HEALTH EDUCATION

ON HERNIA
Submitted to : Submitted by:
Dr. B.Sudha Kayalvizhi.R
HOD cum Professor M.Sc (N) 2nd Year
Dept. of Pediatric Nursing Dept. of Pediatric Nursing
VMCON VMCON

Submitted on: 20-02-2021

 PROFILE

Name of the student teacher: Kayalvizhi.R

Subject : Pediatric nursing

Topic : Hernia

Group : Child mothers

Date of presentation : 21-02-2021

Time : 2-3pm

AV Aids used : PPT, flash cards

Name of the evaluator : Dr. B.Sudha

General objectives:
Help the group to gain in depth knowledge about hernia and also develop desired skill and attitude in providing child care.

Specific objectives:
At the end of the health education group will be able to-
◦ define hernia
◦ list out the types and classification of hernia
◦ discuss the causes and risk-factors of hernia
◦ explain the pathophysiology of hernia
◦ state the diagnostic findings of hernia
◦ discuss the management and prevention of hernia
Sl.no Time Specific Content Teaching/ AV Evaluation
objectives Learning Aids
methods
HERNIA
1 3 min discuss about Introduction:
regions of Discussing flash What
abdomen A hernia is an opening or weakness in the muscular structure of the cards activities
wall of the abdomen. This defect causes a bulging of the abdominal wall. causes
abdominal
This bulging is usually more noticeable when the abdominal muscles are: pressure?
tightened, thereby increasing the pressure in the abdomen. Any activities
that increase intra-abdominal pressure can worsen a hernia: examples of
such activities are lifting, coughing, or even straining to have a bowel
movement.
Definition: Explaining/
2 2 min define hernia Listening What is
A hernia is protrusion of an organ or the muscular wall of an organ PPT hernia?
through the cavity that normally contains it. It is an abnormal protrusion of
the intestine or other abdominal organ through a weakness or defect in the
musculature into another cavity.

3 2 min Incidence:
discuss the
Generally, most of the hernias occur in the groin in adults (75%). Discussing
incidence of Which type
hernia Approximately 90% of all inguinal hernia occur in males. Umbilical PPT of hernia is
hernias usually occur in infants and reach their maximal size by the first more
common in
month of life. males?
4 2 min list out the
Types of hernia:
types of hernia Discussing/ PPT What are the
There are many different kinds of hernias that are able to affect
Listening three types
different areas of the body. Each hernia will be one of three types; of hernia?
reducible, irreducible, and strangulated.
1. Reducible hernias: When the hernia is reducible it has the ability to be
pushed back inside of the abdominal cavity. This allows people to
remove the lump that is showing through and to help control it for a little
while. Many people with this type of hernia will wear a special hernia
belt to keep it in at all times. 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. It may
be reduced (pushed back into the abdomen) unless very large.
2. Irreducible hernias: When a hernia is irreducible it means that you do
not have the ability to push the mass back inside of the abdominal cavity.
This is probably because the mass is lodged into place and is too large
or blocked in by other intestines. Many people prefer to treat the through
surgery as soon as possible to avoid it becoming a strangulated hernia.
It may be an occasionally painful enlargement. Some may be chronic
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.
3. Strangulated hernias: When the hernia is strangulated surgery is only
the option. This is when the hernia has become twisted with an intestine
and is cutting off its blood supply. This will cause ischemia, and later
necrosis and gangrene and the intestine will die within a few hours if
surgery is not performed. This is an irreducible hernia in which the
entrapped intestine has its blood supply cut off. Pain is always present,
to allowed quickly by tenderness. Sometimes symptoms of bowel
obstruction nausea and vomiting) The affected person may appear ill
with or without ever. This condition is a surgical emergency.

5 6 min explain the Classification of hernia: Discussing/ PPT How are

classification listening hernia
A hernia occurs when the contents of a body cavity bulge out of the
of hernia classified?
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 can be classified
according to their anatomical location:
1. Inguinal hernia: An inguinal hernia occurs in the groin (the area
between the abdomen and thigh). It is called "inguinal" because the
intestines push through a weak spot in the inguinal canal, which is a
 triangle shaped opening between layers of abdominal muscle near the
groin. Obesity, pregnancy, heavy lifting and straining to pass stool can
cause the intestine to push against the inguinal canal.
Inguinal hernias are divided into two different types, direct and
indirect.
a) An indirect hernia follows the pathway that the testicles made
during fetal development, descending from the abdomen into the
scrotum. Sometimes the hernia sac may protrude into the scrotum.
An indirect inguinal hernia may occur at any age.
b) The direct inguinal hernia occurs slightly to the inside of the site
of the indirect hernia, in an area where the abdominal wall is
naturally slightly thinner. It rarely will protrude into the scrotum.
Unlike the indirect hernia, which can occur at any age, the direct
hernia tends to occur in the middle-aged and elderly because their
abdominal walls weaken as they age.
2. Femoral hernia: A femoral hernia occurs in the area between the
abdomen and the thigh, and appears as a bulge on the upper thigh. It
occurs below the inguinal ligament. Femoral hernias are most common
in women, especially those who are pregnant or obese.
3. Umbilical hernia: An umbilical hernia occurs when the abdominal
wall is weakened the point of umbilical cord. Part of the small intestine
 passes through the abdominal wall at near the navel. Umbilical hernias
are most common in children.
4. Incisional hernia: In an incisional hernia, the intestine pushes through
the abdominal wall at the site of previous abdominal surgery. This type
is most common in elderly or overweight people who are inactive after
abdominal surgery. Even after surgical repair, incisional hernias may
return
5. Epigastric hernia: This type of hernia occurs as a result of a weakness
in the muscles of the upper-middle abdomen, above the navel. Men are
about three times more likely to have an epigastric hernia than women,
and the majority occurs in people between 21 and 50 years of age
6. Hiatal hernia: A hiatal hernia develops in a small opening in the
diaphragm through which the esophagus passes that allows the upper
part of the stomach to move up into the chest. It causes heartburn from
the stomach acid that flows back up through the opening.
7. Ventral hernia: This type of hernia occurs when scar tissue weakens
the abdominal wall such as following a surgical operation or following
trauma.
8. Obturator hernia: The obturator hernia occurs when part of the
intestine passes through the gap between the bones of the front of the
pelvis.
 9. Herniation of intervertebral disc: The nucleus of disc protrudes into
the annulus with subsequent nerve compression. Increased pressure on
the intervertebral discs, as produced by heavy lifting or lifting with
improper technique, increases the risk of herniation.

Causes and risk factors:

6 5 min list out the
causes and risk Any condition the intra-abdominal cavity may contribute to the Discussing PPT What are the
factors of main causes
formation of a hernia, including the following:
hernia of hernia?
Common causes of muscle weakness or strain that can lead to a hernia
include:

• a congenital condition that occurs during development in the womb

and is present from birth
• aging
• damage from an injury or surgery
• chronic coughing or chronic obstructive pulmonary disorder (COPD)
• strenuous exercise or lifting heavy weights
• pregnancy, especially having multiple pregnancies
• constipation, which causes you to strain when having a bowel
movement
• being overweight or obese
• fluid in the abdomen, or ascites
 Risk factors include:

• a personal or family history of hernias

• being older
• pregnancy
• being overweight or obese
• chronic constipation
• chronic cough (likely due to the repetitive increase in abdominal
pressure)
• cystic fibrosis
• smoking (leading to weakening of connective tissue)
• being born prematurely or with a low birth weight
6 5 min explain the Pathophysiology:
pathophysiolog Due to causes and risk factors
y of hernia Explaining/ PPT What is the
listening process of
Weakness in the muscular structure of the wall of the abdominal cavity hernia?

Bulging of the abdomen wall

Hernia
7 2min state the clinical Clinical manifestations: Discussing/ PPT What is
manifestations Answering regurgitatio
of hernia • Bulge or lump in the affected area. n?
• Discomfort or pain in the area.
• Heartburn.
• Trouble swallowing.
• Chest pain.
• A dull aching sensation.
• A sense of feeling full or signs of bowel obstruction.
• Indigestion.
• Frequent regurgitation (bringing food back up).
• Fever.
• Inability to move your bowels or pass gas.
• Nausea, vomiting or both.
discuss the Diagnostic evaluations:
8 3 min diagnostic Explaining/ PPT What are the
findings of • History collection listening different
hernia • Physical examination: check for bulging, ask patient to stand and radiological
tests to
cough or strain- because bulging can make a hernia more diagnose
prominent. hernia?

• Complete blood count

• Electrolytes, BUN and creatinine levels
• Urinalysis
 • Ultrasonography
• Upright chest radiograph
• CT scanning
enumerate the
9 10 min management of Management:
hernia It is generally advisable to repair hernias quickly in order to prevent Discussing/ PPT What are the
listening different
complications such as organ dysfunction, gangrene, multiple organ types of
dysfunction syndrome, and death. Most abdominal hernias can be surgical
procedure to
surgically repaired, and recovery rarely requires long-term changes in treat hernia?
lifestyle. For strangulated hernias, start broad-spectrum antibiotics.
Antibiotics are administered routinely if ischemic bowel is suspected.
1. Hernia Repair Surgery
Hernia repair is a surgical procedure to return an organ that
protrudes through a weak area of muscle to its original position. Hernia
repairs are performed in a hospital or outpatient surgical facility by a
general surgeon. Depending on the patient's age, health and the type of
hernia, patients may be able to go home the same day or may remain
hospitalized for upto 3 to 5 days
There are two types of hernia repair.
• A herniorrhaphy (surgical repair of hernia) is used for simpler hernias.
The intestines are returned to their proper place and the defect in the
abdominal wall is mended.
• A hernioplasty is used for larger hernias. In this procedure, plastic or
steel mesh (Decron) is added to the abdominal wall to repair and
reinforce the weak spot.
a. Femoral Hernia Repair: This procedure repairs a hernia that occurs
in the groin where the thigh meets the abdomen. An incision is made
in the groin area. The tissues are separated from the hernia sac, and the
intestines are returned to the abdomen. The area is often reinforced
with webbing before it is sewn shut. The skin is closed with sutures or
metal clips that can be removed in about one week.
b. Inguinal Hernia Repair: Inguinal hernia repair closes a weakness in
the abdominal wall that is near the inguinal canal. An incision made in
the abdomen, and then the hernia is located and repaired. The surgeon
must be alert not to injure the spermatic cord, the testes, or the blood
supply to the testes. If the hernia is small, it is simply repaired. If it is
large, the area is reinforced with mesh to prevent a recurrence. External
skin sutures can be removed in about a week.
c. Umbilical Hernia Repair: This procedure repairs a hernia that occurs
when the intestines bulge through the abdomen wall near the navel. An
incision is made near the navel. The hernia is located and the intestines
are returned to the abdomen. The peritoneum is closed, and then the
large abdominal muscle is pulled over the weak spot in such a way as
 to reinforce the area. External sutures or skin clips can be removed in
about 10 days.
d. Incisional Hernia Repair: Incisional hernias occur most frequently at
site of a scar from earlier abdominal surgery. Once again, the abdomen
is opened and the intestines returned to their proper place. The area is
reinforced with mesh, and the abdominal wall is reconstructed to
prevent another hernia from developing. External sutures can be
removed in about a week.
e. Hiatal Hermia: An incision is made in the abdomen or chest and the
hole or weakness in the diaphragm is located and repaired. The top of
the stomach is wrapped around the bottom of the esophagus, and they
are sutured together to hold the stomach in place. Sometimes the vagus
nerve is cut in order to decrease the amount of acid the stomach
produces External sutures can be removed in about one week.
2. Laparoscopy
Laparoscopy is a surgical procedure for hernia treatment in which a
fiber optic viewing tube and special instruments are used to repair the
hernia without making a large incision. This procedure requires less
recovery time than traditional hernia repair surgery. The possibility and
effectiveness of laparoscopic repair should be discussed with a doctor.
3. Reduction of Hernia
a) Provide adequate sedation and analgesia to prevent straining or
pain. The patient should be relaxed enough to not increase intra-
abdominal pressure or to tighten the involved musculature.
b) Place the patient supine with a pillow under his or her knees. Place
the patient in a Trendelenburg position of approximately 15-20° for
inguinal hernias.
c) Apply a padded cold pack to the area to reduce swelling and blood
flow while establishing appropriate analgesia.
d) Place the ipsilateral leg in an externally rotated and flexed position
resembling a unilateral frog leg position.
e) Place 2 fingers at the edge of the hernial ring to prevent the hernial
sac from riding over the ring during reduction attempts.
f) Firm, steady pressure should be applied to the side of the hernia
contents close to the hernia opening, guiding it back through the
defect.
g) Applying pressure at the apex, or first point that is felt may cause
the herniated bowel to "mushroom" out over the hernia opening
instead of advancing through it.
h) Consult with a surgeon if reduction is unsuccessful after 1 or 2
attempts; do not use repeated forceful attempts.
4. Supportive Truss
A garment known as a truss may be helpful if the hernia is reducible
and causes mild symptoms. A truss is an elastic band or brief that holds the
hernia inside of the abdomen and keeps the area flat. Wearing a supportive
truss can help stop a hernia from protruding, but cannot cure it.
Nursing management:
Preoperative Care
• Pre-tests: Before the operation, the patient will have blood and urine
collected for testing. X rays are taken of the affected area. In a hiatal
hernia, an endoscopy is done.
• Medications:
• Patients should meet with the anesthesiologist before the operation to
discuss any medications or conditions that might affect the
administration of anesthesia.
• Patients may be asked to temporarily discontinue certain medications
such as NSAIDS- aspirin, ibuprofen etc.
• Pre operative medications: Antibiotics (test dose should be done),
probiotics (perinorm) and proton pump inhibitors (rantac).
• NPO: The day of the operation, patients should not eat or drink
anything.
 • Skin preparation: Area of the abdomen to be operated should be
shaved properly
• Bowel preparation: They may be given an enema to clear the
bowels.
• Consent: Surgery consent should be obtained from the patient or
from the patient guardian after a thorough explanation on the surgery
and its outcomes.
• Support: Provide emotional and psychological support to the patient.
Postoperative Care
Postoperative day ‘0’
• Close monitoring of vitals and recording every hourly.
• Inspection at the surgical site and the drainage tube.
• Keeping patient at NPO
• Strict hourly maintenance of I/O charting.
Postoperative day ‘1’
• Inspection of peristaltic sounds, only after the bowel sounds returns
the diet should be started.
• Sips of water at first and only if patient doesn’t regurgitate/ choke the
water- liquid diet should be started.
• Inspection at the surgical site and the drainage tube.
• Close vitals and I/O chart maintenance.
Postoperative day ‘2’
• Soft solid diet should be started.
• Change of surgical dressing by maintaining aseptic technique and use
of PPE.
• Change positions frequently.
• Teach the use of spirometry and educate about its importance.
• Teach deep breathing exercise to prevent postoperative
complications such as blood clots, fluids in the lungs and pneumonia.
• Encourage client for early mobilisation.
Postoperative day ‘3’
• Start solid normal balanced diet.
• Monitoring of vitals and I/O charting every 6th hourly.
• Strict aseptic technique maintenance of surgical dressing.
• Use of spirometry, performing deep breathing exercise and
mobilisation.
General postoperative instruction until discharge:
• They may bathe normally, using a gentle, unscented soap.
• An antibiotic ointment may be prescribed for the incision.
• Administer narcotics or non-narcotic pain medication to relieve pain.
After the operation, a hard ridge will form along the incision line.
With time, this ridge softens and becomes less noticeable.
 • Patients who remain in the hospital will have blood drawn for follow-
up studies.
• Patients should begin easy activities, such as walking, as soon as they
are comfortable, but should avoid strenuous exercise for four to six
weeks, and especially avoid heavy lifting.
• Instruct the patient to avoid wearing tight or rough clothing. It may
rub incision and make it harder for them to heal.
• Learning and practicing proper lifting techniques is an important part
of patient education after the operation.
• Patients may be given a laxative or stool softener so that they will not
strain to have bowel movements.
• They should discuss with their doctor when to resume driving and
sexual activity.
Nursing diagnoses:
• Acute pain related to surgical repair as evidenced by pain scale score.
• Hyperthermia related to infection as evidenced by monitoring of
temperature.
• Imbalanced nutrition less than body requirement related to loss of
appetite as evidenced by weight loss.
• Risk for infection related to presence of surgical site.
• Risk for injury related to intestinal obstruction.
 • Risk for fluid volume deficit related to post-operative status (NPO
status).
Prevention:
list out the
1. Maintain a healthy weight by performing exercise and diet plan.
10 2 min prevention of
hernia 2. Emphasize high-fiber foods. Fresh fruits and vegetables and whole Discussing PPT What is the
technique of
grains are good for overall health. They're also packed with fiber that
lifting
can help prevent constipation and straining. heavy
objects?
3. Lift heavy objects carefully or avoid heavy lifting altogether. If you
have to lift something heavy, always bend from knees, not from waist.
4. Stop smoking. In addition to increasing risk of serious diseases such as
cancer, emphysema and heart disease, smoking often causes a chronic
cough that can lead to or aggravate an inguinal hernia.
11 2 min discuss the Prognosis:
prognosis of Explaining/ PPT What is the
Many people are managed through day surgery centres, and are able
hernia listening prognosis
to return to work within a week or two, while intense activities are rate of a
person
prohibited for a longer period. People who have their hernias repaired with
diagnosed
mesh often recover within a month, though pain can last longer. Surgical with hernia?
complications include pain that lasts more than three months, surgical site
infections, nerve and blood vessel injuries, injury to nearby organs, and
hernia recurrence. Pain that lasts more than three months occurs in about
10% of people following hernia repair.
 SUMMARY:
In this health education we have discussed hernia – definition, incidence, types, classification, causes and risk-factors, pathophysiology,
clinical manifestations, diagnostic findings, management- medical, surgical and nursing management, prevention and prognosis.

CONCLUSION:
Hernia is a protrusion of an organ through the abdominal wall and it can be either a congenital problem as in a child or it may be an
acquired problem as in an adult. Hernias by themselves are usually asymptomatic, but nearly all have a potential risk of becoming strangulated at the
opening in the abdominal wall and having their blood supply cut off, it then becomes a medical and surgical emergency. To prevent this emergency
all hernias should be repaired surgically unless severe pre-existing medical conditions make surgery unsafe.

BIBLIOGRAPHY:
Book reference:
1. Wong ’Essential of pediatric nursing, first South Asia edition ,Elsevier publication in the year 2015.
2. IAP “Text book of Pediatrics” JAYPEE Brothers Publications, Fifth Edition.
3. RN Srivastava and SK Kabra, “Pediatrics A Concise Text” ELSEIER publications.

Websites:
https://en.wikipedia.org/wiki/Hernia
https://www.practo.com/health-wiki/hernia-causes-symptoms-and-treatment/38/article
https://www.mayoclinic.org/diseases-conditions/inguinal-hernia/symptoms-causes/syc-20351547
https://www.healthline.com/health/types-of-hernia