REPORT INTRODUCTION A. understanding a.

Hernia is prostrusi of defective organ sobtained through the hole in the wall cavity orkonginetal which normally contains the organ.Most hernias occur in a place of abdominal cavity and involving the intestines. Curved intestine is pushed through holes defective as a result ofin creased intra-abdominal pressure (Barbara engram, p 212, 1999). b. A hernia is a defect in the abdominal wall that allows the abdominal contents (such as the peritoneum, fat, bowel, or bladder) into the defect, causing abnormal pouches containingmaterial (Dr.Jan Jackson, p. 140, 2000). It can therefore be concluded hernia is aprotrusion that is not normal from the organ through a defect or weakness of the wall cavity resulting from a congenital defect (conginetal) or obtained from the abdominal muscle weakness B. classification Hernia a. Hernias by location can be divided into: 1) Inguinal hernia is the protrusion of abdominal contents are visible in the area between the thighs (inguinal region) 2) A hernia is the protrusion the

umbilical in adults that occurred in the

abdominal wall above the umbilicus. 3) femoral hernia is a protrusion that occurs because the hole through the femoral and common in women than men. Femoral hole isinitially covered by the peritoneum and fat driven by the biological

urine ends up happening fragile and hollow allowing the occurrence of hernia due toin creased intra-abdominal pressure. 4) diafragmaticus hernia is a lump that occurs below the diaphragm. Usually caused by weakmuscles of the diaphragm due to aging. 5) scrotalis hernia is a lump that occurs in thescrotum by the inclusion of the small bowel oromentum. 6) umbilical hernia is the protrusion of abdominal contents that appear in the navel area. 7) the ventral or incisional hernia is theprotrusion of the healing process that occurs because of inadequate or after surgery due topostoperative infection, inadequate nutrition ordue to the harsh suppression. b. Hernia, by its nature can be divided into: 1) A hernia is a hernia that reponibel can still get out and go. Hernia will come out when standingor straining and came back when lying down orpushed in, there are no complaints of pain orsymptoms of intestinal obstruction. 2) irreponibel hernia hernia is when the contents of the bag that comes out can not be returnedinto the cavity. c. Hernia according to its contents can be divided into: 1) adipose hernia, hernia whose contents arecomposed of fatty tissue 2) Littre hernia is incarcerated or strangulatedhernia the gut wall are partially tr apped in thehernia ring. 3) Sliding hernia is a hernia contents becomepart of the pouch wall hernia

C. Type Hernia a. indirect Indirect inguinal hernia is a hernia of the abdominal contents out through the ring and goalong the inguinal diregio duktrus spermatikus inthe inguinal canal, and then exit the inguinal ring in subcutan. In the inguinal hernia there is a small bag into theinguinal canal. Sometimes the hernia bag thatgoes on and into the scrotum, it is called a herniascrotalis. Indirect inguinal hernia is more common in men than women, because men as a decrease in fetaltestis from the abdominal cavity. If the channeldoes not close the testis with a perfect, would be the way the passage of indirect inguinal hernia. b. Direct is a hernia through the posterioringuinal wall in the medial inferior epigastricarteries, which borders triganum bachii Hessel.Direct inguinal hernia can occur konginetal.

D. etiology Causes of hernia are: a. Konginetal or congenital defects b. Increased intra-abdominal pressure due topregnancy, obesity, lifting heavy objects andpressure due to coughing

c. Abdominal wall muscle weakness caused byheavy lifting work is done in a long-term d. age In humans, advanced age weakened supporting tissue E. The disease process

F. Clinical symptoms of Clinical signs and symptoms of hernia is determined by the state of the hernia contents. In the hernia reponibel only complaint was a lump in the groin

appeared on standing, coughing and sneezing orstraining, and disappeared after lying down.Complaints of pain are rarely found, if there isusually felt in the epigastrium or in the form ofvisceral pain due para umbical strain on any one segment mesentrium the small intestine into thepockets of hernia. Pain accompanied by nausea or vomiting occursonly emerged when incarcerated or strangulatedbecause of ileus due to necrosis or gangrene.Clinical signs on physical examination dependson the contents of the hernia. At the time of inspection the client can be seen straining the lateral inguinal hernia appears as a protrusion.May be felt on palpation of the bowel, omentum(like rubber) or ovaries. With the index finger orlittle finger on the child can be tried pushing the contents of the hernia by accentuating the external skin of the scrotum through the annulusso that it can be determined whether thecontents of the hernia can be repositioned. At thetime the finger is still in the external annulus,thus straining the client requested a lump or a state of asymmetry can be seen. G. complication The occurrence of adhesions between the contents of the bag wall hernias with herniahernia, so the contents can not be put back. This situation is called an inguinal hernia irreponibilis.In this situation there is no distribution of the contents of the intestinal disorder, the filteredcontents of the hernia is causing a stateirreponibilis omentum, because it is easilyattached to the wall hernias and their contentsmay become larger due to fatty infiltration. Can also cause hematoma, wound infection,especially in the femoral vein of the dam femoralhernia surgery.

. Medical management A. diagnostic tests Investigations carried out a complete blood count(hemoglobin, Haematokrit, Leukocytes, Platelets,bleeding Period, Period of suspension) 2. therapy Hernia can be treated by the Conservative andOperative Surgery or action. a. Conservative action Done by the client was laid with the feet higherthen in the groin area was given a cushion of sand in order to press for a hernia can go back.At the time of the actions of the client in a state of bedrest. Another way is to put the client with her feet up or lie down in a tub of warm waterand gently push the hernia mass toward theabdomen. b. Operative actions Hernia surgery is often performed for a large orhigh risk incarcerated, obstruction andstrangulated. Operation, called Herniotomya ction. Herniotomy is an operation to cure hernia with the hernia contents of the bag back into thenormal position and lift the bag hernia.Herniorrhaphy the liga tion surgery to remove ahernia and the removal of the bag and reduce ordecrease (cut) the size of the inguinal ring.

Hernioplasthy aims to provide reinforcement to the area / areas of weakness with the client's own fascia or synthetic mesh material. When ahernia that had been clamped (incarcerated)have spontaneously reduced, surgery can beperformed include investigating the abdomen todetermine vitabilitas of the small intestine. Thiscan be done in the same incision or with a separate vertical slices. There are a variety ofvariations in surgical technique depends on the location, size and number of soft tissue. Used in general anesthesia local anesthesia if hernianyavery large or strangulated her nia occurs thenused general anesthesia. Installation of NGT can be used to preventvomiting and abdominal distension inpostoperative or incisional umbilical hernia. NGTcan also prevent the occurrence of postoperativebloating stretch resulting in stitches. c. Pre Care Operations Surgical procedures usually have digestivesystems that are planned (elective) and sudden(Cito). If the client is given time has been planned to prepare a state of physical andpsychosocial. Psychosocial and physical support of clients is very important in terms of pre-operative. Prior to surgery the client has time toovercome the period of pain and discomfort. Mental and physical preparation the day before surgery: 1) Mental Preparation Clients will be operated normally be a bit nervousand scared. Clients do not want to talk and notpay attention to her surroundings, but

trying to turn its attention to other objects. Orotherwise he moves constantly and could not sleep. Clients should be told that during surgeryhe will not feel pain because anesthetists(anesthetic) will always be with him and tried to keep the client during the operation will not feel the pain as imagined. Tell also that before the operation the client will generally anaesthetized,spinal or local. 2). Physical preparation a). Food: the client which will be operated onlow-fat foods, but high in carbohydrates, protein,vitamins and calories. To maintain the entry of food in the body until the time of surgery arrived and immediately after surgery, the client needs tobe fed parenterally or also called an IV. Clientsmust fast 12-18 hours before the operation began. b). Lavamen / Klisma done to empty the bowel so as not to remove fecal material on the operating table. c). Oral hygiene: before the operation the mouthshould be cleaned and teeth brushed to preventinfection. d). Bathrooms have a shower prior to surgeryclients, nail brush and nail polish is removed so that anesthetists can see the discolorationclearly. e). Shaved area to be operated, place and extent of the shaved area in accordance with the type of operation to be performed. f). Rest and sleep: the night before surgery so that the client attempted to rest and sleepsoundly. g). Signed "informed consent". h). Consul physicians providing anesthesia forpremedication. 3. Treatment shortly before entering the operating room: Physical preparation on the day of surgeryinclude checking vital signs (blood pressure,temperature, pulse, respiratory). When the temperature increases reported to the doctor.Nonemergency surgery when fever, throat infection or are menstruating, it is usually put off by the surgeon or anesthetist. Clients will beoperated on transfer to the operating room on time. Told the client the morning shower, hairtied up and not allowed to wear hair clip. Aftertrimming the hair, covered with a clean cloth orsurgical cap. Replaced with a dress shirt specialclient operations. Valuables were used, released and handed over to his family. Before being taken to the operating room, the client was told tourinate in order not to wet the operating table orcut her bladder during the opening of the abdominal wall. If the client does

not urinate for fear of the catheter needs to be installed. Of pre-operative intervention to prevent the possibility of postoperative infection. Preparation of the surgery varies, and the preparation of the surgeon before the operation was performed under aseptic conditions.

When the surgery is done abruptly (Cito)preparations are made are not perfect. d. Post Operative Care assessment Observations made when the client arrives in the room, carried out continuously by the nurses inthe first 24-28 hours after surgery. 1) Vital Signs The main concern is likely related to hypovolemic shock from blood and fluid loss or reduction oftotal peripheral resistance. Increased secretion ofcortisol in the body associated with stress response and the vasoconstriction helps maintain blood vessel stability. Blood pressure and other vital signs are influenced by the response to pain. Increase in body temperatureexceeding 37 C is normal on the day I or II after surgery. After that period the increase in body temperature can identify the occurrence of respiratory tract infection and bleeding in the wound. Examination of vital signs every 15-30minutes or so when the client's condition has not been realized and vital signs have stabilized. 2) Injury Check the signs and symptoms of inflammation such as erythema, burning sensation in the area of injury or severe pain

The wound healing process: a) The acute inflammatory response to injury:including hemostasis, the release of histamine and other mediators from the damaged cells and the migration of white blood cells(polymorphonuclear leukocytes and macrophages) into the broken places. b) Phase destructively: clearance of dead tissueand leukocytes that had devitalisasi bypolymorphonuclear cells and macrophages. c) proliferative phase: that is, when new bloodvessels are strengthened by connective tissue,infiltrated the wound. d) maturation phase: includes re-epitalisasi,wound contraction and connective tissuereorganization. Factors that slow wound healing: a) Lack of blood supply and the effect of hypoxia b) Dehydration c) excessive exudate d) The fall in temperature e) Network necrotic, excessive crusting andforeign bodies f) Hematoma g) Trauma can be repeated h) Malnutrition i) Decreased resistance to infection

3) Intake and Output If the catheter is not used, time and distance of the small bowel should be measured and recorded. Depending on the type of surgery andthe condition of the client, the first urinationoccurred at 4-12 hours after surgery mayindicate retention of urine. Spending a little urinecan also be interpreted to dehydration and shock.Other expenditures must also be measured andrecorded, including what is in the NGT. Intakewas measured and recorded both intravenousand oral in a few days after surgery. 4) Comfort Specific assessment to determine if the pain isfrom the trauma of surgery or other possiblesources of the essential. Assessment of sleephabits and frequency patterns to help in planningneeds an appropriate break. 5) Assessment of Respiratory Assessment of breathing after surgery to helpcaregivers in determining normal and abnormalfrom the respiratory tract. Assessment before and after coughing and deep breathing the client can also help to determine whether exercise ineffective.