SCROTAL HERNIA Prepared by: Reymart B.

Bolagao, CvSU SN 2013

A hernia occurs when the contents of a body cavity bulge out of the area where they are normally contained. These contents, usually portions of intestine or abdominal fatty tissue, are enclosed in the thin membrane that naturally lines the inside of the cavity. Hernias by themselves may be asymptomatic (produce no symptoms) or cause slight to severe pain. Nearly all have a potential risk of having their blood supply cut off (becoming strangulated).

When the content of the hernia bulges out, the opening it bulges out through can apply enough pressure that blood vessels in the hernia are constricted and therefore the blood supply is cut off. If the blood supply is cut off at the hernia opening in the abdominal wall, it becomes a medical and surgical emergency as the tissue needs oxygen which is transported by the blood supply.

 A scrotal hernia, or a hernia in the scrotal or groin area, is more correctly referred to as an inguinal hernia. The primary symptom of an inguinal hernia is a bulge in the groin or scrotum, thus the laymans reference to a scrotal hernia. A scrotal hernia occurs when tissue passes through thin or weakened spots in the groin muscle, which results in a bulge that may be painful or cause burning. Many hernias are the result of heavy lifting and are ten times more common in men than women. There are two types of inguinal hernia, direct and indirect, which are defined by their relationship to the inferior epigastric vessels. Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through a weak spot in the fascia of the posterior wall of the inguinal canal, which is formed by the transversalis fascia. Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring, lateral to the inferior epigastric vessels; this may be caused by failure of embryonic closure of the processus vaginalis. In the case of the female, the opening of the superficial inguinal ring is smaller than that of the male. As a result, the possibility for hernias through the inguinal canal in males is much greater because they have a larger opening and therefore a much weaker wall for the intestines to protrude through. Relationship toinferior epigastric vessels Covered byinternal spermatic fascia

Type

Description

Usual onset

protrudes through the inguinal ring and is ultimately the result of the failure of indirect inguinal embryonic closure of Lateral hernia the internal inguinal ring after the testicle passes through it

Yes

Congenital

direct inguinal hernia

enters through a weak point in the fascia of Medial the abdominal wall (Hesselbach triangle)

No

Adult

Hernia is classified into three types: Reducible, Hernias can be reducible if the hernia can be easily manipulated back into place Irreducible or incarcerated, this cannot usually be reduced manually because adhesions form in the hernia sac. Strangulated, if part of the herniated intestine becomes twisted or edematous and causing serious complications, possibly resulting in intestinal obstruction and necrosis. Hernia Causes and Etiology Although abdominal hernias can be present at birth, others develop later in life. Some involve pathways formed during fetal development, existing openings in the abdominal cavity, or areas of abdominal-wall weakness.

 Any condition that increases the pressure of the abdominal cavity may contribute to the formation or worsening of a hernia. Examples include obesity, heavy lifting, coughing, straining during a bowel movement or urination, chronic lung disease, and fluid in the abdominal cavity. A family history of hernias can make you more likely to develop a hernia. Hernia Manifestations The signs and symptoms of a hernia can range from noticing a painless lump to the severely painful, tender, swollen protrusion of tissue that you are unable to push back into the abdomen (an incarcerated strangulated hernia). Reducible hernia -It may appear as a new lump in the groin or other abdominal area. -It may ache but is not tender when touched. -sometimes pain precedes the discovery of the lump. -The lump increases in size when standing or when abdominal pressure is increased (such as coughing). -It may be reduced (pushed back into the abdomen) unless very large. Irreducible hernia -It may be an occasionally painful enlargement of a previously reducible hernia that cannot be returned into the abdominal cavity on its own or when you push it.

-Some may be chronic (occur over a long term) without pain. -An irreducible hernia is also known as an incarcerated hernia. -It can lead to strangulation (blood supply being cut off to tissue in the hernia). -Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting. Strangulated hernia -This is an irreducible hernia in which the entrapped intestine has its blood supply cut off. -Pain is always present, followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting). -The affected person may appear ill with or without fever. -This condition is a surgical emergency Treatment for Inguinal Hernia The choice of therapy depends on the type of hernia. For a reducible hernia, temporary relief may result from moving the protruding organ back into place. Afterward, a truss may be applied to keep the abdominal contents from protruding through the hernial sac. Although a truss doesn't cure a hernia, the device is especially helpful for an elderly or a debilitated patient, for whom any surgery is potentially hazardous. Herniorrhaphy is the preferred surgical treatment for infants, adults, and otherwise-healthy elderly patients. This procedure replaces hernial sac contents into the abdominal cavity and seals the opening. Another effective procedure is hernioplasty, which involves reinforcing the weakened area with steel mesh, fascia, or wire. Strangulated or necrotic hernia requires bowel resection. Rarely, an extensive resection may require a temporary colostomy

Nursing Diagnosis Primary Nursing Diagnosis: Pain related to swelling and pressure Primary nursing Outcomes: Pain, disruptive effects; pain level Primary nursing Interventions: Analgesic administration; pain management Nursing Outcome, Nursing Interventions, and Patient Teaching For Inguinal Hernia Common Nursing diagnoses found on Nursing care plan for Inguinocrotal Hernia Activity intolerance Acute pain Ineffective tissue perfusion: Gastro Intestinal Risk for infection Risk for injury Nursing outcomes nursing care plans for Inguinal Hernia The patient will perform activities of daily living within the confines of the disease process. The patient will express feelings of comfort. The patient's bowel function will return to normal. The patient will remain free from signs or symptoms of infection. The patient will avoid complications. Nursing interventions Nursing Care Plan For Inguinal Hernia

 Apply a truss only after a hernia has been reduced. For best results, apply it in the morning before the patient gets out of bed. Assess the skin daily and apply powder for protection because the truss may be irritating. Watch for and immediately report signs of incarceration and strangulation. Closely monitor vital signs and provide routine preoperative preparation. If necessary, When surgery is scheduled Administer I.V. fluids and analgesics for pain as ordered. Control fever with acetaminophen or tepid sponge baths as ordered. Place the patient in Trendelenburg's position to reduce pressure on the hernia site. After surgery, Provide routine postoperative care. Don't allow the patient to cough, but do encourage deep breathing and frequent turning. Apply ice bags to the scrotum to reduce swelling and relieve pain; elevating the scrotum on rolled towels also reduces swelling. Administer analgesics as necessary. In males, a jock strap or suspensory bandage may be used to provide support. Patient teaching home health guide Nursing Care Plan For Inguinal Hernia Explain what an inguinal hernia is and how it's usually treated. Explain that elective surgery is the treatment of choice and is safer than waiting until hernia complications develop, necessitating emergency surgery.

 Warn the patient that a strangulated hernia can require extensive bowel resection, involving a protracted hospital stay and, possibly, a colostomy. Tell the patient that immediate surgery is needed if complications occur. If the patient uses a truss, instruct him to bathe daily and apply liberal amounts of cornstarch or baby powder to prevent skin irritation. Warn against applying the truss over clothing, which reduces its effectiveness and may cause slippage. Point out that wearing a truss doesn't cure a hernia and may be uncomfortable. Tell the postoperative patient that he'll probably be able to return to work or school and resume all normal activities within 2 to 4 weeks. Explain that he or she can resume normal activities 2 to 4 weeks after surgery. Remind him to obtain his physician's permission before returning to work or completely resuming his normal activities. Before discharge, instruct him to watch for signs of infection (oozing, tenderness, warmth, redness) at the incision site. Tell him to keep the incision clean and covered until the sutures are removed. Inform the postoperative patient that the risk of recurrence depends on the success of the surgery, his general health, and his lifestyle. Teach the patient signs and symptoms of infection: poor wound healing, wound drainage, continued incision pain, incision swelling and redness, cough, fever, and mucus production. Explain the importance of completion of all antibiotics. Explain the mechanism of action, side effects, and dosage recommendations of all analgesics. Caution the patient against lifting and straining.