HERNIAS P 1048 Protrusion of a viscus through an abnormal opening or a weakened area in the wall of the cavity in which it is normally contained Can occur anywhere but usually in the abdominal cavity Reducible hernias that return easily to the abdominal cavity Irreducible or incarcerated unable to be pushed back into the cavity o Can become strangulated due to obstructed blood flow acute intestinal obstruction GENDER DIFFERENCES Men o Inguinal hernias more common o Groin hernia risk is 25 in their lifetime Women o Femoral hernias more common o Groin hernia risk is less than 5 TYPES OF HERNIAS Inguinal hernia o Most common even more common in men o Occurs at the point of weakness in the abdominal wall where the spermatic cord men and round ligament women emerge o Indirect escapes through the inguinal ring and follows the spermatic cord or round ligament Femoral hernia o Direct escapes through the posterior inguinal wall o Protrusion through the femoral ring into the femoral canal o Bulge below the inguinal ligament o Strangulated easily o More common in women Umbilical hernia o Occurs when the rectus muscle is weak in obesity o Umbilical opening fails to close at birth Ventral or Incisional hernias o Weakness in the abdominal wall at the site of a previous incision o More common in patients who are obese have had multiple abdominal surgeries or poor wound healing due to poor nutrition or infection CLINICAL MANIFESTATIONS Readily visible especially when the abdominal muscles are tense Discomfort with tension Severe pain with strangulation o Symptoms of a bowel obstruction Vomiting cramping abdominal pain and distention NURSING AND COLLABORATIVE CARE History and physical examination to diagnose Surgery is treatment of choice and prevents strangulation o Herniorrhaphy outpatient procedure repair Laparoscopic in most cases o Hernioplasty reinforcement with wire fascia or mesh o Resection with or without temporary colostomy needed for strangulated hernias Truss pad held in place by a belt to keep hernia from protruding o Check for skin breakdown or irritation Postoperative o May have trouble voiding observe for bladder distention Strict I O o Scrotal edema may occur Very painful use ice and support for comfort o Deep breathing exercises NO COUGHING Splint area with coughing or sneezing o Heavy lifting restriction for 6 to 8 weeks
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