A hernia is a condition where the internal organs or fatty tissues protrude through a weakened abdominal wall or surrounding tissue.
Signs and Symptoms of Hernia
Some patients might not experience any signs and symptoms in the early stage of hernia. The signs and symptoms will depend on what kind of hernia the patient has.
- a visible bulge in the affected area – this is the most common sign of hernia
- heartburn
- chest pain
- dysphagia or difficulty swallowing
- feeling of pressure in the affected area
- cough
In severe cases of hernia, these symptoms may be evident:
- constipation
- blood in the stool
- shooting pain at the site of the bulge becoming worse when standing, straining or lifting heavy objects
- nausea and vomiting
Types of Hernia
- Inguinal hernia. Among men, the inguinal canal is a short passage for the spermatic cord and blood vessels directed towards the testicles. In women, the inguinal canal consists of round ligaments that hold and support the uterus in place. An inguinal hernia happens when the intestine or the bladder bulges through the abdominal wall or into the inguinal canal in the groin. The bulge is in the area between the lower abdomen and the Inguinal area and may extend up to the scrotum. Inguinal hernia is the most common type of hernia, and mostly it affects men. Pain in the groin is experienced most of the time, commonly when bending over, coughing, and lifting heavy objects.
- Femoral hernia. This type of hernia happens when fatty tissue or a segment of the intestine enters the groin, carrying the femoral artery, and goes to the lower abdomen, on top of the inner thigh. This type of hernia is less common among men, but greatly affects older women, especially pregnant and obese. Most cases of femoral hernia never had any symptoms. Others may experience a lump in the upper thigh, and groin pain worsened by standing, lifting heavy items, and straining.
- Umbilical hernia. This occurs when part of the small intestine or an adipose tissue pushes around the abdomen closer to the belly button (periumbilical) or at the navel area. It is common among newborns, obese women, and mothers who had born many children. Symptoms include abdominal tenderness, and red, purple, dark-colored bulge. In newborn babies, swelling in the belly button area that goes noticeable when they cry and relieve when they relax or rest on their back.
- Incisional hernia. This commonly happens in an elderly or obese patient who had lesser physical activity after undergoing abdominal surgery. The intestines protrude to the abdominal wall at the site of a previous abdominal or pelvic surgical operation.
- Hiatal hernia. This is a condition in which a portion of the small intestine pushes up to the chest cavity through an opening in the diaphragm. The diaphragm is a muscle used for respiration, located between the chest and abdomen. Most of the time, hiatal hernia does not have any symptoms. In some cases, the patient may experience acid reflux or GERD-like symptoms which include heartburn, bloating and belching, stomach pain, and a bitter or sour taste in the throat due to acid reflux.
- Epigastric hernia. Bulging of the inner layer of the abdominal wall, between the navel and breastbone. It affects both men and women. Symptoms include a bulge in the upper abdomen, sharp pain that gets worse at the end of the day, and tenderness at the affected site.
Causes of Hernia
- Mechanical cause. Generally, all kinds of hernias result from a combination of pressure and weakened or opened abdominal muscles. The pressure pushes the tissue or small intestine through the opening or weak spot.
- Congenital cause. In some cases, weakness of the abdomen is already present at birth, and some appear in the later years.
- Pressure in the abdomen. As a result of lifting heavy items, diarrhea or constipation, persistent coughing or sneezing
- Obesity
- Malnutrition
- Smoking
Risk Factors to Hernia
- Genetic. Hernia can be inherited and may run in the family. Abnormality of the collagen strands that are genetic in the muscle and fascia could increase the possibility of hernia production. Some studies have demonstrated that patients with hernia have an increased possibility of mismatch of collagen, have more immature or weaker types of collagen, or have less strong and mature types of collagen. In some cases, those who have Inherited connective tissue diseases like Ehlers-Danlos and Marfan’s syndrome make a person more prone to developing a hernia.
- Biological sex. Inguinal hernia is more common among males, while umbilical hernia occurs mostly in women.
- Obesity. People with abnormal or excessive body fat and body mass index over 30 are considered obese. Obese people are more at risk of developing a hernia, usually after undergoing abdominal surgery and post hernia repair surgery.
- Work-related injuries. Jobs involving lifting heavy objects regularly have a greater possibility of developing a hernia. Due to increased pressure in the abdominal cavity when carrying heavy items.
- Frequent cough and/or having respiratory diseases like bronchitis and asthma. Patients who have frequent coughs secondary to smoking, bronchitis, asthma, COPD, acid reflux, or post-nasal drip are at risk of developing an inguinal hernia. When a person coughs, it raises the pressure in the abdomen and exerts a lot of pressure in the abdominal cavity much more than any heavy lifting activity.
- Smoking. Smoking induces coughing, thus it increases pressure on the abdominal wall. It also delays wound healing that may result in complications after hernia repair and recurrence of developing a hernia.
- Constipation. Straining related to constipation has a major role in increasing intra-abdominal pressure and increasing the risk of hernia formation. Also, a low fiber diet resulting in constipation is related to the increased risk of hernia.
- Prostate enlargement. Straining to urinate because of enlarged prostate also contributes to increasing intra-abdominal pressure. With this, a tendency to develop a hernia will follow.
- Sleep apnea. Sleep apnea has been correlated with increasing the risk of developing a hernia. The reason is still unknown, but some of the factors the study considers are poor oxygenation of tissues when breathing stops and pressure produced when snoring against a closed airway.
- Surgery. Post abdominal surgery complications such as infection, post-operative cough, poor wound healing related to diabetes and constipation increase the risk of developing an incision hernia.
- Ascites. a condition in which fluid accumulates in the intra-abdominal spaces, thus resulting in increased abdominal pressure and stretching out the holes in the abdomen. Liver failure is one of the most common causes of ascites.
Diagnosis of Hernia
- Physical assessment. During a physical exam, a bulge in the affected area can be seen or felt by the examining doctor. Most of the time, a hernia is more prominent when standing, straining, and coughing. With that, the patient is most likely to be asked to cough, strain, and stand when being assessed.
- Imaging tests. Secondary to physical examination, an imaging procedure like ultrasound, CT scan, or MRI of the abdomen is requested to have an accurate diagnosis.
Treatment for Hernia
The standard treatment for a hernia is conventional hernia repair through surgery. Although it is still possible for a patient to live with a hernia, provided that continuous monitoring is followed. However, the danger of becoming strangulated, infected, and tissue death may occur. The patient will be referred to a surgeon, if the surgeon’s assessment turns out that surgery is the best treatment for the patient’s conditions, methods of repair will be discussed accordingly. These two types of surgery can be an option:
- Open surgery. A cut is made into the body at the site where the hernia is located. The bulging tissue is put back in place and the weakened abdominal muscle is sutured together. Sometimes the surgeon will implant a mesh to provide extra support.
- Laparoscopic surgery. Just like open surgery, laparoscopic surgery for hernia repair repairs the bulging tissue and stitches back the weakened abdominal muscle. The difference is, that instead of having a cut on the skin outside the abdomen or groin, small incisions are made to let the surgical tools be inserted to complete the repair.
Prevention of Hernia
The following preventive measures can be part of the health teaching of nurses to patients who have hernia or are at risk of hernia:
- Keep a healthy body weight. Being overweight and obesity are some of the risk factors for a hernia. As extra body fat increases pressure in the abdominal wall, the greater the risk of developing a hernia. Proper weight management with a diet plan and exercise under the supervision of a doctor is advisable.
- Have enough daily physical activities. daily physical activity in certain ways may help reduce the risk of hernia. However, other types of physical activities that put too much pressure on the abdomen are not advisable. Recommended activities include yoga, pilates, sit-up or crunches, lightweights, running, and cycling.
- Eat high-fiber foods. Foods that are rich in fiber can help maintain regular bowel movements and prevent constipation. Foods that are high in fiber include fruits, vegetables, nuts and seeds, whole grains, and legumes.
- Avoid lifting heavy objects. As much as possible avoid carrying too heavy objects. If not, bend with the knees and not of the waist when lifting heavy objects. Secure that it is the legs that do most of the effort and not the torso.
- Stop smoking. Smoking can induce coughing, which may cause pressure in the abdomen that may result in an inguinal hernia or may worsen symptoms if a hernia is already existing.
- In case of persistent cough, consult a doctor. Persistent cough put a person at risk of developing a hernia, it is important to control the symptoms immediately.
- Seek treatment if prostate enlargement is identified- Enlarged prostate may result in straining when urinating, thus increasing pressure in the abdomen.
- After abdominal surgery, follow the doctor’s advice during hospital discharge- By following the doctor’s instructions post-surgery will minimize the risk of developing infection and having increased pressure at the incision site.
Hernia Nursing Diagnosis
Nursing Care Plan for Hernia 1
Nursing Diagnosis: Acute Pain related to surgical repair secondary to hernia as evidenced by irritability, verbalization of pain with a pain score of 8 out of 10, crying, and refusal to move.
Desired Outcomes:
- The patient will verbalize a reduction in pain, with a score of 4 out of 10 on the previous pain scale.
- The patient will manifest improvement in mood and coping abilities.
- The patient will show improvement in mobility and perform physical activity at a moderate level.
- The patient / parents will exhibit sufficient knowledge of pain and how it is managed
| Hernia Nursing Interventions | Rationale |
| Evaluate the post-op incision site, check the level of pain, and look out for any sign of swelling, bleeding, and redness. Also, assess the nonverbal signs of pain including facial expression, weakness, inactivity, and crying. | A low to moderate level of pain is expected after a hernia repair surgery. Identify the need of starting a pain reliever or analgesic in the treatment. |
| Apply active listening skill when assessing for pain levels and characteristics. | An important duty of a healthcare provider is to ask patients about their pain level to establish rapport and to render appropriate pain management. |
| Administer the prescribed pain reliever. | To effectively relieve the pain. |
| Maintain the patient in a comfortable position. | To provide comfort and reduces strain on the incision site that may cause pain. |
| If the hernia is corrected, put an ice compress on the scrotal area and apply for scrotal support if needed. | To decrease swelling and to provide comfort. |
| For pediatric patients: Promote frequent change of diapers to the parents. | Avoids pain and irritation at the surgical site caused by wet diapers. |
| Offer toys and games for quiet play. | To divert attention and detract from pain. |
| Encourage parents to hold the infant when feeding or when they are irritable. Burp the infant frequently to remove swallowed air. | To avoid strain on the incision site and provide comfort. |
| Provide information to the parents regarding causes of pain and intervention on how to relieve it. | To boost understanding about pain management. |
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Nursing Care Plan for Hernia 2
Nursing Diagnosis: Deficient Knowledge related to lack of information about postoperative care secondary to hernia as evidenced by requesting details about allowed daily activities, proper wound care, diet plan, bathing, and appropriate comfort measures.
Desired Outcomes:
- The parents will acquire accurate and useful information regarding postoperative care.
- The parents will state precise information about post-operative care.
| Hernia Nursing Interventions | Rationale |
| 1. Evaluate parents’ knowledge about hernia, including detailed information such as causes, and surgical treatment. Evaluate parents’ enthusiasm and interest to carry out a treatment plan. | To advocate a structured plan of instruction to secure compliance. |
| 2. Prepare parents and children as suitable with clear and accurate information in understandable language, using teaching materials and promoting questions. | To establish comprehension based on age and learning capacity. |
| 3. Encourage parents to hold infants when crying and at feeding time. Tell the child to avoid pushing, lifting, or engaging in strenuous activities. | To avoid strain on the operative site and risk of hernia recurrence. |
| 4. Instruct in doing sponge baths until the incision heals. | To attain the integrity of the incision. |
| 5. Observe any possible barriers that might make the learning process difficult. | Parents might encounter difficulties in the learning process because of mental or physical hindrances or social disadvantages like illiteracy. This observation may lead to individualized care plans. |
| 6. Inform patients to maintain incision dressing until it peels off and to put diapers on so the incision will remain not covered. | To keep the incision site dry and clean. |
| 7. Instruct the parents to increase the patient’s fluid intake and protein-rich food as advised. | Provides return to required nutritional status without causing gastrointestinal strain on the incision. |
| 8. Discuss to the parents that infants generally tolerate surgery well and recover without any complications. | Promotes assurance and comfort to the parents. |
| 9. Encourage parents to ask questions. | Questions bring about open communication between the parents and healthcare providers. It also allows affirmation of understanding of the information provided. . |
| 10. Provide different learning materials like journals, demonstrations, or informative videos. | There are a variety of ways to learn new information that will assist the parents to absorb the information easier. Different media platforms are available nowadays that provide opportunities to learn new things. |
| 11. Base teaching methods and pacing on the parent’s learning style. | These kinds of methods can encourage parents to strive more when it comes to learning about the disease process. It will be easier on the parent’s side if the learning process is based on their abilities and learning style. |
Nursing Care Plan for Hernia 3
Nursing Diagnosis: Risk for Injury related to intestinal obstruction secondary to hernia.
Desired Outcomes:
- After the health teaching, the patient will identify the elements that increase the risk for injury and will manifest behaviors to prevent injury.
- The patient will remain free of injuries.
| Hernia Nursing Interventions | Rationale |
| 1. Assess for swelling by palpation in the umbilical or inguinal area while the infant cries, strains, or coughs. Assess the capacity to reduce swelling with mild compression if the bowel is forced into the sac. | Proper initial assessment allows effective medical and surgical intervention. |
| 2. Check the hernia site for any sign of tenderness and other symptoms like increased abdominal size, loss of appetite, irritability, and changes in bowel movement. | Shows partial or complete blockage as a result of incarceration and strangulation. |
| 3. Encourage the parents to touch and feed the infant when hungry to prevent the infant from crying. | Crying may force the bowel further into the sac. |
| 4. Instruct the parents to inform the physician of any signs and symptoms. Explain the causes and expected outcome and those that indicate obstruction. | Prevents further complications of eventual gangrene of the bowel. |
| 5. Discuss with the parents the dietary involvement and limitation to avoid straining. | Diet modification is helpful to avoid constipation, reduced straining, and increasing pressure in the intra-abdominal area. |
| 6. Educate the parents on surgical procedures to repair a hernia and the possibility of hydrocele, and the expected course of progress. | Repairing hernia and correcting hydrocele immediately will help prevent the occurrence of any complications. |
| 7. Explain to the parents how the hernia is being resolved and what to expect after surgery. | Provides precise information on the prognosis and expected outcome. |
| 8. Guide the parents to the surroundings. Put a call light and instruct them how to make a call if they need assistance. | Parents should be aware of the environment to avoid any accidents or injuries. |
| 9. Review educational information about hernia. Discuss pathology, triggering factors, and medication regimen if any. | This helps instill the importance of compliance of both infant and parents with the treatment plan. |
Nursing Care Plan for Hernia 4
Nursing Diagnosis: Risk for Fluid Volume Deficit related to postoperative status secondary to hernia.
Desired Outcomes:
- Within 4 hours of nursing intervention, the patient will experience relief from vomiting.
- The patient will show clinical signs of adequate hydration.
- The patient/parents will recognize the reason for fluid deficiency, and the appropriate type of foods and liquids to consume to avoid recurrence.
| Hernia Nursing Interventions | Rationale |
| 1. Assess the onset of symptoms, nausea, and vomiting. Record the quality, amount, and presence of blood, bile, vomitus, and odor. | It gives details about vomiting and its significant characteristics. |
| 2. Check the skin elasticity, mucous membranes, fontanelles (for infants), weight, last void, and changes in behavior. | Physical assessment provides regarding hydration status; it involves extracellular losses, decrease in the level of activity, feeling of discomfort, weight loss, decreased skin turgor, and concentrated urine. |
| 3. Obtain vital signs, including apical pulse. | To monitor cardiovascular response to dehydration, signs include weak pulse and a drop in blood pressure. Increased respiratory rate may contribute to fluid loss. |
| 4. Examine urine-specific gravity. Evaluate urine color and amount every voiding or as per doctor’s order. | Urine concentration and increase in specific gravity can be indicators of dehydration. |
| 5. If vomiting persists, maintain nothing per orem or NPO status as prescribed. | Gives rest to the gastrointestinal tract to avoid getting more nauseous and triggers vomiting. |
| 6. Keep the patient on the side or sitting when vomiting. | This is a safety precaution to avoid aspiration of emesis. |
| 7. Administer antiemetic medication as ordered. | To prevent and treat nausea and vomiting after surgery. |
| 8. Start and monitor IV administration as prescribed by the physician. | To provide fluid replacement and nutritional support. Monitoring IV regulation is important to prevent fluid overload. |
| 9. After nausea and vomiting subside, offer clear liquids as tolerated. For adults, an oral rehydration solution can be given. For breastfeeding babies, frequent short feedings can be done. | Fluid replacement as patient tolerated. |
| 10. Discuss with the parents the possible cause of nausea and vomiting. Provide information regarding signs of dehydration and when to report them to the physician. | Gives information for urgent treatment of dehydration. |
Nursing Care Plan for Hernia 5
Nursing Diagnosis: Risk for Infection related to environmental exposure secondary to hernia repair.
Desired Outcomes:
- The patient will determine the risk factors for infection and the intervention to prevent the risk.
- The patient will remain free from any infections, as manifested by normal vital signs and negative signs and symptoms of infection.
- The patient will maintain a safe aseptic environment.
| Hernia Nursing Interventions | Rationale |
| 1. Follow the standard infection control protocols, sterilization techniques, and aseptic policies and procedures. | To ensure adherence to infection control policies. |
| 2. Validate the sterility of all manufacturers’ products. | Each item must be checked for the manufacturer’s provided details of sterility, package sterilization, expiration dates, and serial numbers must be registered on implant products for any follow-up needed in the future. |
| 3. Examine laboratory studies for probable systemic infections. | An elevated WBC count can be an indicator of infection. |
| 5. Check that all preoperative cleansing procedures including skin, vaginal, and bowel cleansing have been practiced all the time, depending on the specific surgical procedure. | Proper cleansing lower microbial counts on the skin, vaginal mucosa, and alimentary tract. |
| 6. Check the skin for breakdown or irritation that could be a sign of infection. | Break of skin integrity or near the surgical site could be a source of contamination to the wound. To prevent abrasion, be careful when shaving or clipping. |
| 7. Place contaminated items in a specific area in the operating complex and proper disposal should be observed. | Keeping contaminated areas in a particular area will prevent the spread of infection to the environment, other patients, and hospital personnel. |
| 8. During wound care, use sterile dressings. | Keeps the wound safe from environmental contamination. |
| 9. If there are signs of infection, acquire specimens for bacterial growth or gram staining. | This promptly identifies the type of microorganism which then allows immediate treatment. |
| 10. Administer antibiotics as prescribed. | Antibiotics are given to the patient as prophylaxis for suspected infection or as treatment with the identified specific organism. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
