MANAGEMENT

Medical Management
> Antibiotics, e.g, Amoxycillin, Tetracycline or Clarithromycin
Antacids, e.g., Aluminium hydroxide.
Proton pump inhibitor, e.g, Lansoprazole, Omeprazole
H-blocker, e.g, Ranitidine
Antiemetic (For stop vomiting and nausea), e-g., Domperidone.
> Antimicrobial mostly DOC (Drug of Choice) is metronidazole.

Nursing Management
Administer IV fluids as prescribed
Provide clear fluids, liquids in small amounts when oral intake is resumed
diet as tolerated. and
Administer medication as prescribed if vomiting and
diarrhea, e.g.,
progres
antidiarrhoeal.
Instruct the patient not to take gastric irritants food, e.g., caffeine
and spicy foods.
antiemetics,
products, alcohol, hot
Nurse should administer medications as ordered, e.g., antacids,
analgesics
meperidine), anticholinergics.
Nursing Diagnosis
(morphine,
Risk for deficient fluid volume related to haemorrhage and
bleedingvia
Imbalanced nutrition less than body requirement related to changes in vomit and stool.
and altered absorption of nutrient.
Pain related to alteration in the continuity of gastric mucosa.
digestive process
Deficient knowledge related to disease prognosis, treatment self care and
Anxiety related to change in health status and disease process. discharge needs.
Note: for Nursing Intervention of above Nursing Diagnosis refer
page nos. 128-133.

ABDOMINAL HERNIA
INTRODUCTION
A hernia is the abdominal exit of an organ
resides. through the wall of the cavity in which it normally
Herni occurs when an internal part of the body pushes
of surrounding tissue wall or abdominal wall. through a weakness in the muscle
Symptoms are present in about 66% of people with groin hernias. This may include pain or
discomfort especially with coughing, exercise or going to the bathroom often it gets worse
throughout the day and improves when lying down. A bulging area may occur that
larger when bearing down. becomes
DEFINITION
A protrusion from cavity wall of any organ, tissue or structure is called Hernia. This is
seen in abdominal cavity. mostly
 Gastrointestinal Disorders and Its Management 95

CLASSSIFICATION((According to Area)
Hiatal Hernia/Diaphragmatic Hernia:.
a: Aprotrusion of a part of stomachinto oesophagus
1.
through diaphragm (see Fig. 7.5).
Inguinal Hernia: Hernia in inguinal canal (see Fig. 7.6). Itis oftwo types:
2. Indirect Hernia: When some part of intestine comes out from abdominal cavity and
also from inguinal ring.
Direct Hernia: It is direct comes out from abdominal wallexcept inguinal ring
3.
Femoral Hernia: Any part of intestine comes out from abdominal cavity through femoral
ring
Ventral/Incisional/Surgical IHernia: Hernia occurs due to only surgery or at site of surgery.
Tlubilical Hernia: It occurs when part of the intestine protrudes through the umbilícal
affect
openinginthe abdominal muscles. They are most common in infants but they can
adults as well.

Esophagus Small
intestine
Hiatal hernia
-Inguinal
Diaphragm canal

Direct inguinal hernia Indirect inguinal hernia

Stomach
Fig. 7.5: Hiatal Hernia. Fig. 7.6: Inguinal Hernia.

Femoral hernia

Herniated
intestine causing
visible bulge
Fig. 7.7: Femoral Hernia. Fig. 7.8: Ventral/Incisional/Surgical Hernia.

CLASSIFICATION (According to Severity)

Hiatal Hernia
to oesophagus.
Aprotrusion of any part of stomach through diaphragm
CAUSES
AAA Increases intra abdominal pressure
Weakness of muscles
Chronic constipation Surgery
> Poor nutrition Trauma
96 Medical Surglcal Nursing
> Heavy weight lifting
Old age > Ascites
>Excessive physical work or exercise
> Obesity.
> Pregnancy
CLINICAL MANIFESTATION (According to Classification)
In Sliding Hernia
> Heart burn up to 30 to 60 min. after meal.
In Rolling Hemia
> Dyspnoea > Pain like anginal pairn
Pain increase in supine positive and decreases in standing and sitting position
> Vomiting
In Strangulated Hernia
> Pain > Vomiting
> Swelling of hernial sac > Peritoneal irritation
Feve.

DIAGNOSTIC EVALUATIONS
> Chest X-ray > Barium meal test.

MANAGEMENT
Medical Management
> Antaid for heart burn, e.g, Magnesium
> Antiemetic for vomiting.
hydroxide.
Prokinetic agents, e.g., Metoclopramide (which induces movement, especially intestinal
activity).
Antihistamine.
Dietary Management
Advise to patient to avoid alcohol or caffeine and spicy food.
> Give blend diet.
> To give low fat diet.
Advise patient to take small and
To reduce reflex action, rise head frequent diet (4-6 times in a day).
of bed about 6-8 inch.
Surgical Management
> Nissen Surgery: Suturing of Hitus part.
> Herniorrhaphy: Surgical repairing of
Manual Hernria.
Reduction: Re-adjust to herniated organs by slight pressure.
Hernioplasty: The surgical operation to repair a hernia.
Nursing Management
2 Place the patient in
trendelenburg's
Instruct to take small frequent mealsposition to reduce pressure on hernia site.
a Encourage not to take
meals 2 hours before going to bed
Explain the surgical procedures to patient and family
Administer IV fluids and analgesics for pain control.
Avoid heavy weight lifing to avoid
unnecessary increase intraabdominal pressure.
 Gastrolntestinal Dlsorders and Its Management 97

Postoperative nursing care:

Assess for distended bladder - Deep breathe but no coughing
Splint incision when coughing or sneezing
To bags to scortal area to reduce swelling
Scortal and support.

NursingDiagnosis
o Imbalanced nutrition less than body requirement related to difficulty in swallowing-
ate pain related to dysphagia, ingestion of abrasive agent, a tumour or reflux.
Defcient knowledge related to treatment and rehabilitation.
Anxiety related to change in health status and disease process.
Note: for Nursing Intervention of above Nursing Diagnosis refer page nos. 128-133.
HEALTHEDUCATION
5A'S
Avoid smoking and alcohol > Avoid intake of heavy meal
> Avoid obesity. > Avoid tight clothing around abdomen
Avoid to take bed rest just after taking meal

ULCERATIVE COLITIS