Hernias

A hernia occurs when the inside layer of the abdominal wall weakens, resulting in a bulge or a tear. Hernias can occur in a number of places, most commonly in the abdomen, groin, umbilicus, or at the site of a previous operation. Some hernias are congenital, while others occur over time as a result of heavy lifting, persistent coughing, or difficulty in bowel movements or urination. The signs and symptoms of a hernia may include: a bulge under the skin, pain with lifting or coughing, pain associated with straining during urination or bowel movements, pain after prolonged sitting or standing.
Hernias are repaired by implanting a sterile surgical mesh to strengthen the weakened abdominal wall. An incision is made in the abdominal wall that goes through the skin, an underlying fatty layer and into the abdomen. Sutures, which go through the entire thickness of the abdominal wall, are placed through smaller incisions around the circumference of the mesh.
Pre-op - Make sure it’s the right patient; check name, date of birth, medical record number, scheduled operation (site, side and nature) and written consent. It is recommended that the patient showers the night before of the operation. Ensure the patient is NPO and the bladder is emptied. Check for the taking of over-the-counter medications, alternative, illicit drugs or alcohol use, as these can also cause serious complications. Medications may also indicate the nature of concurrent illnesses that the patient my have neglected to talk about. Drugs such as aspirin, anticoagulants, anti-inflammatory medications and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery. In this case, there was no pre-op medication given. Assess patient’s record on previous surgeries, allergies, previous exposure to anesthesia –agents used and any adverse reactions. The main goal is to evaluate patient’s general health and prevent possible complications.
Intra-op - When I entered the operating room, the first patient was already positioned on the operating table in the supine position, with an IV running, connected to a cardiac monitor-which kept track of his vital signs. The circulating nurse was working with an intra-operative checklist. The patient’s chart also included a pre-operative assessment checklist, a signed informed consent and an anesthesiologist’s assessment. The team was waiting for the anesthesiologist to administer spinal anesthesia so that in 10 minutes the surgery could begin. The operating room nurse confirmed that the patient is mobile, and was psychologically prepared for the surgery pre-op.
What does the operating room look like? The operating table is positioned in the center of the room. It can be raised, lowered or tilted in any position. There is a operating lamp allowing for illumination without shadows during surgery. An anesthesia machine stands by the head of the operating table. Sterile operating instruments that are to be used during surgery are systematically arranged on a stainless steel table.
The surgical team included:
The surgeon – runs the procedure
Surgical assistant – helps suture the wound, performs wound suctioning
Anesthesiologist – administers anesthesia, infuses IV fluids, monitors the patient’s alertness and physical status
Operating room nurse – assists with positioning of the patient, skin preparation, assists all team members, writes up all the paperwork (pre- and intra- operative). At the end of the surgery she counts all instruments, needles, sponges and 4x4’s
Scrub nurse – handles instruments including everything that’s arranged on the sterile field.
Post-op Once surgery is completed, the patient is transported on a stretcher to the recovery room. The length of time spent in recovery largely depends on the type of surgery performed and the individual patient. For this particular patient, the patient was expected to be discharged as soon as his pain is controlled, vital signs are stable and he’s able to walk without dizziness.
While the patient is in recovery, the nurse monitors the following:
1) vital signs- blood pressure, pulse rate, respiratory rate, breathing rate, temperature and pain
2) for signs of complication - hemorrhage, shock, wound complications
3) checks for gag reflex and level of consciousness
4) monitors IV infusions ( Lactated Ringer’s solution at 100 ml/hr)
5) monitor patient’s bladder distention
6) checks if he is able to move his lower extremities
7) maintains the patient’s comfort with pain medication and body positioning
The patient was alert and oriented x 3 with stable VS. Airway clear, unlabored breathing (RR=18). IV in (L) arm, Lactated Ringer’s solution infusing at 100 ml/hr. Patient was able to move his extremities, patient unable to change positions effectively, c/o pain at the incision site (3 out of 10), fatigue and general weakness.
Nursing Diagnoses:
1) Acute pain RT surgery AEB patient c/o pain (3 out of 10).
2) Impaired physical mobility RT pain and fatigue, 2to surgery, AEB inability to change position on his own and general weakness.
3) Impaired skin integrity RT surgical incision 2to herniorrhaphy, AEB scar –LRQ.
Most patients are in the hospital 7 to 10 days with an open hernia repair, and may need a ride home when discharged form the hospital. As with any surgery, there are risks such as bleeding, infection, or an adverse reaction to the anesthesia. Other risks include injury to the bowel or a reoccurrence of the hernia. The patient is encouraged to call the doctor if any of the following symptoms appear: fever or chills, persistent nausea or vomiting, drainage from the incision, inability to urinate, or prolonged soreness. www.PassNurseExams.com