Deliver effective care to patients with Umbilical and Inguinal Hernia this nursing care plan and management guide. Gain insights into nursing assessment, interventions, goals, and diagnosis customized for their specific needs. Enhance your ability to provide specialized care for Umbilical and Inguinal Hernia.
Table of Contents
- What is a Hernia?
- Nursing Care Plans and Management
- Recommended Resources
- See also
What is a Hernia?
A hernia occurs when abdominal contents protrude through an opening in a weakened area of a muscle. An umbilical hernia is the bulging of the intestine and omentum through the umbilical ring as a result of incomplete closure following birth. An inguinal hernia is the protrusion of the intestine through the inguinal ring caused by a failure of the vaginal process to atrophy to close prior birth allowing for a hernial sac to develop along the inguinal canal.
An umbilical hernia usually resolves by the age of 4-5 years old. Surgery is recommended for those that become enlarged and for those that do not disappear by school age. An inguinal hernia is commonly associated with a hydrocele that becomes prevalent in the infant by 2 to 3 months of age when intra-abdominal pressure increases enough to open the sac. Both are corrected by surgical repair (herniorrhaphy) to prevent obstruction and eventual incarceration of a loop of the bowel.
Nursing Care Plans and Management
Rendering effective nursing care is important after a surgical repair for a hernia which includes providing comfort, educating parents and child as appropriate with information related to the postoperative condition and care measures, and preventing the occurrence of complications.
Nursing Problem Priorities
The following are the nursing priorities for patients with umbilical and inguinal hernia:
- Managing pain
- Preventing swelling
- Preventing complications
Assess for the following subjective and objective data:
See nursing assessment cues under Nursing Interventions and Actions.
Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with umbilical and inguinal hernia based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.
Goals and expected outcomes may include:
- The client will express feelings of comfort and reduce pain as described using a pain scale.
- Request for information about activity allowed, wound care, diet, bathing, and comfort measures
- Parents will obtain knowledge about postoperative care.
- The client will experience adequate fluid volume.
Nursing Interventions and Actions
Therapeutic interventions and nursing actions for patients with umbilical and inguinal hernia may include:
1. Managing Postoperative Pain
Acute pain after surgical repair of umbilical and inguinal hernias is common and can be caused by the trauma of the surgery and the manipulation of the affected area. In some cases, there may also be inflammation and nerve damage, which can exacerbate the pain.
Assess incision pain and nonverbal signs of pain such as crying, lethargy, and facial grimace.
Determines the need for the initiation of analgesic therapy.
Maintain a position of comfort.
Facilitates comfort and decreases pain caused by the strain on the incision.
Apply an ice compress on the scrotal area if the hydrocele is corrected and apply for scrotal support if appropriate.
Promotes comfort by decreasing swelling.
Provide support to the buttocks during lifting or position changes.
Avoid strain and pull on the incision site.
Encourage parents to change diapers frequently.
Prevents irritation and pain at the incision area caused by wet diapers.
Provide toys and games for quiet play.
Facilitates diversionary activity to detract from pain.
Instruct parents to hold the infant during feeding or when irritable, frequently burp to remove swallowed air.
Reduces strain on the incision and promotes comfort.
Educate parents on the causes of pain and interventions needed to relieve it.
Promotes understanding of treatments for pain postoperatively.
Administer analgesics appropriate for the severity of pain and age.
Alleviate pain and discomfort caused by the incision.
2. Preventing Injury and Swelling
Assess by palpation for any swelling in the umbilical or inguinal area while the infant cries or when the child strains or coughs, and the ability to diminish swelling with gentle compression if the bowel is forced into the sac.
Shows a hernia that is reducible (easily manipulated back into place).
Assess the hernia site for any tenderness and other symptoms such as increased abdominal girth, loss of appetite, irritability, and defecation changes.
Reveals partial or complete obstruction as a result of incarceration and strangulation.
Encourage parents to hold and feed the infant when hungry to prevent the infant from crying.
Avoids the bowel from being forced into the sac.
Instruct parents to notify signs and symptoms to the physician; inform of the reason for the disorder and expected effect and those that signify an obstruction.
Prevents more severe complications of eventual gangrene of the bowel.
Counsel parents regarding dietary inclusions and restrictions to avoid straining.
Modification of diet to prevent constipation, decreased straining, and increased intraabdominal pressure that forces the bowel into the sac.
Teach parents about surgical procedures to repair the hernia and possible hydrocele and the course of progress to expect.
Corrects and repairs hernia and hydrocele if present before the development of a complication.
Reassure parents that a hernia usually resolves itself and if not, surgery may be expected to repair it.
Provides information regarding the prognosis of the disorder.
Assess skin turgor, mucous membranes, weight, fontanelles of an infant, last void, and behavior changes.
Provides information about hydration status; including extracellular fluid losses, decreased activity levels, malaise, weight loss, poor skin turgor, and concentrated urine.
Assess vital signs, including apical pulse.
Provides monitoring of cardiovascular response to dehydration (weak, thready pulse, drop in blood pressure). Increased respiratory rate may contribute to fluid loss.
Monitor urine specific gravity, color, and amount of every voiding or as ordered.
Concentrated urine with an increased specific gravity indicates a lack of fluids to dilute urine.
Monitor laboratory data results, as ordered (electrolytes, BUN, CBC, pH, etc.).
Allows identification of fluid losses and electrolyte imbalances.
Maintain NPO status, if prescribed.
Provides rest for the gastrointestinal tract because of nausea and vomiting and
associated medical conditions.
Position the child on the side or sit up when vomiting; keep suction available.
Avoids aspiration of emesis.
Initiate small amounts of clear liquids, as tolerated when nausea and vomiting subside; offer oral hydration fluids; breastfed babies need frequent short feedings at the breast.
Provides fluids in minimal amounts until nausea and vomiting resolve.
Initiate and monitor IV administration of nutrients as prescribed.
Provides fluid and nutritional support to replace active fluid loss and prevention of fluid overload.
Administer antiemetics as ordered.
Given as a prophylaxis and treatment for postoperative nausea and vomiting.
Instruct parents regarding causes of nausea and vomiting, signs of dehydration, and when to report them to the physician.
Provides information for immediate treatment of excessive loss of fluids and electrolytes caused by nausea and vomiting.
3. Initiating Patient Education and Health Teachings
Assess the parent’s knowledge of hernia including its causes, and surgical management; Assess the parent’s willingness and interest to execute the treatment regimen.
Promotes efficient plan of instruction to ensure compliance.
Provide parents and child as appropriate with clear and precise information in understandable language, utilizing teaching aids and encouraging questions.
Ascertain understanding based on age and learning ability.
Encourage parents to hold infants when crying and during feeding; instruct the child to avoid pushing, lifting, or engaging in vigorous activity or gym classes.
Prevents strain on the incision and possible hernia recurrence.
Instruct in doing sponge baths till the incision heals.
Maintains integrity of the incision.
Inform to keep incision dressing until it peels off and to apply diaper so that it does not cover the incision.
Maintains dry and clean incision site.
Encourage parents to increase fluid intake and protein-rich diet as ordered.
Promotes return to nutritional status without causing gastrointestinal strain on the incision.
Reassure parents that the infant normally tolerates surgery well and recovers without incident and that this condition is one of the most usual surgeries in infancy.
Provides assurance and comfort to parents in giving care.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
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