regular checkups imp.
how often should a pt with hemorrhoids use a sphincter bath
- 15-0 min, 2-3xday, for 7-10 days
describe nursing mngmt after a hemorrhoidectomy (7)
- narcotics for sphincter spasm
- sitz baths 1-2 days after surgery
- dressing and packing changes
- maintain privacy during dressing change
- pain meds before first BM
- stool softeners (Colace)
- if no BM within first 2-3 days, give oral laxative
