Shane D.

Damian BSN 3 September 3, 2021

ACMH-OR/DR 1st Shifting

Disease Study
Definition of terms
 Anesthesia is a treatment using drugs called anesthetics. These drugs keep you from
feeling pain during medical procedures.
 Bulging- swelling or thrusting out from a surrounding or adjacent surface
 Umbilical- relating to the central region of the abdomen
 Omentum is a large flat adipose tissue layer nestling on the surface of the intra-peritoneal
organs. Besides fat storage, omentum has key biological functions in immune-regulation
and tissue regeneration.
 Herniorrhaphy refers to the surgical repair of a hernia, in which a surgeon repairs the
weakness in your abdominal wall.
 Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of
the abdomen (tummy) and pelvis without having to make large incisions in the skin.
 Hernial sac a protruding pouch of peritoneum that contains a herniated organ or tissue

 Incision is a cut through the skin that is made during surgery. It is also called a surgical
wound.

 Hiatal hernia occurs when the upper part of your stomach bulges through the large
muscle separating your abdomen and chest (diaphragm).

 Epigastric hernia is a lump in the midline between your umbilicus (belly button) and
sternum (breastbone) which can cause pain.
 Hernia

A hernia occurs when abdominal contents protrude through an opening in a weakened area of a
muscle. An umbilical hernia is the bulging of the intestine and omentum through the umbilical
ring as a result of incomplete closure following birth.
An inguinal hernia is the protrusion of intestine through the inguinal ring caused by a failure of
the vaginal process to atrophy to close prior birth allowing for a hernial sac to develop along the
inguinal canal.

Other types of hernias include:

 Femoral hernia.
 Umbilical hernia.
 Incisional hernia.
 Epigastric hernia.
 Hiatal hernia.

Incidence rate

Rate of incident inguinal hernia diagnoses between 2010 and 2019 among U.S. active component
service members was 34.3 per 10,000 person-years, with a modest decline over the surveillance
period. Among the 44,898 incident inguinal hernia diagnoses, 22,349 were followed by an open
or laparoscopic repair and among these, 6,276 (28.1%) had a pain diagnosis within 1 year.

Etiology
Some inguinal hernias have no apparent cause. Others might occur as a result of:

 Increased pressure within the abdomen

 A preexisting weak spot in the abdominal wall
 Straining during bowel movements or urination
 Strenuous activity
 Pregnancy
 Chronic coughing or sneezing

Risk Factors

Factors that contribute to developing an inguinal hernia include:

 Being male. Men are eight times more likely to develop an inguinal hernia than are
women.
 Being older. Muscles weaken as you age.
 Being white.
 Family history. You have a close relative, such as a parent or sibling, who has the
condition.
  Chronic cough, such as from smoking.
 Chronic constipation. Constipation causes straining during bowel movements.
 Pregnancy. Being pregnant can weaken the abdominal muscles and cause increased
pressure inside your abdomen.
 Premature birth and low birth weight. Inguinal hernias are more common in babies who
are born prematurely or with a low birth weight.
 Previous inguinal hernia or hernia repair. Even if your previous hernia occurred in
childhood, you're at higher risk of developing another inguinal hernia.

Complications

Complications of an inguinal hernia include:

 Pressure on surrounding tissues. Most inguinal hernias enlarge over time if not repaired
surgically. In men, large hernias can extend into the scrotum, causing pain and swelling.
 Incarcerated hernia. If the contents of the hernia become trapped in the weak point in the
abdominal wall, the contents can obstruct the bowel, leading to severe pain, nausea,
vomiting, and the inability to have a bowel movement or pass gas.
 Strangulation. An incarcerated hernia can cut off blood flow to part of your intestine.
Strangulation can lead to the death of the affected bowel tissue. A strangulated hernia is
life-threatening and requires immediate surgery.

Lab/Diagnostic test
 An abdominal X-ray or CT scan may be ordered to look for a hernia and determine if it is
strangulated or incarcerated.

Medical and Surgical Management

Inguinal hernia repair is a common surgical procedure. Inguinal hernia surgery is also called
herniorrhaphy or hernioplasty. There are 3 types of inguinal hernia repair:

 Open hernia repair: A surgical procedure in which an incision, or cut, is made in the
groin. The surgeon then pushes the hernia back into the abdomen and strengthens the
abdominal wall with mesh and stitches. This surgery may be done under local anesthesia
for the abdominal area, or general anesthesia in which you will be put to sleep.
 Minimally invasive or laparoscopic hernia repair: A less invasive surgical procedure in
which the surgeon makes small, half-inch cuts in the lower abdomen and inserts a
laparoscope (a thin tube with a tiny video camera attached). The laparoscope sends
images to a video monitor and the surgeon to repairs the hernia through the small
incisions.
 Robotic hernia repair: Like laparoscopic surgery, robotic surgery uses a laparoscope, and
is performed in the same manner (small incisions, a tiny camera and projecting the inside
of the abdomen onto television screens).
 Robotic surgery differs from laparoscopic surgery in that the surgeon is seated at a
console in the operating room, and handles the surgical instruments from the console.
 While robotic surgery can be used for some smaller hernias, or weak areas, it can now
also be used to reconstruct the abdominal wall.

What are the risks of inguinal hernia repair surgery?

The risks of inguinal hernia repair include:

 Infection
 Bleeding
 Pain that is not relieved by medication
 Long-term complications are rare, but can include nerve damage or a return of the hernia,
which requires a second surgery.

2 Nursing Care Plans

Nursing Diagnosis 1: Acute Pain related to surgical repair

Subjective Cues: “ Makirot pa rin po ang tahi ko sa kanan pero wala naman pong sakit sa
bandang kaliwa ng sugat” as verbalized by the patient.

Objective Cues: Patient states that his abdominal pain level is 4 on a 0-10 point pain rating scale.

General objective: to promote comfort.

Specific objectives:
After 8 hours of nursing intervention the patient will able to:
 Express feelings of comfort and reduce pain as described using a pain scale.

Nursing Interventions and Rationales:

1. Assess the patient’s pain by using the 10 point pain rating scale.
Rationale: The client’s report of pain is the single most reliable indicator of pain.

2. Assess incision pain and nonverbal signs of pain such as crying, lethargy, facial grimace
Rationale: Determines the need for the initiation of analgesic therapy.

3. Maintain position of comfort.

Rationale: Facilitates comfort and decreases pain caused by the strain on incision.

4. Educate parents on the causes of pain and interventions needed to relieve it.
Rationale: Promotes understanding of treatments for pain postoperatively.

5. Explaining and teaching nonpharmacologic pain relief methods, such as breathing

exercise, music therapy, distraction and progressive relaxation before, after, and if
possible during painful activities.
Rationale: These relaxation techniques decrease oxygen consumption respiratory rate,
heart rate and muscle tension which interrupt the cycle of pain-anxiety-muscle tension.
Evaluation:
Goals met. After 8 hours of nursing intervention the patient was able to express feelings of
comfort and reduce pain as described using a pain scale.

Nursing Diagnosis 2: Deceased mobilization related to discomfort on operation site.

Subjective Cues: “Di pa ako masyado makakilos” as verbalized by the patient.

Objective Cues:
 Irritable
General objective: to promote comfort.

Specific objectives:
After 4 hours of nursing intervention hours of the patient will able to
 Move willingly on his own.

Nursing Interventions and Rationales:

1. Provide comfort measures, quiet environment, and calm activities.

Rationale: To promote nonpharmalogical pain management.

2. Support and assist the client in doing such activities.

Rationale: to help patient do his activities.

3. Keep the area clean and dry, carefully dress wounds, support incision, prevent
infection.
Rationale: To assist natural body’s repair.

Evaluation:
Goals met. After 4 hours of nursing intervention hours of the patient was able to move willingly
on his own.

- Include the references of your work (APA Format) 

Andrew Gonzalez, M.D., J.D., MPH (September 11, 2017) healthline, Herniorrhapy
https://www.healthline.com/health/herniorrhaphy
Cleveland Clinic (September 30,2020). Anesthesia

https://my.clevelandclinic.org/health/treatments/15286-anesthesia

 Cleveland Clinic (September 27, 2018). Laboratory and Diagnostic Test, Risk Factors
https://my.clevelandclinic.org/health/diseases/16266-inguinal-hernia

Debra G. Wechter, MD, FACS(March 5, 2020).MedlinePlus, Incision

https://medlineplus.gov/ency/patientinstructions/000040.htm

Healtdirect(September 2020).Epigastric Hernia

https://www.healthdirect.gov.au/surgery/epigastric-hernia-repair-adult

Kathleen Romito MD(April 15,2020). University of Michigan Health, Hernia

https://www.uofmhealth.org/health-library/aba5300

Mayo Clinic (April 24,2021).Etiology, Risk Factors, and Complication

https://www.mayoclinic.org/diseases-conditions/inguinal-hernia/symptoms-causes/syc-20351547

Mayo Clinic( February 23,2021). Hiatal Hernia

https://www.mayoclinic.org/diseases-conditions/hiatal-hernia/symptoms-causes/syc-
20373379#:~:text=your%20chest%20cavity.-,A%20hiatal%20hernia%20occurs%20when
%20the%20upper%20part%20of%20your,before%20connecting%20to%20your%20stomach.

Merriam Webster (July 18,2021). Bulging

https://www.merriam-webster.com/dictionary/bulging

Merriam Webster (September 2, 2021).Hernial sac

https://www.merriam-webster.com/medical/hernial%20sac

Merriam Webster (August 24,2021).Umbilical

https://www.merriam-webster.com/dictionary/umbilical

NHS(August 1, 2021) Laparoscopy

https://www.nhs.uk/conditions/laparoscopy/

Shauna Stahlman, PhD, MPH; Michael Fan, PhD(September 1, 2020). Health.mil, Incidence
Rate
https://health.mil/News/Articles/2020/09/01/Update-Incidence-of-Inguinal-Hernia-MSMR-
2020?type=Infographics&page=3#pagingAnchor

Valerio Di Nicola (December 1,2019) Science Direct, Omentum

https://www.sciencedirect.com/science/article/pii/S2352320419300872