Dr.

Ibrahim Bashayreh RN, PhD

What is a hernia

Hernia is derived from the Latin for "rupture"

It is the protrusion of an organ or part of
an organ through a defecte in the wa of the
cavity normay containing it.
Hernia is classifed into three types:
! Reducibe, "ernias can be reducibe if
the hernia can be easiy manipuated bac#
into pace.

! Irreducibe or incarcerated, this cannot

usuay be reduced manuay because
adhesions form in the hernia sac.
! %tranguated, if part of the herniated
intestine becomes twisted or edematous
and causing serious compications,
possiby resuting in intestina obstruction
and necrosis.
Types of hernia
Inguinal
Indirect or indirect

Inguina hernias can be direct which is herniation

through an area of musce wea#ness, in the
inguina cana,

and inguina hernias indirect herniation through

the inguina ring. Indirect hernias, the more
common form, can deveop at any age but are
especiay prevaent in infants younger than age &.
'his form is three times more common in maes.

Femoral Herniation through the femora cana

Types of hernia

Incisional Herniation
through an area wea#ened by a scar

Umbilical

Paraumbilical
(c)uired defect above or beow the
umbiicus

Epigastric
in the midine of abdomen above the
umbiicus caused by a defect in inea aba.
Groin Hernias

Incidence:
*roin hernias are found in +, of mae popuation.
- Represents ./, of a hernia cases.
- It occurs + times more often in maes than
femaes.
- Inguina 0/, 1 indirect 2+,, direct 3+,4.
- Biatera in 35, of cases
- Right sided hernias are more fre)uent than
eft sided ones
- 6emora 7,.
!irect Inguinal Hernia

Incidence8 3+, of hernia cases

'he hernia contents enter the inguina cana.

'hese hernias are generay considered to be

ac)uired, and may be associated with heavy
ifting, straining due to constipation, coughing,
or prostatic enargement.
"ilateral Hernia

De9nition8 %imutaneous Right and Left

Inguina "ernia

:ommon in chidren and edery men

If a eft inguina hernia is present, there is a

3+, ris# of an occut right inguina hernia

#ymptoms
(. ;ften asymptomatic 1especiay in direct
hernias4
B. Pain or du sensation in groin
$omplications
(. Bowe incarc<ration 1 acute, chronic 48 'he
trapping of abdomina contents within the Hernia
itsef
B. %tranguation8 pressure on the hernia
contents may compromise bood suppy
1especiay veins, with their ow pressure, are
sensitive, and venous congestion often resuts4
and cause ischemia, and ater necrosis and
gangrene, which may become fata.
:. %ma Bowe ;bstruction
FE%&'() HE'*I(

I. Epidemiology
(. (ccounts for 7, of *roin "ernias 10/, are inguina4
B. =ore common in edery women
:. *ender predisposition8 6emae by > to & ratio
&. 6emora seen ess than Inguina "ernia even in
women

II. Pathophysiology
(. (ssociated with increased intraabdomina
pressure
B. "ernia sac buges into femora cana
. 6emora cana ies immediatey media to femora
vein
I*$I#I&*() HE'*I(

I. Pathophysiology
(. 'ype of ?entra "ernia
B. Deveops in scar of prior aparotomy or drain site
:. Ris#s for postoperative hernia deveopment
&. ?ertica scar more commony a@ected than
horiAonta
3. Bound infection
>. Bound dehiscence
7. =anutrition
+. ;besity
/. 'obacco abuse
Treatment &ptions

( hernias shoud be surgicay corrected to remove

the ris# of incarceration and stranguation.

If there are compeing co-morbid medica conditions

that precude surgery, then a truss, or support hernia
bet may be empoyed. ( truss does not repair the
hernia defect, but wi a@ord some reief of symptoms.

=odern methods of repair incude open primary cosure

of the defect with sutures 1%houdice or ":anadian"
Repair, Bassini Repair4C patch cosure with prosthetic
materias 1Poypropyene or *orteD4 tension-free
1Lichtenstein-type4 and aparoscopic repair.
(ssessment

Inspection may revea an obvious sweing in

the inguina area. If he has a sma hernia, the
a@ected area may simpy appear fu.

(s part of your inspection, have the patient ie

down. If the hernia disappears, itEs reducibe

(uscultation shoud revea bowe sounds.

'he absence of bowe sounds may indicate
incarceration or stranguation.

Palpation heps to determine the siAe of an

obvious hernia. It aso can discose the
presence of a hernia in a mae patient.
Primary Nursing Diagnosis8 Pain reated to sweing
and pressure
Primary nursing ;utcomes8 Pain, disruptive e@ectsC
pain eve
Primary nursing Interventions8 (nagesic
administrationC pain management
:ommon Nursing diagnoses found on Nursing care
pan for Inguina "ernia
(cti+ity intolerance
(cute pain
Ine@ective tissue perfusion8 *I
Ris# for infection
Ris# for inFury