Client Initials:                                                                                   Name:
Medical Diagnosis: Hernia                                                                          Date:
  DEFINITION: A hernia is a protrusion of a viscus through an abnormal         RELATED DIAGNOSTIC TESTS: The diagnosis is based on history
  opening or a weakened area in the wall of the cavity in which it is          and physical examination findings
  normally contained. Ventral hernias occur on the abdominal surface
  usually in an area of previous surgery.
  ETIOLOGY: cause Ventral, or incisional, hernias occur due to a               MEDICAL MANAGEMENT:                     Surgery is the treatment of choice
  weakness of the abdominal wall at the site of a previous incision. It is     for hernias to prevent the possibility of strangulation. Surgical repair of
  found most commonly in patients who are obese, have had multiple             a hernia is known as herniaorrhaphy. Reinforcement of the weakened
  surgical procedures in the same area, or who have had inadequate wound       area with wire, fascia, or mesh is known as hernioplasty. Appropriate
                                                                               pain medications should be prescribed.
  healing because of poor nutrition or infection.
  PATHOPHYSIOLOGY: A ventral hernia is a defect or gap in the                  NURSING MANAGEMENT:
  abdominal muscle wall through which an intra-abdominal organ can             Observe for a distended bladder.
  protrude. A gap in the muscle can occur because of a weakness or a           Coughing is discouraged, but deep breathing and turning are encouraged.
                                                                               Incision should be splinted if patient needs to cough or sneeze.
  small tear.
                                                                               Patient should sneeze with mouth open.
                                                                               Observe surgical site for signs of infection.
                                                                               Administer analgesic medications as prescribed/necessary.
  SIGNS & SYMPTOMS: The most common symptom is a bulge or                      HEALTH DEVIATION SELF-CARE REQUISITES:
  swelling on the abdominal wall. The bulge can change in size and             Teach patient the importance of deep breathing and turning.
  become larger with exertion. There may be discomfort as a result of          Instruct patient in proper technique of splinting incision in case of cough
  tension; severe pain occurs if the hernia becomes strangulated (unable to    or sneeze.
  be put back into the abdominal cavity and obstructing the intestinal flow    Tell patient to sneeze with mouth open.
  and blood supply). In this situation, the clinical manifestations of bowel   Patient will require analgesic pain medications.
  obstruction (vomiting crampy abdominal pain, or distention) are found.       Teach patient that heavy lifting or physical activities should be restricted
  REFERENCE PAGES:                                                             for 6 to 8 weeks after surgical hernia repair.

  Medical-Surgical Nursing Clinical Companion
  Dirksen, Lewis, Heitkemper pg 301-302

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