20 terms

Inguinal hernia

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Overview
Part of an internal organ that protrudes through an abnormal opening in the wall of the cavity that surrounds it
Most common type of hernia (see Common sites of hernia)
Possibly direct or indirect, reducible (able to return contents into abdominal cavity spontaneously or with manipulation), incarcerated (no longer reducible without compromise to vascular supply), or strangulated (incarcerated with compromise to the vascular supply)
Overview-Pathophysiology
In an inguinal hernia, the large or small intestine, omentum, or bladder protrudes into the inguinal canal.
In an indirect hernia, abdominal viscera leave the abdomen through the inguinal ring and follow the spermatic cord (in males) or round ligament (in females); they emerge at the external ring and extend down into the inguinal canal, commonly into the scrotum or labia.
In a direct inguinal hernia, instead of entering the canal through the internal ring, the hernia passes through the posterior inguinal wall, protrudes directly through the transverse fascia of the canal (in an area known as Hesselbach's triangle ), and emerges at the external ring.
Overview-Causes
Direct—weakness in fascial floor of inguinal canal
Either—weak abdominal muscles (caused by congenital malformation, trauma, or aging) or increased intra-abdominal pressure (caused by heavy lifting, pregnancy, obesity, or straining)
Indirect—weakness in fascial margin of internal inguinal ring
Overview-Incidence
Indirect hernias are more common; they may develop at any age, are significantly more common in males.
Direct hernias occur more commonly in middle-aged and elderly adults.
Overview-Complications
Strangulation
Intestinal obstruction
Infection (after surgery)
Assessment-History
Asymptomatic
History of hernia
Sharp or "catching" pain when lifting or straining
Aching sensation
Pain out of proportion to swelling (incarceration or strangulations)
Assessment-Physical Findings
Obvious swelling or lump in the inguinal area (large hernia) (see Identifying a hernia)
Diagnostic Test Results-Laboratory
White blood cell count may show leukocytosis with a shift to the left (with strangulation).
Urinalysis helps to rule out other causes of groin pain.
Diagnostic Test Results-Imaging
Physical examination helps confirm the diagnosis.
Abdominal X-rays help identify bowel obstruction if incarcerated or strangulated hernia is suspected.
Treatment-General
Manual reduction
Watchful waiting
Treatment-Diet
Nothing by mouth (if surgery necessary)
Treatment-Activity
As tolerated
Treatment-Medications
Analgesics
Antibiotics, such as I.V. cefoxitin sodium, if strangulation is present
Fluid and electrolyte replacement if strangulation is present or surgery is planned
Treatment-Surgery
Herniorrhaphy (laparoscopic or open technique)
Hernioplasty
Bowel resection (with strangulation or necrosis)
Nursing Considerations-Nursing Diagnoses
Activity intolerance
Acute pain
Risk for ineffective gastrointestinal tissue perfusion
Risk for infection
Risk for injury
Nursing Considerations-Expected Outcomes
perform activities of daily living within the confines of the disease process
express feelings of increased comfort
demonstrate adequate GI function
have normal GI function
remain free from signs or symptoms of infection
avoid complications.
Nursing Considerations-Nursing Interventions
Assist with manual reduction as appropriate. Apply ice or a cold compress to the site for several minutes prior to reduction.
Give prescribed drugs for pain. If strangulation is present, administer prescribed antibiotics I.V. and ensure patent I.V. access.
Encourage the patient to plan for rest periods.
Inspect the abdomen and groin area for distention; auscultate bowel sounds for changes.
Be alert for complaints of pain after manual reduction, which may suggest strangulation necessitating surgical evaluation.
Prepare the patient and family for surgery, if indicated.
Nursing Considerations-Monitoring
Vital signs
Pain status
GI function
Signs and symptoms of strangulation or incarceration
Postoperative surgical site, as appropriate
Nursing Considerations-Associated Nursing Procedures
IV bag preparation
IV bolus injection
IV catheter insertion
Pain assessment, pediatric
Postoperative patient care, ambulatory surgery
Preoperative care, pediatric
Preparing a patient for abdominal surgery, OR
Temperature assessment
Venipuncture, pediatric
Patient Teaching-General
disorder, diagnosis, possible causes, and treatment, including manual reduction or surgery
technique involved with manual reduction, if indicated
preoperative and postoperative care measures, if indicated
need to avoid activities that increase intra-abdominal pressure, such as straining with defecation and lifting heavy objects
use of support devices for hernia after manual reduction
signs and symptoms of incarceration and strangulation and the need to notify a practitioner if any occur
possible reappearance of the hernia in the same location, even after surgical repair
signs and symptoms of infection (oozing, tenderness, warmth, and redness) at the incision site
wound care
activity restrictions required until evaluation by a surgeon
need for high-fiber foods to prevent constipation and maintaining a healthy weight
postoperative activity limitations, such as refraining from heavy lifting (more than 25 lb) for approximately 4 to 6 weeks after surgery; returning to work within 10 days of surgery if employment is sedentary
importance of adhering to scheduled follow-up.