A hernia occurs when an organ or fatty tissue squeezes through a weak spot in the surrounding muscle or connective tissue called fascia. This nursing diagnosis focuses on identifying symptoms, managing pain, preventing complications, and preparing patients for potential surgical intervention.
Causes (Related to)
Hernias can develop due to various factors that increase intra-abdominal pressure or weaken supporting tissues:
- Chronic cough or COPD
- Pregnancy and childbirth
- Obesity or rapid weight gain
- Heavy lifting or straining
- Previous abdominal surgery
- Chronic constipation
- Family history of hernias
- Age-related factors such as:
- Weakening of abdominal muscles
- Loss of muscle tone
- Decreased tissue elasticity
- Contributing conditions including:
- Smoking
- Poor nutrition
- Diabetes
- Connective tissue disorders
Signs and Symptoms (As evidenced by)
Hernia presents with characteristic signs and symptoms that nurses must recognize for proper assessment and intervention.
Subjective: (Patient reports)
- Bulge or lump that may disappear when lying down
- Pain or discomfort at the hernia site
- Increasing pain with physical activity
- Pressure sensation in the affected area
- Nausea and vomiting (if obstruction occurs)
- Difficulty with bowel movements
- Pain during coughing or straining
Objective: (Nurse assesses)
- Visible protrusion at the hernia site
- Tenderness on palpation
- Changes in skin color over the hernia
- Inability to reduce the hernia
- Increased heart rate and blood pressure (if strangulated)
- Abdominal distention
- Decreased bowel sounds
- Signs of tissue compromise
Expected Outcomes
The following outcomes indicate successful management of hernia:
- The patient will report decreased pain and discomfort
- The patient will demonstrate proper body mechanics
- The patient will maintain optimal nutritional status
- The patient will avoid hernia complications
- Patient will understand warning signs requiring immediate attention
- The patient will demonstrate compliance with the treatment plan
- The patient will maintain regular bowel movements
Nursing Assessment
Physical Examination
- Assess hernia characteristics (size, location, reducibility)
- Monitor for signs of incarceration or strangulation
- Evaluate skin condition over the hernia site
- Document any changes in hernia appearance
Pain Assessment
- Evaluate pain intensity and characteristics
- Note aggravating and relieving factors
- Monitor impact on daily activities
- Document pain management effectiveness
Nutritional Status
- Assess BMI and weight history
- Monitor dietary intake
- Evaluate fluid balance
- Check for nutritional deficiencies
Activity Level
- Assess current physical limitations
- Evaluate occupational risks
- Document exercise habits
- Monitor activity tolerance
Complications Screening
- Check for signs of bowel obstruction
- Monitor for tissue compromise
- Assess circulation to the affected area
- Document any acute changes
Nursing Care Plans
Nursing Care Plan 1: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to pressure and tissue displacement from hernia as evidenced by verbal reports of pain, guarding behavior, and altered activity levels.
Related Factors:
- Tissue displacement
- Increased intra-abdominal pressure
- Inflammation
- Physical activity
Nursing Interventions and Rationales:
- Assess pain characteristics regularly
Rationale: Enables early detection of complications and evaluation of interventions - Teach proper body mechanics
Rationale: Reduces strain on hernia site and minimizes discomfort - Administer prescribed pain medications
Rationale: Provides comfort and enables participation in necessary activities
Desired Outcomes:
- The patient will report decreased pain levels
- The patient will demonstrate proper body mechanics
- The patient will maintain optimal activity level within pain limitations
Nursing Care Plan 2: Risk for Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to pressure and tension on tissue at the hernia site as evidenced by skin changes and compromised circulation.
Related Factors:
- Tissue distention
- Compromised circulation
- Pressure from hernia
- Mechanical factors
Nursing Interventions and Rationales:
- Assess skin condition regularly
Rationale: Enables early detection of tissue compromise - Maintain proper hygiene
Rationale: Prevents skin breakdown and infection - Monitor circulation to the affected area
Rationale: Ensures adequate tissue perfusion
Desired Outcomes:
- The patient will maintain intact skin integrity
- The patient will demonstrate proper skincare
- The patient will recognize and report signs of skin compromise
Nursing Care Plan 3: Risk for Ineffective Gastrointestinal Perfusion
Nursing Diagnosis Statement:
Risk for Ineffective Gastrointestinal Perfusion related to potential bowel obstruction or strangulation as evidenced by changes in hernia characteristics and gastrointestinal function.
Related Factors:
- Bowel entrapment
- Compromised blood flow
- Increased intra-abdominal pressure
- Tissue edema
Nursing Interventions and Rationales:
- Monitor bowel function
Rationale: Enables early detection of obstruction - Assess hernia reducibility
Rationale: Identifies potential complications - Monitor vital signs
Rationale: Indicates systemic response to complications
Desired Outcomes:
- The patient will maintain normal bowel function
- The patient will recognize signs of complications
- The patient will seek immediate care for warning signs
Nursing Care Plan 4: Activity Intolerance
Nursing Diagnosis Statement:
Activity Intolerance related to pain and restricted movement as evidenced by difficulty performing daily activities and decreased activity levels.
Related Factors:
- Pain with movement
- Fear of injury
- Mechanical restrictions
- Muscle weakness
Nursing Interventions and Rationales:
- Assess activity limitations
Rationale: Establishes baseline for activity planning - Teach energy conservation techniques
Rationale: Enables performance of necessary activities while minimizing strain - Develop a progressive activity plan
Rationale: Promotes gradual return to normal function
Desired Outcomes:
- The patient will participate in daily activities within limitations
- The patient will demonstrate proper body mechanics
- The patient will report improved activity tolerance
Nursing Care Plan 5: Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to unfamiliarity with hernia management and prevention as evidenced by questions about the condition and verbalized misconceptions.
Related Factors:
- Lack of exposure to information
- Misinterpretation of information
- Anxiety about condition
- Complex medical terminology
Nursing Interventions and Rationales:
- Provide education about hernia management
Rationale: Enables informed decision-making - Teach warning signs of complications
Rationale: Promotes early recognition and intervention - Demonstrate proper body mechanics
Rationale: Prevents hernia progression
Desired Outcomes:
- The patient will verbalize understanding of hernia management
- The patient will demonstrate proper preventive techniques
- The patient will identify warning signs requiring medical attention
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Baker, J. J., & Rosenberg, J. (2024). Primary and incisional hernias should be considered separately in clinical decisions and research: A nationwide register-based cohort study. Surgery, 176(6), 1676-1682. https://doi.org/10.1016/j.surg.2024.09.003
- Burcharth J. The epidemiology and risk factors for recurrence after inguinal hernia surgery. Dan Med J. 2014 May;61(5):B4846. PMID: 24814748.
- DeAngelo N, Perez AJ. Hernia Prevention: The Role of Technique and Prophylactic Mesh to Prevent Incisional Hernias. Surg Clin North Am. 2023 Oct;103(5):847-857. doi: 10.1016/j.suc.2023.04.021. Epub 2023 Jun 9. PMID: 37709391.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
