GARDEN CITY UNIVERSITY COLLEGE

FACULTY OF HEALTH SCIENCES

DEPARTMENT OF NURSING
SURGICAL NURSING I
NURS 315
 Lesson Objectives

By the end of the lesson, students will:

• define hernia
• state the types of hernia
• Describe the clinical manifestations of a patient with hernia.
• Describe the nursing management of a patient with hernia.
HERNIA
 HERNIA
Hernia is a protrusion or bulging of a
viscus (cavity organ) or a part of it
through an opening or a weakened area
in the wall of the cavity in which the
organ is contained.
 HERNIA

Generally, a hernia mass is made up of 4

parts:
• The sac;
• Coverings of the sac;
• Content of the sac;
• Hernia ring;
 HERNIA
INCIDENCE
Hernia occurs in all age groups.
All races are affected. Both sexes are susceptible.
It is more common in men than women.
 HERNIA
CLASSIFICATION
Hernia may be classified into three;
Reducible Hernia
Strangulated
Irreducible Hernia
 HERNIA
AETIOLOGY
There are two main factors responsible for the causation of hernias:
A defect in, or weakness of the wall of the abdominal cavity which
predisposes one to it:
• Congenital
• Acquired
 HERNIA
AETIOLOGY
Repeated increased intra-abdominal pressure which precipitates the
protrusion of the viscus. The intra-abdominal pressure may be increased
by chronic cough, chronic constipation, heavy manual work, weight
lifting, and chronic urinary obstruction from urethral stricture, or
prostatic hypertrophy.
 HERNIA
RISK FACTORS
Chronic constipation Constant blowing of wind
Chronic cough instrument
Enlarged prostate, straining to Smoking
urinate Obesity
Heavy lifting Pregnancy
Fluid in the abdomen Surgery at some part of the body
Peritoneal dialysis
Poor nutrition
 HERNIA
PATHOPHYSIOLOGY
Hernias occur at certain sites which are abnormally weak, or weakened
by an operation.
When there is increased pressure inside the abdomen the internal organs
are pushed out and they protrude through the weakened abdominal wall.
The internal organs push against the inner lining of the abdominal cavity
and the peritoneum through the weakened point on the abdominal wall,
and it forms a hernia sac.
 HERNIA
PATHOPHYSIOLOGY
Initially the sac may be small and reducible.
Later there may be narrowness of the sac, and constriction of the neck
may cause strangulation.
As the sac pushes through the subcutaneous layers of the abdomen it
is seen and felt to bulge under the skin.
TYPES
 HERNIA
TYPES OF HERNIA
Inguinal Hernia
This form of hernia is characterised by a bulge in the groin. It is more
common in men.
Femoral Hernia
This is a bulge in the upper part of the thigh just below the groin. This is
common in the females.
Umbilical Hernia
Mostly common in children and frequently disappears spontaneously by
two years of age.
 HERNIA
TYPES OF HERNIA
Incisional Hernia
This occurs mostly through scars; it occurs after an abdominal surgery
has been done. It may also occur as a result of an incompletely healed
surgical wound.
Hiatal or Diaphragmatic Hernia
It occurs in the upper part of the stomach when part of the upper
stomach pushes up into the chest cavity.
 HERNIA
TYPES OF HERNIA
Scrotal Hernia
Inferior Lumbar Hernia
Cerebral Hernia
NB. A Hernia may be said to be external, when it is seen and felt
outside the body; or Internal when it is within the body.
 HERNIA
CLINICAL MANIFESTATIONS
Sudden pain over the hernia.
Generalised abdominal pain.
Swelling.
Nausea and vomiting.
Tenderness around the swelling.
Weakness, pressure or feeling of heaviness in the abdomen.
Burning, gurgling at the site of bulge.
 HERNIA
DIAGNOSTIC INVESTIGATIONS
Physical examination: the patient may be asked to cough, bend,
push or lift and hernia may get bigger.
Ultrasound or CT Scans may be done to look for hernia.
X-ray of the abdomen may be done especially if there is blockage
in bowel.
 HERNIA
TREATMENT
 Non-operative Treatment:
 A large number of hernias are easily reduced as soon
as the patient lies down.
 After a firm pressure has been applied gently the
hernia is completely reduced, and a truss is applied.
 NB. A truss is an apparatus in the form of a belt with a
pressure pad, for retaining the hernia in place after
reduction.
 HERNIA
TREATMENT
Operative Treatment
Herniorrhaphy- excision of hernia sac and repair of defect.
Herniotomy-excision of the sac of the hernia
Hernioplasty- plastic repair of abdominal wall after reducing hernia.
 HERNIA
PRE-OP MANAGEMENT
Most Hernias are day surgeries. If the patient needs to be detained in the
hospital, they are discharged the next day.
Reassure the patient and introduce him/her to other patients recovering
successfully from the same procedure.
Remove all contraindicated items of surgery.
Fast patient over night to decrease the probability of vomiting during
surgery.
Patient and family education, explain anticipated post-operative activity
recommendations and limitations.
 HERNIA
PRE-OP MANAGEMENT
Educate on high fibre diet to prevent straining at stool post-operatively.
Ensure patient or relatives sign the consent form to serve as legal
backing.
Explain procedure to patient and reassure to allay fears and anxiety.
Position or place patient in bed with the lower part of the body elevated
to enable hernia gravitate into place in strangulated hernia.
 HERNIA
PRE-OP MANAGEMENT
Apply cold compress on the hernia.
Monitor vital signs.
Administer prescribed drugs.
Ensure all laboratory investigations are done and results are
collected for review.
 HERNIA
POST-OP MANAGEMENT
During herniorrhaphy, patient may undergo general anaesthesia, spinal
or epidural block, regional anaesthesia with sedation or local
anaesthesia without sedation.
Encourage patient to resume normal activities between 6-8 weeks post-
operatively.
Monitor vital signs.
Intravenous infusion is inserted for fluid replacement and medication
administration.
 HERNIA
POST-OP MANAGEMENT
Observe operation site for any bleeding.
Monitor patient for potential complications.
If urethral catheter is inserted, check to see if it is draining well.
Administer all prescribed medications which may include analgesics and
antibiotics.
Put patient in a comfortable position and start with fluid diet to normal
diet.
Emphasize patient education on coughing and sneezing techniques.
 HERNIA
POST-OP MANAGEMENT
Use aseptic techniques in dressing wound according to surgeon’s
protocol.
Encourage and assist with early ambulation.
Maintain adequate oral fluid intake without nausea and vomiting
before discontinuing IV fluids.
Educate patient on nutritious diet.
 HERNIA
COMPLICATIONS
Irreducibility
Strangulation
Recurrence
 REFERENCES

LeMone, P. Burke, K. (2004) Clinical handbook for medical-surgical nursing: critical thinking
in client care.
Prentice Hall Inc. New Jersey

Lewis, S. M., Heitkemper, M. M. Dirksen, S. R. Goldsworthy, S., & Barry, M. (2006).

Medical-
Surgical Nursing in Canada: Assessment and Management of Clinical, Mosby, Canada

Smeltzer, S. C. & Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner & Suddarth’s
Textbook of Medical-Surgical Nursing, 11th Ed. Lippincott Williams & Wilkins,
Philadelphia