Umbilical Hernia

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Running head: SURGICAL FOLLOW-THRU

Surgical Follow-Thru: Umbilical Hernia Repair

October 15, 2010

Surgical Follow-Thru: Umbilical Hernia Repair

On September 5, 2010, a fifty-two year old African American male was admitted to the emergency department with severe abdominal pain. His diagnosis was an umbilical hernia with a palpable fascia defect to the right of the umbilicus that measured 2cm across. The client complained of pain on reduction and did not want to leave the hernia unaided for the fear that it may get larger over time. According to the chart, the client is obese and has a history of hypertension. Together, these conditions are implications of a poor health status that may increase the risk of complications with the umbilical hernia. (Rastegari, 2004) To prevent further problems, he was recommended for an elective outpatient surgery for umbilical hernia repair with possible mesh scheduled on October 15, 2010. Psychosocially, the client was anxious about how his abdomen would look after the surgery and worried about his ability to continue with his daily activities.

An umbilical hernia repair, also known as an umbilical herniorrhaphy, is a surgical procedure carried out to correct an umbilical hernia. (Rastegari, 2004) A brief description of the procedure is as follows: the patient is given local or general anesthesia depending upon the protuberance of the hernia. Then a small incision is made in close proximity to the umbilicus and the tissues are pushed back inside the abdomen. The muscles are then sutured and the opening is closed with stitches. (Pakhare, 2009) If the opening is too big and cannot be sutured, a sterile mesh is placed inside to keep the tissues together and relieve tension on the open area. (Venclauskas, Jolita, & Mindaugas, 2008)

After the umbilical hernia repair has been discussed and elected as treatment, it is the primary duty of the physician to obtain informed consent from the patient after disclosing the risks and benefits of the procedure. The nurse is not allowed to obtain consent for the physician at any time. On the other hand, the nurse is allowed to clarify information that is unclear to the patient after the physician has explained it in detail first. The nurse’s responsibility is to witness the patient signing the consent form after the patient has acknowledged understanding of the procedure. (Wissmann, 2007)

The pathophysiology of an umbilical hernia is a weakness in the abdominal wall near the umbilicus that has permitted abdominal contents, such as intestine or peritoneum, to protrude or bulge out. The hernia may or may not be enclosed within a membrane. (Rastegari, 2004) In this client, his abdominal contents were contained right under the skin. Umbilical hernias are most commonly found in infants. In adults, they usually occur in the fifth and sixth decades of life. (Halm, Heisterkamp, Veen, & Weidema, 2005) The hernia usually occurs from a result of increased abdominal pressure. People who are obese or pregnant, have increased abdominal fluids such as ascites, or do heavy lifting are at greater risk for getting an umbilical hernia. An umbilical hernia can be diagnosed through physical examination sometimes with an x-ray or ultrasound. The hernia may develop gradually overtime without any pain or discomfort, and may only present as a bulge in the abdomen. (Pakhare, 2009)

A hernia that has become strangulated, or has lack of blood supply to the abdominal contents, is a medical emergency. Signs and symptoms of such an emergency include: nausea, vomiting, abdominal swelling or distension, pale complexion, odor, weakness, or extreme pain. In this event, medical assistance will be needed as soon as possible and surgery for an umbilical hernia repair will be required. (Rastegari, 2004) In this client, his condition was not a medical emergency. Instead, an elective outpatient surgery was recommended for him to improve his comfort and prevent future...
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