“I can’t lift too much or pull cause I have a hernia!” I’m sure that you’ve heard someone saying this at some point. In fact, a Hernia is a very common problem amongst older adults.
Let’s start by understanding what a Hernia actually is and why it happens.
A hernia is caused by a small “tear or weak part” in the abdominal muscle or tissue. Because of this, the abdominal organs start to “fall through” it, and they create a bulge that can often be seen under the skin. The surgery is then done, to push the organs back to place and repair the weak part of muscle or tissue.
Now in most cases, a Hernia Repair Surgery is done as an elective surgery a few weeks after the diagnosis. However, there are 2 instances where a Hernia may become a Life-Threatening condition, and surgery is needed immediately. These situations are known as:
Incarcerated Hernia: The intestines fall through the hernia and become trapped, blocking the faeces from reaching the anus. This blockage will cause a lot of pain, vomiting and abdominal swelling.
Strangulated Hernia: Eventually, if an Incarcerated Hernia is left untreated, it will continue to swell up. This swelling will make a “tight ring” around the intestines, and so it reduces the blood flow, which may cause Gangrene (aka. Tissue Death).
How are you doing so far? All good? There’s another thing that you need to know before we talk about preparing your patient.
A Hernia may occur in several different areas:
– Inguinal: In the Groin or scrotum
– Femoral: From the lower belly into the upper thigh
– Umbilical: Near the navel
– Incisional: In the abdomen post-surgery
– Epigastric: Fat pushing through a weak part of the abdominal wall
Pre-Operative Nursing Care for Hernia Repair
Pre-Operative Nursing Assessment
Start by having a chat with your patient to establish a safe and therapeutic relationship. While having the conversation, make sure to ask specific questions that will explain your patient’s situation. So, ask your patient:
How he feels about the diagnosis
Whether he knows how the surgery works, and why it’s being done
If it’s affecting his everyday life
Is he experiencing any pain or discomfort
Whether he needs any psychological or emotional support
If he has a relative or friend who can support him
Pre- Operative Nursing Diagnosis for Hernia Repair
Having finished the conversation, you can now build your nursing diagnosis, and you’ll most likely find the following:
Lack of knowledge about the surgery
Fear from having the surgery
Concern about limited physical activity
Inadequate fluid volume in Incarcerated/ Strangulated Hernia
Pre-operative Nursing Interventions for Hernia Repair
1. Education about Hernia Repair
Naturally, when patients first find out that they need to have surgery, they feel anxious, confused, and lost. So the information given to them at the first appointment is rarely absorbed.
As a nurse, you play a significant role in effectively educating your patient and addressing any questions. Start by giving him an overview of the surgery, what he can expect before, during and after the Hernia Repair. Moreover, you should advise your patient that he won’t be able to lift heavy things or drive for a couple of weeks.
Lastly, reassure your patient that the post-operative pain will be addressed through analgesia and supportive measures.
2. Managing Anxiety & Fear
Pre-operative anxiety and fear can arise from many factors. Particularly in a Hernia Repair patients often feel scared of how the surgery will affect their lifestyle. Reassure your patient, that he will be able to return to his normal daily activities within 4-6 weeks after the surgery.
Encourage your patient to verbalise his fears and answer any questions that he might have. Explain to him that he can contact you or the clinic at any time if he wants. Advise your patient that you have additional healthcare staff who can help him, including social workers, spiritual advisors, psychologists and support groups.
3. Managing Symptoms
Depending on which type of hernia your patient has, he might experience different symptoms. Such as pain, vomiting and constipation. In such cases, you should discuss your patient’s symptoms with the doctor to formulate a plan of medications that can ease the symptoms.
4. Preparation on the Day of Surgery
The final step is to make sure that your patient is ready for surgery from the medical perspective. Your patient should be starved for at least 6 hours before the surgery, and make sure that he is kept hydrated through adequate IVI infusions.
Check that the incision site is marked and confirm whether shaving is required.
Finally, make sure that your patient has the following:
Allergy Bracelet (if applicable)
Changed into a hospital gown and removed her underwear
Removed all jewellery/ foreign teeth/ hearing aid/ contact-lenses/ glasses/ make-up
Before going down to the Operating Theatre, your patient’s file should have:
All medical notes and treatment charts
A signed consent form
Pre-operative medical assessment
An ECG done in the last 2weeks
Blood results, and Blood type from the past 3 days (often found online)
Post-Operative Nursing Care for Hernia Repair
Post Hernia Repair Nursing Assessment
Start by having a quick chat with your patient to determine his consciousness level. While having the conversation, ask him if he is in pain or feeling nauseous as these are expected after surgery. And you will also be assessing his airway and breathing patterns.
The next thing to do is to check:
Circulation in his hands and feet
Incision site (look out for swelling, bleeding, redness)
Before leaving his side, ensure that the environment is safe; Place the bed rails up and give the nurse call bell to the patient. Check that all IV lines are secure and that the drain and catheter are not kinked. Lastly, ask the patient if she wants a relative or a friend to be by his side.
Post-Hernia Nursing Diagnosis
The nursing assessment is likely to highlight the following nursing diagnoses:
Acute pain and discomfort
Lack of knowledge about preventing complications
Post-Hernia Nursing Interventions
1. Relieving Pain and Discomfort
Moderate to low pain is expected after a Hernia Repair, depending on which method was used. Particularly, if your patient had laparoscopic surgery, you should encourage him to mobilise and lay on his side. These will help her pass flatus and decrease abdominal distention.
Administer the prescribed analgesia regularly to keep your patient from experiencing spikes of pain.
2. Patient Education
Given that a Hernia Repair takes 4 – 6 weeks to heal fully, it is vital to educate your patient about home care. This will decrease the chance of experiencing post-operative complications such as surgical site infection, or a recurrent hernia.
You should tailor your methods according to the patient’s learning needs. Make use of images, videos and written notes to ensure that your patient can understand you.
Start by advising your patient to rest and engage in light physical activity when he returns home, heavy lifting and vigorous movements should be avoided. The incision site must be kept clean and dry, with regular check-ups at the clinic. Post-operative constipation can be avoided by eating a high fibre diet and plenty of water. This will decrease the pain associated with straining when passing stools.
Lastly, make sure to explain any medication that the patient has to take at home, such as analgesia or possibly anti-biotics.
Post Hernia Repair Discharge Planning
Before sending your patient home, make sure that:
Anxiety is under control
Pain and discomfort are minimised
The patient has verbalised knowledge of self-care at home
No Complications are present