1. RAKCON
Bsc(H)Nursing

2. INTRODUCTION
Hernia is bulging of an organ or tissue through an
abnormal opening.
Typically hernia involves stomach and intestine i.e.
abdominal cavity.
It is generally due to congenital or acquired weakness
of abdominal musculature.

3. Hernia is usually self diagnosable, and its
symptoms include a bulge swelling or pain.
This is treated by monitoring the condition
and if required surgery can return tissue to
its normal location and close the opening.

4. A hernia is the
abdominal protrusion of
an organ tissue or a part
of an organ through the
structure that normally
contains it.
DEFINITION

6. ON THE BASIS OF LOCATION
 INGUINAL HERNIA

7. Inguinal canal anatomy
◦ Anterior wall aponeurosis of external oblique (along and Entire
length)
- Internal oblique on lateral one third.
◦ Posterior Fascia transversalis
- conjoint tendon in medial one third
◦ Roof arching fibres of internal oblique
- Transverse abdominal
◦ Floor( interior) inguinal ligament
- Lacunar ligament at the medial end

9. INGUINAL
CANAL
CONTENTS
• Spermatic cord structure
• Vas deferens
• Testicular artery
• Testicular vein
• Artery of vas deferens
• Lymphatics
• Autonomic nerves
• Processes vaginalis
• Ilioinguinal nerve
Male
• Round ligament of uterus
• Genital branch of genitofemoral nerve
• Lymphatics
• Sympathetic plexus
FEMALE

11. THERE ARE TWO TYPES OF INGUINAL HERNIA
Indirect inguinal hernia
oOrigin : lateral to the inferior epigastric
artery.
oContents : sac of peritoneum (coming
through internal ring through which
omentum or bowel can enter)
oIt is common in males because of the
space allowed for the testicles to
descend
oHigh risk in young people and 50 to 60
years of age.
Direct inguinal hernia
oOrigin :medially to inferior
epigastric vessels.
oContents: retroperitoneal fat
(mainly), less commonly peritoneal
sac containing bowel.
oIt is common in elders
oIt develops in weak areas giving to
a congenital deficiency in number
of fibres it contains.

12. FEMORAL HERNIA
Defect is in transversalis fascia overlying the femoral ring at the entry
to the femoral canal.
The hernia passes
through the femoral
canal and present in
the groin below and
lateral to the pubic
tubercle.

13.  More common in females
 Higher risk of strangulation
 It begins as plug of fat in femoral
canal that enlarges and gradually pulls
the peritoneum and inevitably the
urinary bladder into sac.

14. UMBILICAL HERNIA
This occurs in children because of incomplete closure of the
umbilical orifice.
The majority close spontaneously during the first year of life
PARA UMBILICAL HERNIA
It occurs just above or just below the umbilicus and is more
common in obese females .
Predisposing factors include multiple pregnancies and obesity
.
The neck of the sac usually narrow and therefore there is a
high risk of strangulation.
The most common content is omentum the transverse colon
and small intestine.

15. PARAUMBILICAL HERNIA

16. INCISIONAL HERNIA
Occurs through a defect in the scar of previous abdominal incision.
 Caused due to post operative problem such as post-operative Wound infection,
inadequate nutrition, extreme distension ,obesity and raised intra-abdominal
pressure postoperatively (coughing ,straining Etc.)

17. HIATAL HARNIA
Part of stomach protrudes up into chest.
It is of two types -
1. Sliding hernia: The gastro-
esophageal junction itself slides
through the defect into chest.
2. Para-esophageal Hernia:
Juncion remains fixed.
Other portion of stomach moves
up.
More dangerous as allows
stomach to rotate and obstruct.

23. Defects in the muscular wall maybe congenital and due to weakened
tissue or a wide space at the inguinal ligament or May be caused by
trauma. Intra abdominal pressure increases with pregnancy ,obesity ,heavy
lifting, coughing and traumatic injuries from blood pressure . when two of
these factors coexist with some tissue weakness a hernia may occur.
Increase pressure without a weakness is not likely to cause a hernia.
Weakness in addition to being present from birth is acquired as part of the
aging process. As clients age muscular tissue become infiltrated and are
replaced by adipose and connective tissue.

25. CLINICAL
MANIFESTATION
◦ Bulge or lump
◦ coughing
◦ fever
◦ pain
◦ discomfort when coughing or lifting
◦ weakness
◦ burning
◦ Gurgling
◦ itching sensation
◦ vomiting
◦ Swelling
HOW HERNIA
CAN BE
DIAGNOSED
• Physical
examination
• Ultrasound
• endoscopy x-ray

26. MANAGEMENT
MEDICAL MANAGEMENT
◦ Truss is an appliance with a pad and belt that hold
strongly over hernia. Parastomal hernia is managed with
hernia support belt with velero.
SURGICAL MANAGEMENT
◦ Recommended to correct hernia
◦ Herniorrhaphy
◦ Hernioplasty

27. TRUSS

28. Nursing
Assessment
Ask hernia is enlarging and
uncomfortable reducible or
irreducible
Assess bowel sound
Assess strangulation
Assess intake and output by
charting
Assess for pain

29. NURSING
DIAGNOSIS
◦PRE-OPERATIVE DIAGNOSIS
◦ Diagnosis 1 : chronic pain related to bulging hernia.
◦ Goal : to achieve comfort.
◦ Intervention :
Provide trendelenburg’s position.
Evaluate for signs of nausea, distension , fever , hernia
strangulation
Apply ice or cold compression
Provide supportive belt or truss
Insert NG tubes for incarcerated hernia.

30. DIAGNOSIS 2

31. DIAGNOSIS 3

34. DIAGNOSIS 6
◦ ineffective breathing pattern related to
cough
◦ Goal : to help patient reduce cough and
improve breathing pattern .
◦ Intervention :
Place patient to proper body alignment for
maximum breathing pattern
provide respiratory medications and oxygen
per doctors order
encourage small frequent meals.
encourage frequent rest period and teach
patient pace activity.

35. DIAGNOSIS 7
◦ Acute pain related to surgical repair
◦ Goal:client will express feeling of
comfortable and reduce pain.
◦ Intervention:
Assess incision pain
Adminster analgesic
Maintain position of comfort
Apply ice pack
Change position
Educate relatives

36. COMPLICATION
◦Untreated hernia may grow &
cause more pain
◦Bowel obstruction cause
constipation or nausea
◦Swelling and pain in the
surrounding area
◦Strangulation can occur
◦Parts of intestine get blocked
and produce pain

37. PREVENTION
Not smoking
Maintain a healthy body weight
regular check up
Avoid heavy lifting
avoid Coughing

38. LIFESTYLE
Avoid large and heavy meals
avoid Harsh travelling to prevent pressure
gas forming food should be avoided
do exercise
eat foods rich in high fibre example fruits and vegetables

39. HOME CARE
Herbal supplements
gentle exercise
deep breathing
avoid heavy lifting for 6 to 8 hrs
Self massage
wear loose and comfortable clothes
follow high fibre diet rich in protein and vitamins
aloe vera
ice cream should be apply

40. Health education
APPLY ICE IN SWELLING
REGION.
TEACH TO MAINTAIN
SELF FOR SIGNS OF
INFECTIONS PAIN,
DRAINAGE FROM
INCISION AND TEMP
ELEVATION
HEAVY LIFTING SHOULD
BE AVOIDED
INFORM REGULAR
CHECK-UPS SHOULD BE
DONE
AVOID TIGHT CLOTHES
AVOID IMMEDIATE
EXERCISE AFTER EATING
MEALS FOR 2 TO 3
HOURS
APPLY ICE PACKS.

41. Research
Laparoscopy limit to lower surgical infection for hernia surgery
Published Date: May 15, 2019
A large retrospective study found that laparoscopic repair of umbilical hernias in patient with
obesity resulted in lower rates of wound complications that open repair even though the
laproscopic group had higher body mass index and rates of other key. Comorbidites , according to
results reported at the annual meeting of the society of the AMERICAN GASTROINTESTINAL
AND ENDOSCOPIC SURGEONS
“In patient with obesity , even though our laproscopic umbilical hernia ( UHR) group had an
overall higher BMI ; higher rates of diabetes , hypertension and current smoking status ; and
larger operative times , they experienced decreased post-operative wound complications ,
compared to the open repair group”. said “ Kristen William of trihealth in Cincinnati . The
retrospective cohort study evaluated 12,026 adult patients with BMI of more than 30 kg / m2 in the
American College of surgeons National Surgical quality improvement Program ( ACNSQCP)
database who had UHR in 2016 . Almost four times as many patients had open rather than
laproscopic surgery.

42. SUMMARY AND CONCLUSION
Today we all have discussed about hernia . In
this we all get to know its definition
,classification, etiology , nursing management ,
prevention & health teaching of HERNIA.

43. BIBLIOGRAPHY
BURNERS & SIDDHARTH : textbook of medical surgical
nursing 12th edition
Luckmann textbook of medical surgical nursing 4th edition
Clinical management for positive outcomes by joyce black 6th
edition patient 742 to 788
https//www.slideshare net / drsamehs/ henria genral