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hernia nursing diagnosis

Hernia Nursing Diagnosis and Nursing Care Plan

Last updated on May 18th, 2022 at 08:09 am

Hernia Nursing Care Plans Diagnosis and Interventions

Hernia NCLEX Review and Nursing Care Plans

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
  • dysphagia or difficulty swallowing
  • feeling of pressure in the affected area

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
  • Malnutrition

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

Nursing Care Plan for Hernia 2

Deficient Knowledge

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. 

  • The parents will acquire accurate and useful information regarding postoperative care.
  • The parents will state precise information about post-operative care.

Nursing Care Plan for Hernia 3

Risk for Injury

Nursing Diagnosis: Risk for Injury related to intestinal obstruction secondary to hernia.

  • 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.

Nursing Care Plan for Hernia 4

Risk for Fluid Volume Deficit

Nursing Diagnosis: Risk for Fluid Volume Deficit related to postoperative status secondary to hernia.

  • 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.

Nursing Care Plan for Hernia 5

Risk for Infection

Nursing Diagnosis: Risk for Infection related to environmental exposure secondary to hernia repair.

  • 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.

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

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The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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3 Umbilical and Inguinal Hernia Nursing Care Plans

Umbilical & Inguinal Hernia Nursing Care Plans and Nursing Diagnosis

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 problem priorities, nursing assessment, nursing diagnosis, nursing goals, 1. managing postoperative pain, 2. preventing injury and swelling, 3. initiating patient education and health teachings, recommended resources.

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.

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:

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.

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 i t . Provides information regarding the prognosis of the disorder.

Assess the onset of nausea and vomiting, quality, quantity, presence of blood , bile, food, and odor. Provides information about emesis and defining characteristics.

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.

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.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

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 case study on hernia

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.

nursing case study on hernia

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 case study on hernia

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!

nursing case study on hernia

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.

nursing case study on hernia

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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Good Job Thank you for your help

Mr. x is a male patient 50 years old he has abdominal hernia. He visited the surgical outpatient clinic of EGH for the first time. The surgeon decided that he needs abdominal surgery after 3 months. Answer the following questions: 1- What is the type of this operation? 2- Define preoperative period and mention the preoperative care for this patient? 3- Define the postoperative period and mention the postoperative care for this patient?

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Nursing care of Inguinal Hernias

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An inguinal hernia is a protrusion of the abdominal contents through the inguinal canal, often into the groin or scrotum. They are a very common problem and patients may complain of pain or discomfort when coughing, exercising or during bowel movements. Inguinal hernias are so common, they are often one of the first surgical procedures postgraduate surgical residents are trained in ​[NO_PRINTED_FORM]​ . The protrusion may not be visible, particularly in overweight patients, however, a bulging area may occur in the area of the hernia, and may become markedly bigger when the patient is asked to bear down ​[NO_PRINTED_FORM]​ .

Illustration of an inguinal hernia

Classifications of Hernias

There are two classifications of Inguinal hernias, direct and indirect. A direct inguinal hernia occurs medial to the inferior epigastric vessels when the abdominal contents herniate through a weak spot in the fascia of the posterior wall of the inguinal canal. An indirect inguinal hernia occurs when the abdominal contents protrude through the deep inguinal ring, lateral to the inferior epigastric vessels.

Hernias in general are divided into three categories depending on their nature and severity.

  • Strangulated: Strangulated hernias are the most serious category, and are categorised by part of the herniated organ becoming twisted or edematous, leading to serious complications. Strangulated hernias may result in necrosis the affected area if not treated promptly. A strangulated hernia is considered a medical emergency and requires prompt surgical intervention.
  • Reducible hernias:  A hernia may be deemed reducible if it can be easily manipulated into place. This can often be done with non-invasive procedures.
  • Irreducible hernias: Also known as an incarcerated hernia, they can not be reduced manually due to adhesions of the hernia sac. This type of hernia is symptomatic of long-term herniation, or lack of treatment. Surgical intervention may be required in serious cases.

Organ Involvement

Inguinal hernias by definition involve the protrusion of the abdominal contents, but will generally involve a section of the small intestine or bowel protruding through the herniated site. It is important to note that any abdominal organs and structures can be involved including the bladder ​1​ , ovaries and uterus ​2​ .

Medical Management

Surgical correction is always recommended for inguinal hernias in children ​[NO_PRINTED_FORM]​ .

Until recently, surgical correction of inguinal hernias has been recommended, and as a result, there is no current medical recommendations about how to treat inguinal hernias in adults ​​3​​ ​​4​​ . Surgical repair is still recommended as the current approach in the majority of cases, whereas surgical intervention is not recommended in asymptomatic or minimally symptomatic in favour of monitoring the condition for progression ​​5​​ . Hernia repair surgery is commonly performed as an outpatient procedure and is not considered a complex procedure. The methods of surgical repair, and surgical techniques vary greatly, but may include the use of a mesh, either synthetic or biological to repair the herniated site. The surgery may be performed through an open surgical site, laparoscopy, and may be performed under either a general or local anaesthesia.

The use of a hernia truss administered to retain the hernia within the abdominal cavity is recommended, however, this is not intended to be a curative measure. A truss also increases the risk of complications including strangulations and atrophy of the fasical margins. This could allow the hernia to enlarge and make subsequent surgical repair difficult ​6​ . For this reason, surgical repair is recommended if the hernia progresses ​5​ .

Inguinal hernias can be very painful

Differential Diagnosis

Risk factors ​7​.

Inguinal hernias are most common in men, although up to 5% of newborn children present with inguinal hernias. Although women can still develop an inguinal hernia, they are at a much greater risk of developing one during pregnancy.

  • Peritoneal Dialysis
  • Previous Appendectomy
  • Collagen Vascular Disease

Diagnostic Tests:

physical presentation of an inguinal hernia

There are no specific laboratory tests for inguinal hernias. Often they can be objectively observed through physical examination, and such physical examination is often sufficient for accurate diagnosis ​8​ . Large hernias may present as obvious swelling in the inguinal or groin area. In males, the hernia may extend into the scrotum. Smaller hernias may present as a fuller appearance to the inguinal area. Inguinal hernias are noted to be more prevalent on the right side than the left.

In the case of a suspected inguinal hernia, the area can be auscultated, which should reveal prevalent bowel sounds ​8​ indicating the presence of an inguinal hernia.

Suspected bowel obstructions require an imaging scan and associated WBC, which would be expected to be elevated.

Nursing Outcomes:

  • The patient will perform ADL’s within the confines of the disease process.
  • The patient will express feelings of comfort
  • The patients bowel function will return to normal
  • The patient will remain free of sign and symptoms of infection
  • The patient will avoid any complications.

Nursing Interventions ​8​ ​9​ :

  • Place the patient in the Trendelenburg’s position to reduce pressure on the hernia site.
  • Apply truss only after the hernia has been reduced. For best results, apply it in the morning before the patient gets out of bed.
  • Assess the skin daily and apply powder to prevent irritation.
  • Watch for and immediately report signs of incarceration and strangulation.
  • Closely monitor vital signs and provide routine preoperative preparation.
  • Administer IV fluids and analgesics for pain as ordered.
  • Control fever with acetaminophen as ordered.

Postoperative interventions:

  • Provide routine postoperative care.
  • Do not allow the patient to cough.
  • Encourage deep breathing and frequent turning.
  • Apply ice bags to the scrotum to reduce swelling and relieve pain; elevating the scrotum on rolled towels may also help to alleviate swelling.
  • Administer analgesic as prescribed.
  • In males, a jock strap or suspensory bandage may be used to provide support.
  • 1. Taskovska M, Janež J. Inguinal hernia containing urinary bladder—A case report. Int J Surg Case Rep . 2017;40:36-38.
  • 2. Malik K, Al S, Al Q, Al K, Al H. Ovarian Hernia: A rarity. Sultan Qaboos Univ Med J . 2012;12(2):225-227.
  • 3. Purkayastha S, Chow A, Athanasiou T, Tekkis P, Darzi A. Inguinal hernia. BMJ Clin Evid . 2008;2008.
  • 4. Kulacoglu H. Current options in inguinal hernia repair in adult patients. Hippokratia . 2011;15(3):223-231.
  • 5. Fitzgibbons R, Forse R. Clinical practice. Groin hernias in adults. N Engl J Med . 2015;372(8):756-763.
  • 6. Nursing Care Plan For Inguinal Hernia. Nursing Directory. http://www.nursingdirectorys.com/2011/01/nursing-care-plan-for-inguinal-hernia.html . Published January 25, 2011. Accessed May 18, 2017.
  • 7. Nursing Outcome, Nursing Interventions, and Patient Teaching For Inguinal Hernia. Nursing care Plans. http://nurse-thought.blogspot.com.au/2009/07/nursing-outcome-nursing-interventions.html . Published July 19, 2009. Accessed May 18, 2017.

Last Reviewed: 14th March, 2018

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AMER SHAKIL, MD, MBA, KIMBERLY APARICIO, MD, ELIZABETH BARTA, DO, AND KRISTAL MUNEZ, MD

Am Fam Physician. 2020;102(8):487-492

Patient information: See related handout on inguinal (groin) hernias , written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Groin hernias are caused by a defect of the abdominal wall in the groin area and comprise inguinal and femoral hernias. Inguinal hernias are more common in men. Although groin hernias are easily diagnosed on physical examination in men, ultrasonography is often needed in women. Ultrasonography is also helpful when a recurrent hernia, surgical complication after repair, or other cause of groin pain (e.g., groin mass, hydrocele) is suspected. Magnetic resonance imaging has higher sensitivity and specificity than ultrasonography and is useful for diagnosing occult hernias if clinical suspicion is high despite negative ultrasound findings. Herniography, which involves injecting contrast media into the hernial sac, may be used in selected patients. Becoming familiar with the common types of surgical interventions can help family physicians facilitate postoperative care and assess for complications, including recurrence. Laparoscopic repair is associated with shorter recovery time, earlier resumption of activities of daily living, less pain, and lower recurrence rates than open repair. Watchful waiting is a reasonable and safe option in men with asymptomatic or minimally symptomatic inguinal hernias. Watchful waiting is not recommended in patients with symptomatic hernias or in nonpregnant women.

Hernias are a common reason for primary care physicians to refer patients for surgical management. There are many different types of hernias, with most occurring in the abdomen or groin. The term groin hernia comprises three types of hernias depending on location relative to the inguinal (Hesselbach) triangle ( Figure 1 1 ) : direct inguinal, indirect inguinal, and femoral. A direct inguinal hernia is a protrusion of tissue through the posterior wall of the inguinal canal, medial to the inferior epigastric vessels ( Figure 2 1 ) , whereas an indirect inguinal hernia protrudes through the internal inguinal ring, lateral to the inferior epigastric vessels ( Figure 3 1 ) . A femoral hernia is the protrusion of tissue below the inguinal ligament, medial to the femoral vessels.

nursing case study on hernia

In the United States, 1.6 million groin hernias are diagnosed annually, and 700,000 are repaired surgically. 2 The lifetime prevalence of groin hernias is 27% in men and 3% in women. 3 The frequency of groin hernia repair rises from 0.25% in patients 18 years of age to 4.2% in patients 75 to 80 years of age. 3

In the United States, approximately 96% of groin hernias are inguinal hernias, about 20% of which are bilateral. 1 Femoral hernias comprise the remaining 4% of groin hernias and are more common in women (16% to 37% of women). 4 Risk factors for inguinal hernias include a family history of the condition, male sex, older age, low body mass index, systemic connective tissue disease, and history of radical prostatectomy or radiation therapy. 5 – 8 In women, inguinal hernias have also been associated with taller height, chronic cough, umbilical hernia, and rural residence. 6 No association has been found between smoking or alcohol use and hernias. 4

Presentation

Patients with a groin hernia may report a bulge in the groin that becomes progressively larger over time. Most patients with groin hernias report pain or vague discomfort, but up to one-third of patients have no symptoms. 9 Symptoms may worsen with standing, straining, lifting, or coughing. These movements increase intra-abdominal pressure, causing intra-abdominal contents to be pushed through a hernial defect. 10 Patients may report having symptoms only at the end of the day or after prolonged activity and that the bulge disappears when they are lying flat. However, the absence of a reducible mass or palpable defect does not rule out a hernia. In a subset of patients, groin or pelvic pain is caused by an occult, or hidden, hernia.

Groin pain, if present, is described as a dull aching, pulling, or burning sensation. Localized discomfort may develop from stretching or tearing of the tissue at or around the site of the hernial defect. As this occurs, the hernia usually increases in size. Severe pain could suggest that the hernia has become incarcerated and may require emergent surgical intervention. Table 1 10 , 11 and Table 2 10 list other diagnoses to consider in patients presenting with groin pain with or without a scrotal mass. However, asymptomatic hernias may be found incidentally on physical examination.

Physical Examination

In men, the examination should begin with the patient standing and the physician seated in front of the patient. The groin should be inspected for an obvious bulge. The physician should observe for any expansile bulge while the patient “bears down” (Valsalva maneuver). An indirect hernia is often piriform in shape—broad in the scrotum and narrow over the medial half of the inguinal ligament. A direct hernia is globular in shape over the medial half of the inguinal ligament and usually does not enter the scrotum. 12

If a hernia is not visualized, additional maneuvers should be performed. Using an index finger, the physician should palpate the base of the scrotum and gently invaginate the redundant skin of the scrotum into the inguinal canal toward the pubic tubercle. The finger follows adjacent to the spermatic cord, and the fingertip will be just within the external ring. The patient should then be asked to strain or cough as the physician palpates for a soft impulse, which is suggestive of herniation. 13

In women, groin hernias often do not present with a visible bulge. However, a bulge can sometimes be detected on direct palpation with the Valsalva maneuver. 14

Diagnosis in men usually does not require imaging. 15 However, imaging is often required in women and may be helpful when a recurrent hernia, surgical complication after repair, or other cause of groin pain (e.g., groin mass, hydrocele) is suspected. Ultrasonography, which is the first-line imaging modality, has a sensitivity of 33% to 86% and specificity of 77% to 90% for occult hernias and can be used to diagnose suspected groin hernias not evident on clinical examination. 16 , 17

Magnetic resonance imaging (MRI) with Valsalva maneuver may be considered if the clinical suspicion of a groin hernia is high despite negative ultrasound findings. MRI has a sensitivity of 91%, specificity of 92%, positive predictive value of 95%, and negative predictive value of 85% for occult hernias. MRI is superior to ultrasonography and computed tomography in diagnosing inguinal hernias, particularly occult hernias. 12 Herniography, which involves injecting contrast media into the hernial sac, has a sensitivity of 91% and specificity of 83% for detecting occult hernias. It is superior to ultrasonography and computed tomography (sensitivity = 80%; specificity = 65%) and may be useful in selected patients. 17

In 2018, various international societies (the HerniaSurge group) reviewed the literature and created guidelines for the management of groin hernias. The group received direct financial support from hernia mesh manufacturers Bard and Johnson & Johnson. The HerniaSurge group classifies management into two major categories: conservative and surgical. 18 , 19

CONSERVATIVE MANAGEMENT

Watchful waiting is a reasonable and safe option in men if the patient's usual activities are not limited by pain and discomfort and there is no difficulty reducing the hernia. 20 Surgical intervention should be initiated if pain develops. Watchful waiting is not recommended in nonpregnant women because of the higher likelihood of femoral hernias, which are associated with a higher risk of strangulation. 21 Watchful waiting is also not recommended for symptomatic hernias because of a higher risk of incarceration. 19

Abdominal contents becoming trapped within the hernial sac, leading to incarceration, is a risk of watchful waiting. Over time, this can impede the blood flow in the incarcerated hernial contents (i.e., strangulation). Richter hernia, a rare complication with a high mortality rate, occurs when part of the intestinal circumference is entrapped and strangulated in the hernial sac. 22 The HerniaSurge guideline recommends that physicians counsel patients with asymptomatic or minimally symptomatic inguinal hernias about the expected natural course of the condition and the risks of emergency surgery. 19

Family physicians may choose to refer patients to or work closely with a surgeon during the conservative management timeframe, which includes regular follow-up to monitor for development of symptoms and to continue surveillance for underlying diagnoses that may have contributed to the hernia. The best interval for follow-up during watchful waiting is unclear.

Watchful waiting is also commonly used in pregnant patients because groin swelling can be caused by self-limited round ligament varicosities. 23 Color flow Doppler imaging can be used to distinguish between a true hernia and round ligament varicosities. In a 2017 cohort study of 20,714 pregnant patients, only 25 had inguinal hernias and none underwent elective or emergency hernia repair during pregnancy. In 10 patients, the groin bulge disappeared spontaneously after delivery. 24 For reducible inguinal hernias in pregnant patients, it seems safe and cost-effective to wait until after delivery to attempt repair.

SURGICAL MANAGEMENT

The choice of surgical technique for repairing an inguinal hernia depends on factors such as anesthesia accessibility, the surgeon's preference and training, patient preference, cost, availability of mesh, and other logistics. Becoming familiar with the common types of surgical interventions can help family physicians facilitate postoperative care and assess for complications, including recurrence. Surgical interventions can be categorized as open anterior repair, open posterior repair, tension-free mesh repair, and laparoscopic repair.

Although nonmesh techniques have fallen out of favor in the United States, they are still acceptable internationally. Mesh techniques are strongly recommended because of lower recurrence rates compared with nonmesh techniques. 19 If mesh is unavailable, a 2009 European guideline suggests that an open anterior nonmesh technique is most favorable. 19 , 25

The use of laparoscopic techniques has been shown to be superior to tension-free mesh repair for postoperative pain outcomes. 19 Common laparoscopic techniques include the total extraperitoneal approach and transabdominal preperitoneal approach. In both of these approaches, mesh is placed in the preperitoneal space, but access starts at different anatomic points.

Laparoscopic repair of groin hernias is preferred over open repair because of better recovery outcomes. 26 – 29 Guidelines specifically recommend laparoscopic approaches in women to decrease the risk of chronic pain and avoid missing femoral hernias. Laparoscopic approaches can also be used in patients with previous hernias that were repaired with an open approach to avoid significant scar tissue. 19 A Cochrane review comparing open and laparoscopic repair found that laparoscopic repair took longer and was associated with a higher rate of vascular, colonic, or bladder injury; however, overall, laparoscopic surgery was associated with shorter recovery, earlier resumption of activities of daily living, less pain, and lower recurrence rates. 29

Postoperative Care

Historically, surgeons have recommended four to six weeks of inactivity after groin hernia repair, which was based on expert opinion. 30 However, there is no evidence that early physical activity increases the risk of recurrence, regardless of surgical approach. 31 Most patients undergoing laparoscopic hernia repair should be encouraged to resume physical activity three to five days after the procedure. 32 Extended periods of analgesic treatment and extended sick leave are not supported by evidence. 32

This article updates previous articles on this topic by LeBlanc, et al. , 10 and Bax, et al. 1

Data Sources: A PubMed search was completed using the key phrases (“hernia, inguinal”[mesh] and “hernia”[mesh]) and (“hernia, inguinal/classification”[mesh] or “hernia, inguinal/diagnosis”[mesh] or “hernia, inguinal/diagnostic imaging”[mesh] or “hernia, inguinal/prevention and control”[mesh] or “hernia, inguinal/rehabilitation”[mesh] or “hernia, inguinal/surgery”[mesh]). Search dates: December 6, 2019, and January 18, 2020.

Bax T, Sheppard BC, Crass RA. Surgical options in the management of groin hernias. Am Fam Physician. 1999;59(4):893-906. Accessed April 9, 2020. https://www.aafp.org/afp/1999/0215/p893.html

Montgomery J, Dimick JB, Telem DA. Management of groin hernias in adults–2018. JAMA. 2018;320(10):1029-1030.

Itani KMF, Fitzgibbons R. Approach to groin hernias [published correction appears in JAMA Surg . 2019;154(6):569]. JAMA Surg. 2019;154(6):551-552.

Köckerling F, Koch A, Lorenz R. Groin hernias in women—a review of the literature. Front Surg. 2019;6:4.

Jansen PL, Klinge U, Jansen M, et al. Risk factors for early recurrence after inguinal hernia repair. BMC Surg. 2009;9:18.

Ruhl CE, Everhart JE. Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol. 2007;165(10):1154-1161.

Liem MS, van der Graaf Y, Beemer FA. Increased risk for inguinal hernia in patients with Ehlers-Danlos syndrome. Surgery. 1997;122(1):114-115.

Öberg S, Andresen K, Rosenberg J. Etiology of inguinal hernias: a comprehensive review. Front Surg. 2017;4:52.

Townsend CM, Beauchamp RD, Evers BM, et al., eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice . 20th ed. Elsevier; 2017.

LeBlanc KE, LeBlanc LL, LeBlanc KA. Inguinal hernias: diagnosis and management. Am Fam Physician. 2013;87(12):844-848. Accessed April 9, 2020. https://www.aafp.org/afp/2013/0615/p844.html

Omar IM, Zoga AC, Kavanagh EC, et al. Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics. 2008;28(5):1415-1438.

Miller J, Cho J, Michael MJ, et al. Role of imaging in the diagnosis of occult hernias. JAMA Surg. 2014;149(10):1077-1080.

Bickley LS, Szilagyi PG, Bates B, et al., eds. Bates' Guide to Physical Examination and History Taking . 8th ed. Lippincott Williams & Wilkins; 2003:359–372.

Glassow F. Inguinal hernia in the female. Surg Gynecol Obstet. 1963;116:701-704.

Kraft BM, Kolb H, Kuckuk B, et al. Diagnosis and classification of inguinal hernias. Surg Endosc. 2003;17(12):2021-2024.

Alam A, Nice C, Uberoi R. The accuracy of ultrasound in the diagnosis of clinically occult groin hernias in adults. Eur Radiol. 2005;15(12):2457-2461.

Robinson A, Light D, Kasim A, et al. A systematic review and meta-analysis of the role of radiology in the diagnosis of occult inguinal hernia. Surg Endosc. 2013;27(1):11-18.

Köckerling F, Simons MP. Current concepts of inguinal hernia repair. Visc Med. 2018;34(2):145-150.

HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165.

Fitzgibbons RJ, Giobbie-Hurder A, Gibbs JO, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial [published correction appears in JAMA . 2006;295(23): 2726]. JAMA. 2006;295(3):285-292.

Fitzgibbons RJ, Forse RA. Clinical practice. Groin hernias in adults. N Engl J Med. 2015;372(8):756-763.

Steinke W, Zellweger R. Richter's hernia and Sir Frederick Treves: an original clinical experience, review, and historical overview. Ann Surg. 2000;232(5):710-718.

Buch KE, Tabrizian P, Divino CM. Management of hernias in pregnancy. J Am Coll Surg. 2008;207(4):539-542.

Oma E, Bay-Nielsen M, Jensen KK, et al. Primary ventral or groin hernia in pregnancy: a cohort study of 20,714 women. Hernia. 2017;21(3):335-339.

Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343-403.

Callesen T. Inguinal hernia repair: anaesthesia, pain and convalescence. Dan Med Bull. 2003;50(3):203-218.

Bittner R, Arregui ME, Bisgaard T, et al.; International Endohernia Society. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia. Surg Endosc. 2011;25(9):2773-2843.

Sajid MS, Leaver C, Baig MK, et al. Systematic review and meta-analysis of the use of lightweight versus heavyweight mesh in open inguinal hernia repair. Br J Surg. 2012;99(1):29-37.

McCormack K, Scott NW, Go PM, et al. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2003(1):CD001785.

Robertson GS, Burton PR, Haynes IG. How long do patients convalescence after inguinal herniorrhaphy? Current principles and practice. Ann R Coll Surg Engl. 1993;75(1):30-33.

Amid PK, Lichtenstein IL. Long-term result and current status of the Lichtenstein open tension-free hernioplasty. Hernia. 1998;2:89-94.

Tolver MA, Strandfelt P, Forsberg G, et al. Determinants of a short convalescence after laparoscopic transabdominal preperitoneal inguinal hernia repair. Surgery. 2012;151(4):556-563.

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Inguinal bladder hernia: a case report

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Ramzi Mejri, Kays Chaker, Bibi Mokhtar, Sami Ben Rhouma, Yassine Nouira, Inguinal bladder hernia: a case report, Journal of Surgical Case Reports , Volume 2021, Issue 9, September 2021, rjab386, https://doi.org/10.1093/jscr/rjab386

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Inguinal hernia is a common disorder that requires urgent and adequate surgical management. Multiple organs may be associated with inguinal hernias, but bladder involvement is rarely seen. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower urinary tract symptoms. Retrograde urethrocystography or intravenous urography confirms the diagnosis. We report a case of inguinal hernia involving the bladder at the right side with a 72-year-old man. We performed a hernia repair after reintegration of the bladder.

Nowadays, inguinal hernia is a frequent pathology. It requires prompt and appropriate surgical management. Inguinal hernias can be associated with several organs, but bladder involvement is uncommon, occurring in <4% of cases. Bladder hernia in inguinal hernia is rare and accounts for 0.5–3% of lower abdominal hernias [ 1 ]. It is often asymptomatic and the diagnosis is usually made intraoperatively during the surgical cure. Therefore, it is clear that the diagnostic approach and intraoperative strategy can be problematic for the surgeon. We report here an unusual case of an elderly man who presented with a massive right-sided inguinoscrotal hernia with complete bladder involvement.

A 72-year-old man with a history of controlled diabetes and hypertension presented to our department with right inguinal swelling and intermittent lower urinary tract symptoms (LUTS) with pollakiuria, dysuria, prolonged micturition time and a sensation of a full bladder after micturition. He reported nausea, vomiting and right lower quadrant paint. The patient also reported having to manually compress the scrotum in order to empty the bladder. Physical examination revealed a slightly painful on palpation and reducible 6 cm right inguinal hernia extending into the right hemiscrotum. The body mass index of the patient was 31.4 kg/m2. His PSA was 4.3 ng/ml. On uroflowmetry, maximum flow rate (Qmax) was 13 ml/s and the voided volume was 180 cc. The uroflow curve was flat. The Bacteriological examination of urine was negative. Retrograde urethrocystography revealed right inguinal hernia containing a portion of the urinary bladder ( Figs 1 , 2 ). He also had an intravenous urography in order to study the upper urinary tract and to have an idea of the renal function. This radiological exploration confirms the data of the retrograde urethrocystography and illustrates well the bladder hernia. However, a moderate left hydronephrosis with a nonobstructive pyelic calculus of 1.5 cm was observed on intravenous urography ( Figs 3 , 4 ). Intraoperative findings revealed a direct right inguinal hernia with complete herniation of bladder into the scrotum. The bladder appeared healthy with no signs of injury and was restored to its normal anatomical position without resection. The hernia was repaired with a biologic mesh by the Lichtenstein technique. The patient had an uneventful postoperative course. Concerning his pyelic calculus problem, shock wave lithotripsy sessions were scheduled.

Retrograde urethrocystography: right inguinal hernia containing a portion of the urinary bladder.

Retrograde urethrocystography: right inguinal hernia containing a portion of the urinary bladder.

Urethrocystography: no obstruction under the bladder in the per mictional image.

Urethrocystography: no obstruction under the bladder in the per mictional image.

Intravenous urography: moderate left hydronephrosis and bladder addition image.

Intravenous urography: moderate left hydronephrosis and bladder addition image.

Intravenous urography: nonobstructive pyelic calculus of 1.5 cm.

Intravenous urography: nonobstructive pyelic calculus of 1.5 cm.

Inguinal hernia of the bladder was first reported by Levine in 1951 as a scrotal cystocele [ 2 ]. The bladder is involved in <4% of all inguinal hernias. Most bladder hernias are direct, with a 70% male predominance, and most cases occur on the right side [ 3 ]. Inguinal bladder hernias occur mainly in the elderly and the associated risk factors are overweight, chronic urinary tract obstruction and weak pelvic muscles [ 4 ]. In our case, advanced age, male sex and obesity are the main risk factors used.

Pathologies associated with inguinal hernias of the bladder include benign prostatic hypertrophy, hydronephrosis with or without acute renal injury, vesico-ureteral reflux, urinary tract infections, bladder necrosis and scrotal abscesses [ 5 ]. However, it can be seen in infants, but usually disappears spontaneously with age. Most of the time, inguinoscrotal hernia is asymptomatic. It is often diagnosed intraoperatively during hernia repair surgery. Inguinoscrotal bladder hernia can be subdivided into the paraperitoneal, intraperitoneal and extraperitoneal type according to the relation with the parietal peritoneum [ 6 ]. In our case, the bladder was herniated directly without being covered by the peritoneum, which can be classified as the extraperitoneal type.

Patients with bladder hernias can present with LUTS. In cases of large inguinoscrotal bladder hernias, patients typically present with two-stage urination, involving spontaneous emptying of the bladder with a second step of manual compression of the hernia.

Radiological modalities include computed tomography, intravenous urogram and cystography. Ultrasound may be performed to detect the presence of hydronephrosis and to differentiate the bladder from other intrascrotal conditions [ 7 ]. A dog ear shaped bladder or a dumbbell shaped bladder may be a diagnosis on cystography. Computed tomography scan may be beneficial in obese men over the age of 50 with inguinal swelling and LUTS. This radiological investigation may be followed by cystoscopy to confirm the diagnosis and exclude other bladder pathology [ 8 ]. The presence of a bladder hernia does not modify the indications or the surgical strategy. The therapeutic procedure (open or laparoscopy) consists of fully reintegrating the bladder into the abdominal cavity and repairing the parietal defect. Currently, bladder resection is recommended only in cases with bladder wall necrosis, true herniated bladder diverticulum, a tight hernia neck or tumor in the herniated bladder [ 5 ]. Sometimes patients may opt for conservative treatment such as watchful waiting or intermittent catheterization [ 9 ]. Preoperative imaging is useful in planning the approach and anticipating difficulties.

Inguinal bladder hernia is uncommon. It is often difficult to diagnose and remains a surgical challenge. It should be considered in obese men, over 50 years of age, with LUTS. Preoperative imaging is essential to prevent iatrogenic injury and complications. Cystography performed during intravenous or retrograde urography is a simple way to make the diagnosis. Treatment of this condition consists of returning the bladder to its anatomical position, repairing the inguinal hernia and treating subvesical obstruction if present.

The authors declare that there are no conflicts of interest regarding the publication of this article.

Conde Sanchez   JM , Espinoza   OJ , Salazar   MR , et al.    Giant inguino-scrotal hernia of the bladder: clinical case and review of the literature . Actas Urol Esp   2001 ; 25 : 315 – 9 .

Google Scholar

Levine   B . Scrotal cystocele . JAMA   1951 ; 147 : 1439 – 41 .

Wagner   AA , Arcand   P , Bamberger   MH . Acute renal failure resulting from huge inguinal bladder hernia . Urology   2004 ; 64 : 156 – 7 .

Fisher   PC , Hollenbeck   BK , Montgomery   JS , Underwood   W . Inguinal bladder hernia masking bowel ischaemia . Urology   2004 ; 63 : 175 – 6 .

Kraft   KH , Sweeney   S , Fink   AS , Ritenour   CWM , Issa   MM . Inguinoscrotal bladder hernias: report of a case series and review of the literature . Can Urol Assoc J   2008 ; 2 : 619 – 23 .

Gomella   LG , Spires   SM , Burton   JM , Ram   MD , Flanigan   RC . The surgical implications of herniation of the urinary bladder . Arch Surg   1985 ; 120 : 964 – 7 .

Catalano   O . Ultrasound evaluation of inguinoscrotal bladder hernias: report of three cases . Clin Imaging   1997 ; 21 : 126 – 8 .

Moufid   K , Touiti   D , Mohamed   L . Inguinal bladder hernia: four case analyses . Rev Urol   2013 ; 15 : 32 – 6 .

Yong   GL , Siaw   MY , Yeoh   AJL , Lee   GEG . Inguinal bladder hernia: case report . Open J Urol   2013 ; 3 : 217 – 8 .

  • hernia, inguinal
  • surgical procedures, operative
  • urinary bladder
  • intravenous pyelogram
  • hernia repair
  • lower urinary tract symptoms

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  • Case study - Hernia repair

...Mr K claims he was unaware he'd be undergoing open surgery and did not understand the risks...

  • Date:  23 April 2020

Mr K is 51 years old and works in finance. He presents to his GP with an abdominal bulge in the left groin and pain, especially on bending or lifting. He is diagnosed with an inguinal hernia and referred to a surgical unit.

Mr K is admitted to hospital and undergoes a laparoscopic inguinal hernia repair, using surgical mesh. He is discharged after two days, with advice on pain relief.

The patient re-attends his GP complaining of persistent pain and some swelling in the left groin. He is referred back to the surgical unit. An MRI reveals no problem related to the mesh and no recurrence of the hernia. The surgeon advises Mr K that there appears to be some fatty infiltration of the inguinal canal (cord lipoma) and this may be causing discomfort but she would be reluctant to embark on further surgery. She refers the case to a senior colleague.

ONE MONTH LATER

Mr K is admitted for surgery and signs a consent form. Mr J undertakes open groin surgery and excises a small but elongated cord lipoma. The patient is discharged the next day but on follow-up reports that the pain has in fact grown worse. Subsequent treatment including steroid injections and neurectomy are ineffective in relieving the pain. Mr K finds sitting for any long period uncomfortable and his mobility is reduced. He is later referred to a pain clinic.

A consultant surgeon reviews the MRI and in discussion with the patient advises open groin surgery and removal of the cord lipoma. Mr K agrees but requests a private referral to avoid having to wait. The consultant contacts a colleague – Mr J – who agrees to undertake the procedure. Mr J’s secretary contacts Mr K offering an appointment to discuss the treatment but the patient (wanting no further delay) opts for a quick admission.

A LETTER is sent by solicitors acting for Mr K claiming clinical negligence in Mr J’s treatment. It alleges that the patient was not informed he would be undergoing open surgery, nor was there discussion of the procedure’s risks/benefits. Mr K claims that he would not have undergone the operation had he been fully informed.

MDDUS acting on behalf of Mr J reviews the case and commissions an expert report from a consultant surgeon. In his response, Mr J states that in the letter from the referring NHS surgeon it was clear that the proposed treatment had been discussed and agreed with the patient prior to his requesting private care in order to avoid a prolonged wait. Mr J had offered to see Mr K in clinic to further discuss the operation but the patient opted for direct admission to the surgical unit.

Mr J states that his usual practice on the day of surgery is to have a quick word with the patient to ensure understanding of the procedure and to answer any last questions. The records show that a surgical consent form was signed but the operative method is not detailed, nor is there any record of benefits and risks discussed.

The surgical expert opines that the decision to undertake open exploration and removal of the cord lipoma was appropriate. He notes that a consent form for the named procedure was signed but there was an assumption that Mr K was aware he was undergoing an open procedure and fully understood the risks/benefits. The expert states that, in his view, this constitutes a failure of informed consent and a breach of duty of care by Mr J.

In regard to causation (the consequences of the breach), the expert acknowledges that it would be up to a court to decide what Mr K might have done had he been fully informed about the open procedure and its associated risks. Had he chosen more conservative treatment Mr K would still have endured persistent chronic pain.

MDDUS decides to settle the case, with Mr J’s agreement, for a modest sum.

  • Ensure the patient understands what treatment is being proposed – this is the essence of shared decision-making.
  • Record what was discussed with the patient in regard to consent.
  • GMC guidance, Consent , states that the treating doctor has responsibility to discuss agreed plans with the patient. Always confirm consent, never assume.

This page was correct at the time of publication. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Read more from this issue of Insight Secondary

  • Raising concerns amidst COVID-19
  • Remote consulting in the coronavirus outbreak
  • Safe working and delegation in difficult times
  • Turning the other cheek?
  • Profile: Under pressure
  • Creating positive change
  • ETHICS: It's the small things
  • Book choice: The Body
  • Vignette: Margaret Fairlie (1891-1963)

Insight Secondary Q2 2020

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Case Report on Nursing Management of a Client with Hiatus Hernia

Profile image of Vaishali Tembhare

2021, Journal of Pharmaceutical Research International

A hiatus hernia occurs when a portion of the stomach protrudes into the chest cavity. It enters through the same entrance through which the food tube (oesophagus) travels to the stomach. A case of an 39-year-old male with a history of diabetic presented to the emergency room with acute onset shortness of breath, epigastric pain and chest pain. The stomach bulges up into the chest through that opening in a hiatal hernia (also known as a hiatus hernia). The client was having burning sensation in epigastric region since from 2-5 year, acid reflux after taking food, heartburn, nausea, regurgitation, vomiting, and abdominal pain and irritation. After the physical examination, history collection and investigations he was diagnosed as case of hiatus hernia.The study&#39;s main focus is on professional management and excellent nursing care, which may be able to give the holistic care that hiatus hernia requires while also efficiently treating the difficult case. Following a complete recover...

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nursing case study on hernia

British Journal of Surgery

Stefano Merigliano , M. Costantini

ANZ Journal of Surgery

Glyn Jamieson

Northern Clinics of Istanbul

Ahmet Tuncer

Journal of Clinical Gerontology and Geriatrics

hilit hassidim

Surgical and Radiologic Anatomy

Denzil Etienne , Marios Loukas

Vijay Naraynsingh

BMC Surgery

Christophe Berney

Background Laparoscopic large hiatal hernia (LHH) repair remains a challenge despite three decades of ongoing attempts at improving surgical outcome. Its rarity and complexity, coupled with suboptimal initial approach that is usually best suited for small symptomatic herniae have contributed to unacceptable higher failure rates. Results We have therefore undertaken a systematic appraisal of LHH with a view to clear out our misunderstandings of this entity and to address dogmatic practices that may have contributed to poor outcomes. Conclusions First, we propose strict criteria to define nomenclature in LHH and discuss ways of subcategorising them. Next, we discuss preoperative workup strategies, paying particular attention to any relevant often atypical symptoms, indications for surgery, timing of surgery, role of surgery in the elderly and emphasizing the key role of a preoperative CT imaging in evaluating the mediastinum. Some key dissection methods are then discussed with respect...

Medicine and Pharmacy Reports

Alice Sfara

Background and aim. Hiatal hernia (HH) occurs quite frequently in the general population and is characterized by a wide range of non-specific symptoms, most of them related to gastroesophageal reflux disease. Treatment can be challenging at times, depending on the existence of complications. The most recent guideline regarding the management of hiatal hernia was released by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in the year 2013. This review aims to present the most recent updates on the diagnosis and management of hiatal hernia for clinical practitioners. Methods. The PubMed database was screened for publications using the terms: “hiatal hernia”, “paraesophageal hernia”, “management”, “treatment”, “hiatal repair”. A literature review of contemporary and latest studies was completed. The studies that we looked into include prospective, randomized trials, systematic reviews, clinical reviews and original articles. The information was compiled in nar...

Annals of Laparoscopic and Endoscopic Surgery

Gregory Falk

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Case Study: Endometriosis or Hernia?

— a tricky diagnostic dilemma in a woman with groin pain.

by Kate Kneisel , Contributing Writer, MedPage Today

Illustration of a written case study over a uterus with endometriosis

"Medical Journeys" is a set of clinical resources reviewed by doctors, meant for physicians and other healthcare professionals as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.

This month: A noteworthy case study.

A 33-year-old woman presented with pain in her left groin that radiated to her left thigh and worsened during menstruation. She told clinicians she had been experiencing these symptoms for the last 2 years, but was otherwise in good health. She noted that her periods were regular, with no severe menstrual cramps or pain, and neither did she have dyspareunia or any other symptoms that might be associated with endometriosis.

She had not undergone any abdominal or pelvic surgeries or gynecological interventions and was not on hormone therapy or contraceptives or any regular medications.

Physical Examination/Scanning

Physical examination identified a 1.5-cm left inguinal mass, which was adherent to the underlying tissue and tender on palpation. Clinicians performed an ultrasound of the abdomen and pelvis, which revealed a poorly defined speculated solid hypoechoic left inguinal mass, 1.6×1.4 cm in diameter. Ultrasound findings of the uterus and ovaries were unremarkable.

Computed tomography (CT) of her pelvis showed a central hypo-attenuation left inguinal mass 1.7×1.2 cm in diameter, and thickening of the left round ligament.

image

The scan did not reveal any other lesions, or signs of endometriosis, cancer, or inguinal lymphadenopathy. Given the patient's presenting symptoms, and findings of the physical and radiological examinations, clinicians considered left inguinal hernia as one of the differential diagnoses.

Surgical Findings

The patient underwent surgical examination of the left inguinal canal exploration, which revealed a mass measuring 1.5 cm attached to the round ligament and floor of the canal, which was completely excised along with a 0.5 cm margin. Surgeons repaired the floor of the inguinal canal and reinforced it with proline mesh. The patient had no complications from the procedure, recovered well, and was discharged in good condition.

The mass -- which macroscopically measured 3.5×3×1.5 cm and consisted of fibrous tissue with a cut section showing hemorrhagic areas -- was sent to histopathology for assessment, which revealed multiple foci of endometrial glands surrounded by endometrial stroma embedded within the fibrous tissue.

Post-Discharge

After her discharge, the patient attended surgery and gynecology outpatient clinics for follow-up. The consulting gynecologist reported that there was no need for additional surveillance imaging or postoperative hormonal therapy. Her symptoms did not reappear.

Rare and Mimics Other Common Conditions

Clinicians reporting this case of inguinal endometriosis note that because it is a rare clinical entity that mimics several other common inguinal conditions, a high index of suspicion is important for diagnosis before surgical treatment. This is especially crucial in cases involving a palpable inguinal mass, usually associated with cyclic changes in size and severity of pain.

Endometriosis, which affects an estimated 10% of women of reproductive age, typically manifests in intra-pelvic organs and peritoneum, although organs external to the pelvis may also be involved. The condition generally develops following pelvic surgical procedures, due to implantation of endometrial tissue, the authors added.

Inguinal endometriosis, however, is very rare, with only about 50 cases reported in the literature, the case authors noted. As such, "it is often misdiagnosed as other inguinal pathologies such as inguinal hernia, soft tissue tumors, and inguinal lymphadenopathy." Those cases have generally been addressed through surgery, and without the use of diagnostic imaging or biopsy.

First described in 1986, inguinal endometriosis is "characterized by the presence of endometrial stroma and glands in the extraperitoneal portion of the round ligament and in the surrounding connective and lymphatic tissues," explained the authors of a 2021 study of three such cases.

The condition tends to occur in women who have had several children and have undergone gynecological or obstetric surgery, the case authors said, noting that their review of the English literature identified just 29 cases of inguinal endometriosis affecting nulliparous women, as in this patient's case.

Affected women present with an inguinal swelling that is easily detected on palpation, along with cyclical pain and change in size. The authors cautioned that this periodic worsening of symptoms is a typical feature of endometriosis that is often missed during the initial assessment. Patients may also report having pain with menstruation and with intercourse, as well as a history of difficulty conceiving – symptoms suggestive of pelvic endometriosis.

Distinguishing Features

Features that may help distinguish inguinal from pelvic endometriosis include the presence of regular menstrual cycles, which the authors explained, "can be a misleading point in the clinical assessment ."

In addition, the right side is more likely to be affected in patients with inguinal endometriosis, presumably due to the presence of the sigmoid colon, which the case authors explained, "places pressure on the left inguinal area, acting as a preventive measure ." Only 13 cases of left-sided inguinal endometriosis have been reported in the literature to date, the group said.

The condition can present with symptoms common to various other inguinal conditions, such as inguinal hernia, hemangioma, lymphadenopathy, and hydrocele of canal of Nuck. The rarity, along with inconclusive results of imaging, make inguinal endometriosis very challenging to diagnose before surgery is performed, and the relative efficacy of the various imaging modalities in these cases has yet to be studied, the case authors noted.

Ultrasound imaging often shows "a hypoechoic unilocular or multilocular cyst that is difficult to distinguish from other inguinal region pathologies such as lymph nodes and simple cysts," although it may help rule out possible differential diagnoses, the group stated.

As was the case with this patient, CT does not always help confirm the diagnosis of inguinal endometriosis, but it can be used to exclude other possibilities, the authors noted. "Magnetic resonance imaging (MRI) is the most specific and sensitive imaging modality for the diagnosis of endometriosis in general," due to its ability to detect iron particles in the hemosiderin that is present in the endometrioma. On MRI, both inguinal and pelvic endometriosis show high intensity on T1-weighted images and hypointensity on T2-weighted images, and the generally atypical and non-specific MRI findings for endometriosis prevent a conclusive diagnosis of inguinal endometriosis.

The team referenced a case series of 20 inguinal endometriosis patients in which most had a mixed hyper- and hypointensity of both T1- and T2-weighted images (61.1% and 50%, respectively).

Although preoperative fine-needle aspiration cytology (FNAC) can be used to diagnose endometriosis, it is only rarely utilized because "most patients are treated surgically with a preoperative diagnosis of incarcerated inguinal hernia or other inguinal pathologies," and post-excision, histopathological evidence of endometrial glands and stroma from testing of the mass confirms the diagnosis, the authors said.

They noted that CT findings in their patient did not point to endometriosis, and because a possible inguinal hernia had not been ruled out, they did not use preoperative FNAC, which carried a risk of injuring the hernial sac.

Inguinal endometriosis – typically managed with radical surgery to reduce the chance of recurrence -- often exists concurrently with an inguinal hernia or hydrocele of canal of Nuck -- both of which may be treated surgically before endometriosis is diagnosed. This is why radical surgical resection is not done in most cases without evidence of recurrence on follow-up, the authors explained.

Recommendations

They advised that because inguinal endometriosis often occurs concomitantly with pelvic endometriosis, patients should be referred following surgery for a complete gynecological assessment. Patients with inguinal endometriosis who have clinical symptoms such as dysmenorrhea, dyspareunia, or infertility that suggest pelvic endometriosis should be assessed laparoscopically, the clinicians added.

Hormone therapy may be used in patients with concomitant inguinal and pelvic endometriosis, the authors stated, adding that its use in women with only inguinal endometriosis is more controversial, although it may be recommended as adjuvant postsurgical therapy to reduce the risk of recurrence.

Since their patient had no signs suggesting pelvic endometriosis, she received only gynecological follow-ups, without the need for diagnostic laparoscopy and hormonal therapy, the authors said.

Read previous installments of this series:

Part 1: Endometriosis: Understanding the Pathogenesis and Pathophysiology

Part 2: Diagnosing Endometriosis

Part 3: Managing Endometriosis: Research and Recommendations

author['full_name']

Kate Kneisel is a freelance medical journalist based in Belleville, Ontario.

Disclosures

The case report authors noted no conflicts of interest.

Primary Source

American Journal of Case Reports

Source Reference: AlSinan FM, et al "Inguinal endometriosis in a nulliparous woman mimicking an inguinal hernia: A case report with literature review" Am J Case Rep 2021; 22: e934564.

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  • Nursing Care Plan

Hiatal Hernia Nursing Care Plan

hiatal hernia nursing care plan

Hiatal hernias are more common in Western countries. Most hiatal hernias are asymptomatic and are discovered incidentally. On rare occasions, a life-threatening complication, such as gastric volvulus or strangulation, may present acutely .

A hiatal hernia occurs when a portion of the stomach prolapses through the diaphragmatic esophageal hiatus. The stomach pushes through an opening in the diaphragm and into the chest and compromises the lower esophageal sphincter (LES). This laxity of the LES can allow gastric content and acid to back up into the esophagus and is the leading cause of gastroesophageal reflux (GERD) .

The classification of hiatal hernias is divided into four types.

  • Type I (sliding type). This represents more than 95% of hiatal hernias, which occur when the gastroesophageal junction (GEJ) is displaced upwards towards the hiatus.
  • Type II. This type is a paraesophageal hiatal hernia, which occurs when part of the stomach migrates into the mediastinum parallel to the esophagus.
  • Type III. this is both a paraesophageal hernia and a sliding hernia, where both the GEJ and a portion of the stomach have migrated into the mediastinum.
  • Type IV. Type IV is when the stomach, as well as an additional organ such as the colon, small intestine, or spleen, also herniates into the chest.

Hiatal hernias may be congenital or acquired. Predisposing factors include the following:

  • Advanced age. Muscle weakening and loss of elasticity as people age is thought to predispose to hiatal hernia, based on the increasing prevalence in older people. With decreasing tissue elasticity, gastric cardia may not return to its normal position below the diaphragmatic hiatus following a normal swallow.
  • Gender. Hiatal hernias are more common in women. This may relate to the intra-abdominal forces exerted in pregnancy.
  • Diet. A study suggested that the Western, fiber-depleted diet leads to a state of chronic constipation and straining during bowel movement, which might explain the higher incidence of this condition in Western countries.
  • Comorbidities. Conditions such as chronic esophagitis may cause shortening of the esophagus by causing fibrosis of the longitudinal muscles and, therefore, predispose to a hiatal hernia. The presence of abdominal ascites also is associated with hiatal hernias.

Hiatal Hernia

The gastroesophageal junction acts as a barrier to prevent the reflux of contents from the stomach into the esophagus by a combination of mechanisms forming the anti-reflux barrier. The components of this barrier include the diaphragmatic crura, the LES baseline pressure and intra-abdominal segment, and the angle of His. the presence of a hiatal hernia compromises this reflux barrier not only in terms of reduced LES pressure but also reduced esophageal acid clearance. Clients diagnosed with hiatal hernias also have longer transient LES relaxation episodes, particularly at night time. These factors increase the esophageal mucosa acid contact time predisposing to esophagitis and related complications.

The typical presentation leading to an evaluation for a hiatal hernia is GERD. Clients typically complain of heartburn and sometimes regurgitation. While heartburn is the most common complaint, some clients will present with extra-esophageal symptoms such as a chronic cough or asthma. The presentation of regurgitation or extra-esophageal symptoms typically is a sign of disease progression.

Management for hiatal hernias depends on the type of hernia and the severity of the symptoms. The goals of treatment include prevention of reflux of gastric contents, improved esophageal clearance, and reduction in acid production. The following are nursing diagnoses associated with hiatal hernia.

  • Risk for Bleeding
  • Imbalanced Nutrition: Less than Body Requirements

Hiatal Hernia Nursing Care Plan 

Below are sample nursing care plans for the problems identified above.

Hiatal hernia results from the translocation of intra-abdominal contents from their usual position into the thorax. The symptomatology can range from just chest pain in the less severe types to respiratory and hemodynamic compromise resulting from strangulation in the advanced hernias. The acid may also cause ulcerations within the stomach that can bleed and lead to acute anemia and pain.

Nursing Diagnosis

Related factors.

  • Chemical burn of gastric mucosa or oral cavity
  • Physical response, such as reflex muscle spasm in the stomach wall

Evidenced by

  • Verbalizations of pain
  • Abdominal guarding
  • Rigid body posture
  • Facial grimacing
  • Autonomic responses, such as changes in vitals signs in reaction to acute pain

Desired Outcomes

  • The client will verbalize relief of pain.
  • The client will demonstrate a relaxed body posture and be able to sleep or rest appropriately.

Nursing Interventions

A hiatal hernia may be responsible for intermittent bleeding from associated esophagitis, and erosions (Cameron ulcers), or a discrete esophageal ulcer, leading to iron-deficiency anemia. Splenic and live injuries may also result in bleeding and occurs in 2.3% of clients.

Risk Factors

  • Active fluid volume loss
  • Ulcerations
  • Not applicable; the presence of signs and symptoms establishes an actual diagnosis
  • The client will be free of signs of bleeding in GI aspirate or stools, with stabilization of hemoglobin and hematocrit.
  • The client will demonstrate improved fluid balance as evidenced by individually adequate urinary output with normal specific gravity, stable vital signs, moist mucous membranes, good skin turgor, and prompt capillary refill.
  • Fear/Anxiety
  • Change in health status
  • Increased tension, restlessness, irritability
  • Tachycardia
  • Diaphoresis
  • Lack of eye contact, focus on self
  • Verbalizations of anxiety
  • The client will discuss fears and concerns recognizing healthy versus unhealthy fears.
  • The client will verbalize an appropriate range of feelings.
  • The client will appear relaxed and report anxiety is reduced to a manageable level.
  • The client will demonstrate problem-solving and effective use of resources.
  • Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span . F.A. Davis Company.
  • Khan, M. Z. (2020, November 12). Chest Pain: A Relatively Benign Symptom of Type IV Hiatal Hernia . NCBI. Retrieved January 14, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733775/
  • Patti, M. G., & Anand, B. (2021, October 20). Gastroesophageal Reflux Disease: Practice Essentials, Background, Anatomy . Medscape Reference. Retrieved January 14, 2023, from https://emedicine.medscape.com/article/176595-overview#a1
  • Qureshi, W. A., & Katz, P. O. (2019, September 5). Hiatal Hernia: Practice Essentials, Background, Pathophysiology . Medscape Reference. Retrieved January 14, 2023, from https://emedicine.medscape.com/article/178393-overview#a5
  • Smith, R. E., & Shahjehan, R. D. (2022, August 22). Hiatal Hernia – StatPearls . NCBI. Retrieved January 14, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK562200/

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Urinary tract infection nursing care plan, anemia nursing care plan, diarrhea nursing care plan, pulmonary embolism nursing care plan, pleural effusion nursing care plan, acute glomerulonephritis (agn) nursing care plan, leave a reply cancel reply.

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Nursing Care Plan & Diagnostics: Hiatal Hernia Case Study

Overview with cultural considerations.

My patient is a 30-year old white American, who was hospitalized with complaints about sharp and acute pain in his neck and shoulders. The patient is a Christian who, however, does not attribute much attention to religion in his life. The patient has a family, and his wife and 7-year old daughter are rather supportive to him. The patient is a highly open person using the eye-contact and touch in his communicational acts.

The urgent medical assessment and testing proved that the patient had a hiatal hernia and required an urgent laparoscopic gastric bypass surgery to be carried out. After this, the patient went through a set of tests to examine his blood, pulse, blood pressure, and urine. The results of the preliminary tests manifested the patient’s readiness for the surgery and the possibility of using general anesthesia.

So, the patient was prepared for the surgery and brought to the surgery room. The very laparoscopy started 5 minutes later when the general anesthesia started working. Four minor incisions were made in the right part of the patient’s abdomen and the hiatal hernia repair was carried out. No complications were observed before, during, or after the surgery. The patient recovered from the general anesthesia rather early, and the PACU score of the patient was 2, using the gradation in which late recovery is 0, intermediate recovery is 1, and early recovery is 2.

After the surgery, the patient was placed in an ordinary ward because he coped with all general anesthesia effects well, and no need was observed to place the patient into the reanimation ward. The drainage sponge was placed in one of the stitches left after the laparoscopy to prevent the remaining blood and ichor from accumulating in the wound. Daily bandaging was carried out for the patient, who started walking the next day after the surgery. Now, the patient is on a non-irritating diet that limits his vegetarian preferences to neutral drinks and food. The nursing care plan is developed on the basis of nursing diagnostics to present the patient with the highest care standards (Muller-Staub, et al., 2008, p. 293).

Functional health pattern assessment

General appearance.

My patient is in his bed now. His conditions are rather good, as he tried to sit in the bed, walks to the bathroom with the help of a nurse, and starts eating the simplest products his diet allows him to.

Reason for hospitalization

My patient was admitted xx/xx/010 reporting the long-lasting sharp pain in his chest. According to his complaints, the pain had been lasting for 15 minutes before he was placed in the hospital, and this was not the first case of such a pain fit (Smeltzer and Bare, 2009, p. 692).

Past medical history

The patient has a past medical history of angina and sharp and continuous pain in his neck and shoulders.

Health perception

The patient was taken to the hospital and underwent the laparoscopic gastric bypass as soon as the testing procedures confirmed his health conditions to be acceptable for such a procedure.

Nutrition/Metabolic pattern

The patient is now on a non-irritating diet, drinking fluids containing no acids and eating only neutral products.

Elimination pattern

The elimination patterns of my patient are all in order. His bowel and bladder control functions are at the proper levels.

Exercise pattern

The patient displays normal levels of activity. He does physical exercises to maintain the tonus of his muscles and avoid complications.

Sleep/Rest pattern

The sleeping and rest patterns are displayed by the patient care at the proper level. The patient can fall asleep during bedtime without taking any medications.

Cognitive pattern

My patient is alert, he recognizes people and things that surround him, can remember his past and can project his future.

Self-perception pattern

The patient is a 30-year old man, who perceives himself adequately and realizes his position in the objective reality. The patient can also properly formulate his needs and wishes.

Role/Relation pattern

The patient has a family, i. e. a wife and a 7-year old daughter. They are very supportive and help him get through the hardships of the post-surgery period. As well, the patient’s parents often visit him to express their love and support. Finally, the patient has many friends, who also help him recover from the surgery and return to his active daily life.

Sexual/Reproductive pattern

As stated above, the patient is married and has a 7-year old daughter. As he is a father, he values his family even more and is committed to recovering for the sake of his daughter.

Coping pattern

The patient displays no signs of stress or any other psychological issues, which evidences that his pattern of coping with the post-surgery recovery is rather strong.

Value/Belief pattern

According to the patient’s words, he is a Christan but is not used to attending church on the regular basis. Moreover, the patient displays deeply philosophical beliefs, which are conditioned by his committed interest in the subject.

Respiratory

The patient experiences slight respiratory difficulties, i. e. a partially ineffective breathing pattern, caused by the still observed effects of the laparoscopic surgery. However, the general characteristics of the patient’s respiratory functioning are positive. His respiratory rate fluctuates between 18 and 20 breathing per minute.

Cardiovascular

The cardiovascular conditions of the patient are proper. The patient’s SE blood pressure is 120/80, while pulse rate is at the stable level of 93. Accordingly, the patient takes no medications facilitating the functioning of the cardiovascular system, but still, he is under the permanent control of a cardiologist, which is the measure to diagnose and eliminate any problem if it emerges.

Neurological

The neurological conditions of the patient are stable and there is no need for special treatment thereof. The patient realizes that the situation he is in now is rather problematic, but the successful laparoscopy is sure to make his post-surgery recovery fast and without any complications.

Gastro-intestinal

The patient underwent laparoscopic gastric bypass and hiatal hernia repair. The current condition of the patient is stable. The drain sponge is placed into a loose stitch so that the remains of blood and ichor from the wound could be eliminated from the organism. The patient takes ketorolac intravenously twice a day to cope with the post-surgery pain (Aschenbrenner, 2008, p. 416). No need for additional medications to be taken is observed.

Genito-urinary

The genitor-urinary function of the patient’s organism is at the proper level of performance. The patient is continent with his bladder.

Musculoskeletal

The musculoskeletal system of the patient is functioning properly. On the whole, the musculoskeletal activities of the patient are voluntary and proper. No muscle strains and/or other problems can be noticed.

Integumentary

The patient’s skin is majorly intact and displays no obvious signs of damages or infections. The only places where the skin is damaged are laparoscopic stitches, around which slight red spots can be observed.

So, my patient is a 30-year old American who has a family, recognizes the right of all people to be equal and to live properly. This patient has undergone laparoscopic gastric bypass surgery and hiatal hernia repair. Before the hospitalization, he experienced regular fits of sharp pain, which evidenced that he had a hiata al hernia. The surgery has been carried out successfully, and now my patient is in the stage of recovery. Thabove-presenteded care plan reflects the basic interventions I carry out to solve two major problems of my patient, i. e. partially ineffective breathing pattern and post-surgical pain (Muller-Staub, et al., 2008, p. 294). So, to achieve the goal of overcoming these problems, I plan to use both medications and breathing improvement techniques after prior analysis of both issues from a professional point of view.

Self-critique of the plan

The self-critique of the presented care plan for my patient allows making rather high assessments of the plan components. First, the RCC Evaluation Guidelines require any nursing care plan to include five major columns to reflect the nursing diagnosis, desired outcomes, nursing interventions, rationale for the latter, and evaluation of the effectiveness of goal achievement (RCC, 2010). The care plan I developed for my patient obviously has all these obligatory elements. Further on, the nursing diagnosis column should identify the patient’s state from the nursing viewpoint, and my care plan complies with this requirement as well (RCC, 2010). Desired outcomes are measurable and specific as the RCC standards require, while the list of nursing interventions always starts with hearing the client out and analyzing his problem. Further on, every nursing intervention is assessed and has its rationale presented, while the overall goal evaluation is presented in the context of achieving/not achieving the major goal of the client. Accordingly, the presented care plan conforms to all RCC requirements for nursing care plans.

Aschenbrenner, D. (2008). Drug Therapy in Nursing. Philadelphia: Lippincott Williams & Wilkins.

Muller-Staub, M. et al. (2008). Implementing nursing diagnostics effectively: cluster randomized trial. Journal of Advanced Nursing 63 (3), 291–301.

RCC. (2010). Practical Nursing Program. Web.

Smeltzer, S. and Bare, B. (2009). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. Philadelphia: Lippincott Williams & Wilkins.

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IvyPanda. (2022, June 29). Nursing Care Plan & Diagnostics: Hiatal Hernia. https://ivypanda.com/essays/hiatal-hernia-case-study-of-patient/

"Nursing Care Plan & Diagnostics: Hiatal Hernia." IvyPanda , 29 June 2022, ivypanda.com/essays/hiatal-hernia-case-study-of-patient/.

IvyPanda . (2022) 'Nursing Care Plan & Diagnostics: Hiatal Hernia'. 29 June.

IvyPanda . 2022. "Nursing Care Plan & Diagnostics: Hiatal Hernia." June 29, 2022. https://ivypanda.com/essays/hiatal-hernia-case-study-of-patient/.

1. IvyPanda . "Nursing Care Plan & Diagnostics: Hiatal Hernia." June 29, 2022. https://ivypanda.com/essays/hiatal-hernia-case-study-of-patient/.

Bibliography

IvyPanda . "Nursing Care Plan & Diagnostics: Hiatal Hernia." June 29, 2022. https://ivypanda.com/essays/hiatal-hernia-case-study-of-patient/.

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Case Report: 21 Cases of Umbilical Hernia Repair Using a Laparoscopic Cephalic Approach Plus a Posterior Sheath and Extraperitoneal Approach

Kunjie zhang.

1 Department of General Surgery, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China

Mingfang Qin

2 The Third Department of General Surgery, Tianjin Nankai Hospital, Tianjin, China

Guoqian Ding

3 Beijing Friendship Hospital, Capital Medical University, Beijing, China

Associated Data

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Purpose: In this study, a novel surgical technique was developed for umbilical hernias, in which a laparoscopic cephalic approach plus a posterior sheath and an extraperitoneal approach was employed. The aim of this study was to determine the results of this new technique.

Methods: From 2019 to 2020, 21 patients (81.8% men) with an umbilical hernia underwent a laparoscopic cephalic approach plus a posterior sheath and extraperitoneal approach, performed by two surgeons specializing in abdominal wall surgery, in two academic hospitals. Intraoperative and postoperative complications, operation time, blood loss, and hernia recurrence were assessed.

Results: Twenty-one cases of umbilical hernia were successfully completed. The size of the hernia ring was 1.5–3 cm 2 , with an average of 2.39 ± 0.47 cm 2 . The operation time was 120–240 min (average, 177.3 ± 42.15 min), and the blood loss volume was 30–40 ml (average, 33.73 ± 3.55 ml). The mean follow-up period was 6 months, and there were no short-term complications and no cases of recurrence.

Conclusion: A laparoscopic cephalic approach plus a posterior sheath and extraperitoneal approach is a safe alternative for the repair of an umbilical hernia. The intraoperative complication rate was low.

Introduction

An umbilical hernia refers to an external abdominal hernia in which the contents of the abdominal cavity protrude from the weakened umbilical area ( 1 ). The umbilicus is located in the middle of the abdominal wall, which is the last part of the abdominal wall to close during embryonic development ( 2 ). The lack of adipose tissue in the umbilical area leads to the outermost skin, fascia, and peritoneum of the abdominal wall being directly connected together, making it the weakest part of the abdominal wall ( 3 ). The contents of the abdominal cavity protrude from this part to form an umbilical hernia. Obesity is the main cause of adult umbilical hernias due to increased abdominal pressure ( 4 ). The current treatment for umbilical hernias includes traditional open surgery, laparoscopic repairs, or even robotic repairs ( 1 , 5 – 7 ). The entirely extraperitoneal technique for repair of inguinal hernia was first reported in 1992 by Dulucq ( 8 ) and has since become one of the gold standard procedures for the treatment of hernias in adults ( 9 ), such as umbilical hernias ( 10 ). We used a laparoscopic cephalic approach plus a posterior sheath and extraperitoneal approach to repair the umbilical hernias in this study, avoiding many complications caused by patch placements in the abdominal cavity, and achieved good clinical treatment results. The report is as follows.

Materials and Methods

General information.

There were 21 patients in this group, including 14 men and 7 women, aged 31–78 years, with an average age of 45.18 ± 13.58 years. The preoperative BMI of the patients was 24–35, with an average of 30.91 ± 4.55. All patients were clearly diagnosed with an umbilical hernia before surgery. The size of the hernia ring was 1.5–3 cm 2 , with an average of 2.39 ± 0.47 cm 2 . The period was from the first case on November 7, 2019, to the last case on November 11, 2020.

Surgical Methods

Endotracheal inhalation and intravenous combined general anesthesia were administered. The patient was placed in the supine position with the legs close together. The surgeon stands directly above the patient's head, and the first assistant stands on the left or right side of the patient's head. The punch position is shown in Figure 1 .

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Punch position.

A longitudinal incision was made about 3 cm under the xiphoid process, ~1.5 cm in length. The skin and subcutaneous tissue was cut first, then the anterior sheath was located; the anterior sheath was cut longitudinally, and 3–0 Medtronic absorbable sutures were applied using round needles and later smeared with paraffin oil. The left and right sides of the cut of the anterior sheath were sutured by continuous stitching and reserved for future use. The pull opened the rectus abdominis muscle, exposing the posterior sheath; the posterior sheath was cut, and, 3–0 Medtronic absorbable sutures were applied using round needles. The left and right sides of the incision of the sheath were sutured continuously, and then pulled for later use. The thin peritoneum and preperitoneal fascia were exposed.

A wet gauze was applied to carefully free the gap between the peritoneum and the posterior sheath. Care was taken to not break the peritoneum in order to maintain its integrity. Wet gauze was used to free an area of ~5 × 5 cm 2 , then the gauze was withdrawn, a 10 mm trocar was inserted along with a 10 mm lens, and the lens was used to perform a pushing action to free the preperitoneal space. The left or right side can be freed first by taking the puncture hole under the xiphoid process as a starting point, taking the midline as one side, and choosing the other side with an angle of 45°, ~5 cm in length, along with two other puncture holes on the left and right sides of the midline. We used gauze balls to free the extraperitoneal space, so one of the holes was 5 mm and the other was 10 mm, which is convenient for the gauze to enter and exit.

After the gap was released, hernia needles and non-absorbable sutures were used to close the hernia ring, place a common polypropylene patch in the extraperitoneal space, fix the patch with four needles, and place a drainage tube to routinely close the incision.

Summary of the Cephalic Approach

The lens hole is set at about 3 cm below the xiphoid process, about 1 cm to the left or 1 cm to the right of the midline. This is to avoid the white line. After pulling the rectus abdominis, one should go straight to the posterior sheath. Otherwise, if the white line is entered, it will be difficult to find the right level.

When the anterior sheath is cut longitudinally through the lens hole, the length of the cut edges on both sides is ~1.5 cm. Johnson or Medtronic 3–0 absorbable sutures are used to suture the two cutting edges of the anterior sheath from top to bottom or from bottom to top. The margin should be ~1.5 mm, the needle pitch should be 1 mm; the end should be reserved and fixed with a vascular clamp. The same is done after the posterior sheath has been incised. In addition, when the posterior sheath is incised, it is not cut too deeply. One must gently cut the posterior sheath with the tip of the knife. Otherwise, if the peritoneum is cut too deeply and the peritoneum is cut, the cranial approach will fail because it is difficult to cut through the peritoneum. The peritoneum was free at the broken site and had moved into the extraperitoneal space.

At the center of the patch, stitch an absorbable suture to mark it. The purpose is to align the hernia ring of the umbilical hernia.

After Patch Placement

After inserting the patch, deflate, and press the hernia ring that is outside of the body. It can be seen that the hernia ring protrudes to the extraperitoneal space (the gap in which we operate) under an external force. When it is aligned in a vertical state, this indicates that the hernia ring faces the patch, ideally in the center of the circle. The patch is centered on the suture marking line and is equilateral around it. This is the ideal situation, as shown in Figure 2 .

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Method 1 of patch placement.

Use a 10 ml syringe needle instead of pressing the hernia ring. The needle vertically enters the extraperitoneal space, the pneumoperitoneum is slightly deflated, and the tip of the needle is aligned with the mark of the absorbable line, which has the same effect (see Figure 3 ).

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Method 2 of patch placement.

Whether the patch is round or quadrilateral, the four corners of the patch need to be fixed with four needles to the peritoneum or extraperitoneal fascia, so that the patch will not easily move or shift ( 11 ). Only four needles need to be fixed, and there is no need to fix them too much.

After the operation, try not to enter the abdominal cavity for checks or visualization. It is necessary to cut the peritoneum into the abdominal cavity in order to perform inspections. In obese patients in particular, the peritoneum is very deep and difficult to suture when inspections are performed. Peritoneum sutures are not ideal, especially if the hole is close to the patch, which may cause the intestinal tube to enter the extraperitoneal space and cause an intestinal obstruction. Additionally, the adhesion of the patch between the intestine, omentum, and the extraperitoneal space may cause related complications.

If the peritoneum is accidentally broken during the process of freeing the peritoneum, one can use a pneumoperitoneum to exhaust gas. If necessary, one can use two insufflation needles to exhaust gas.

Both operation holes should be 5 mm or a 10 mm trocar can be used for one of the operation holes. We are personally accustomed to using gauze to move freely. Here, a 10 mm trocar was used for easy access to the gauze.

Active Peritoneal Inflation or Passive Peritoneal Inflation

Actively break the peritoneum and inflate.

During the process of freeing the extraperitoneal space, the peritoneum should not be damaged. The extraperitoneal space was inflated perfectly in our operations. Pressing the peritoneum at this time may damage the intestinal tube under the peritoneum. Second, when suturing the fixation patch, because the peritoneum is not damaged and is intact, the peritoneum is tightly attached to the intestinal tube by the pressure of the extraperitoneal space. Suturing the peritoneal fixation patch may cause serious complications such as suturing of the intestine, resulting in an intestinal fistula. At this time, it is necessary to actively break the peritoneum and inflate. Under the navel, a small longitudinal incision is actively applied to the peritoneum. With the help of the pressure from the carbon dioxide pneumoperitoneum, the abdominal cavity is quickly inflated, and a gap is formed directly between the intestine and the peritoneum by the gas. To isolate the gap, the exhaust of the abdominal cavity at the same time, to ensure the operation space of the extraperitoneal space. This way, there is no need to worry about the safety of the lower bowel when suturing the peritoneal fixation patch. The peritoneum is cut longitudinally, standing on the side of the head, and the suture will be smoother and more convenient when closing the peritoneum. It is more horizontal or oblique. The incision for active peritoneal inflation should be lower, that is, below the navel, rather than above. The upper part of the peritoneum should be sutured to close the peritoneum. The two operators must work very hard, and the arms will be framed. This is not conducive to later stitching.

Passive Peritoneal Inflation Occurs When the Peritoneum Is Broken During the Freeing Process

At this point, the gas enters the extraperitoneal space naturally, without the need for active re-incision. Then, the abdominal contents form a layer creating the (intestine)-gas-peritoneum-extraperitoneal space (operation space). The peritoneal damage is shown in Figure 4 .

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Treatment of peritoneal damage.

Gauze Ball Blunt Separation Method

When freeing the extraperitoneal space, the steps are as follows: pass through one of the 10 mm puncture holes, enter the laparoscopic gauze, use non-invasive forceps to crimp the gauze, push the abdominal wall upward with the left hand, push the gauze ball forward with the right hand, and press the peritoneum downward. This separation method is very fast and can quickly free the gap, as shown in Figure 5 . However, the shortcoming of the slow release of the electric hook is blood oozing, which causes the wound to be unsightly and elderly patients can easily compress the peritoneum. The gauze ball pressure method is based on the action of the abdominal gas.

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Blunt separation of gauze balls.

Age Factors

For elderly patients over 60 years of age, the peritoneum is thinner, in worse condition, less tough, and less resistant to tension. Compared with young people, there is a greater chance of peritoneal rupture ( 12 ). This also leads to many difficulties in applying peritoneal sutures in the later stage. In this case, if you have insufficient experience, a timely transfer of the TES (post-muscle space) or IPOM is a good treatment option.

Level Selection

The preferred level in which to incise is between the transverse abdominal fascia and the posterior sheath. In the case at the Hunan Provincial People's Hospital, we entered between the peritoneum and transverse abdominal fascia on one side of the operation surface. In theory, this level is the most ideal. There is a layer of peritoneum from the abdominal cavity. However, at this level, the peritoneum is too thin. It is as thin as a cicada's wing and is very easy to break. Therefore, it is not the ideal level in practice. Therefore, the thin transverse abdominal fascia is reserved for the peritoneum, which promotes the peritoneum to become relatively thick, so that the peritoneum is not easily broken during the separation process.

Peritoneal Rupture Suturing

Peritoneal ruptures near the lower abdomen are easy to suture. Choose round needles with 3–0 absorbable sutures. Paraffin oil lubricates the sutures all the way, so that when the sutures pass through the peritoneum, any trauma to the peritoneum will be minimized ( 13 ).

a. If multiple peritoneal breaks are close together, a continuous suturing method should be adopted; that is, after the first break is closed by the suture, do not cut the thread. After tightening, pull the thread over and continue suturing the second break until the continuous suture is completed. If three or four breaches occur, continuous stitching can avoid the cumbersome process of suturing, cutting, ending, and restarting at each breach, enabling the process to be more efficient.

b. If the rupture is large, separate the peritoneum from the front axillary line or even the mid-axillary line on both sides to promote relaxation of the peritoneum. In this way, it will be much easier to close the peritoneal rupture because there will be no tension.

c. If the rupture is large and the peritoneum is free on both sides, and it is still not possible to suture the bulge or the tension after the suture is large, then the greater omentum should be used instead. When this method was employed in our study, the appropriate omentum tissue was selected, and the peritoneal rupture was lifted to the extraperitoneal space. Then the peritoneal rupture was filled, and the greater omentum was continuously sutured along the edge of the peritoneum to fix the peritoneum. In this way, the peritoneal rupture was sealed. The disadvantage of this is that the omentum will adhere to the peritoneum, creating an artificial adhesion, which could potentially lead to internal hernia formation or cause abdominal pain after surgery.

d. Peritoneal rupture can be performed by stamping. Use an anti-adhesion membrane to directly cover the peritoneum to prevent peritoneal rupture. If ruptures are prevented, then stitching is not necessary, thus making the procedure more efficient.

Twenty-one cases of umbilical hernia repairs in this group were successfully completed. The operation time was 120–240 min (average time, 177.3 ± 42.15 min), and the blood loss volume was 30–40 ml (average, 33.73 ± 3.55 ml). The patch was a Xinhua Shanxiu® Light Hernia Repair Patch. There were 20 cases with a 15 × 15 cm 2 cut, and 1 case with a Medtronic polypropylene patch and a 15 × 15 cm 2 cut, and the hernia ring was closed using a hernia needle. The mean follow-up period was 6 months, and there were no short-term complications and no cases of recurrence.

The 21 patients had no postoperative complications and were discharged from the hospital. Since follow-up, there have been no cases of recurrence. The surgeon mainly used the cephalic approach.

We performed an RA separation in a patient. We cut the posterior sheath and peritoneum together, freed the peritoneum, and tried to separate it from the posterior sheath; however, this method failed many times. We therefore had to change the area to the posterior rectus abdominis and operated in the anterior clearance of the posterior sheath. The purpose of the thread that is reserved on both sides is to stretch the left and right sides of front sheath and back sheath incisions, so that the trocar or lens will not enter the wrong level during the later operation as a result from the back sheath incision being pulled up by the thread. In addition, at the end of the operation, it is simple and quick to directly suture the slings on both sides of the carina, which is much faster and safer than suturing alone.is not suspended, the suture when closing the incision after the operation is more laborious and time-consuming. The suturing on both sides of the incision of the anterior sheath and the posterior sheath was performed with a single needle by early surgeons. Because the force area of the anterior and posterior sheath is limited, especially when the posterior sheath is relatively weak, tearing can easily occur, leading to failure of the pulling mechanism. Later, when switched to a continuous suture suspension, the force-bearing area is relatively large, and the aponeurosis is not easy to tear.

Under the cephalic approach, peritoneal ruptures in the upper abdomen are difficult to suture; therefore, care must be taken during the freeing process to prevent peritoneal ruptures. If there is damage, one can lower the patient's head and raise their legs; however, this means that the surgeon's upper limbs are raised during suturing. This will make the surgeon's arms very uncomfortable. Putting a pedal is a good method for the surgeon to improve their comfort.

To date, we have performed a total of 21 cases of umbilical hernia repairs with a cephalic approach plus an extraperitoneal approach on the posterior sheath, and all of them have been successful. A special case was an elderly patient over 60 years of age. Because of the increased age, the toughness of the peritoneum is decreased, so we need to pay more attention when freeing the peritoneum to prevent breaking it. If it is further damaged, there will be further complications during later suturing of the peritoneum.

The advantages of this procedure are that it utilizes the ideal surgical repair level and does not disturb the four-in-one structure of the anterior sheath, rectus abdominis, posterior sheath, and white line. In the extraperitoneal space, the abdominal cavity is not disturbed ( 14 ). The patch has the greatest pressure. We believe that it is the perfect method for hernia repair. It is the closest to the abdominal cavity and is worthy of clinical promotion.

Limitations

This study has some limitations. First, the outcomes of this study are not based on randomized data, and all data were retrospectively collected and analyzed, which creates a potential risk of selection bias. Furthermore, follow-up appointments were made only at a mean of 6 months. Long-term postoperative complications may have occurred thereafter.

The laparoscopic cephalic approach plus a posterior sheath and extraperitoneal approach is a feasible, safe, and easy-to-incorporate surgical approach. The intraoperative complication rate was low. Prospective research and a larger patient cohort are needed to further confirm this novel surgical technique.

Data Availability Statement

Ethics statement.

The studies involving human participants were reviewed and approved by The First Affiliated Hospital of Henan University of Traditional Chinese Medicine. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

College of Nursing

Driving change: a case study of a dnp leader in residence program in a gerontological center of excellence.

View as pdf A later version of this article appeared in Nurse Leader , Volume 21, Issue 6 , December 2023 . 

The American Association of Colleges of Nursing (AACN) published the Essentials of Doctoral Education for Advanced Practice Nursing in 2004 identifying the essential curriculum needed for preparing advanced practice nurse leaders to effectively assess organizations, identify systemic issues, and facilitate organizational changes. 1 In 2021, AACN updated the curriculum by issuing The Essentials: Core Competencies for Professional Nursing Education to guide the development of competency-based education for nursing students. 1 In addition to AACN’s competency-based approach to curriculum, in 2015 the American Organization of Nurse Leaders (AONL) released Nurse Leader Core Competencies (updated in 2023) to help provide a competency based model to follow in developing nurse leaders. 2

Despite AACN and AONL competency-based curriculum and model, it is still common for nurse leaders to be promoted to management positions based solely on their work experience or exceptional clinical skills, rather than demonstration of management and leadership competencies. 3 The importance of identifying, training, and assessing executive leaders through formal leadership development programs, within supportive organizational cultures has been discussed by national leaders. As well as the need for nurturing emerging leaders through fostering interprofessional collaboration, mentorship, and continuous development of leadership skills has been identified. 4 As Doctor of Nursing Practice (DNP) nurse leaders assume executive roles within healthcare organizations, they play a vital role within complex systems. Demonstration of leadership competence and participation in formal leadership development programs has become imperative for their success. However, models of competency-based executive leadership development programs can be hard to find, particularly programs outside of health care systems.

The implementation of a DNP Leader in Residence program, such as the one designed for The Barbara and Richard Csomay Center for Gerontological Excellence, addresses many of the challenges facing new DNP leaders and ensures mastery of executive leadership competencies and readiness to practice through exposure to varied experiences and close mentoring. The Csomay Center , based at The University of Iowa, was established in 2000 as one of the five original Hartford Centers of Geriatric Nursing Excellence in the country. Later funding by the Csomay family established an endowment that supports the Center's ongoing work. The current Csomay Center strategic plan and mission aims to develop future healthcare leaders while promoting optimal aging and quality of life for older adults. The Csomay Center Director created the innovative DNP Leader in Residence program to foster the growth of future nurse leaders in non-healthcare systems. The purpose of this paper is to present a case study of the development and implementation of the Leader in Residence program, followed by suggested evaluation strategies, and discussion of future innovation of leadership opportunities in non-traditional health care settings.

Development of the DNP Leader in Residence Program

The Plan-Do-Study-Act (PDSA) cycle has garnered substantial recognition as a valuable tool for fostering development and driving improvement initiatives. 5 The PDSA cycle can function as an independent methodology and as an integral component of broader quality enhancement approaches with notable efficacy in its ability to facilitate the rapid creation, testing, and evaluation of transformative interventions within healthcare. 6 Consequently, the PDSA cycle model was deemed fitting to guide the development and implementation of the DNP Leader in Residence Program at the Csomay Center.

PDSA Cycle: Plan

Existing resources. The DNP Health Systems: Administration/Executive Leadership Program offered by the University of Iowa is comprised of comprehensive nursing administration and leadership curriculum, led by distinguished faculty composed of national leaders in the realms of innovation, health policy, leadership, clinical education, and evidence-based practice. The curriculum is designed to cultivate the next generation of nursing executive leaders, with emphasis on personalized career planning and tailored practicum placements. The DNP Health Systems: Administration/Executive Leadership curriculum includes a range of courses focused on leadership and management with diverse topics such as policy an law, infrastructure and informatics, finance and economics, marketing and communication, quality and safety, evidence-based practice, and social determinants of health. The curriculum is complemented by an extensive practicum component and culminates in a DNP project with additional hours of practicum.

New program. The DNP Leader in Residence program at the Csomay Center is designed to encompass communication and relationship building, systems thinking, change management, transformation and innovation, knowledge of clinical principles in the community, professionalism, and business skills including financial, strategic, and human resource management. The program fully immerses students in the objectives of the DNP Health Systems: Administration/Executive Leadership curriculum and enables them to progressively demonstrate competencies outlined by AONL. The Leader in Residence program also includes career development coaching, reflective practice, and personal and professional accountability. The program is integrated throughout the entire duration of the Leader in Residence’s coursework, fulfilling the required practicum hours for both the DNP coursework and DNP project.

The DNP Leader in Residence program begins with the first semester of practicum being focused on completing an onboarding process to the Center including understanding the center's strategic plan, mission, vision, and history. Onboarding for the Leader in Residence provides access to all relevant Center information and resources and integration into the leadership team, community partnerships, and other University of Iowa College of Nursing Centers associated with the Csomay Center. During this first semester, observation and identification of the Csomay Center Director's various roles including being a leader, manager, innovator, socializer, and mentor is facilitated. In collaboration with the Center Director (a faculty position) and Center Coordinator (a staff position), specific competencies to be measured and mastered along with learning opportunities desired throughout the program are established to ensure a well-planned and thorough immersion experience.

Following the initial semester of practicum, the Leader in Residence has weekly check-ins with the Center Director and Center Coordinator to continue to identify learning opportunities and progression through executive leadership competencies to enrich the experience. The Leader in Residence also undertakes an administrative project for the Center this semester, while concurrently continuing observations of the Center Director's activities in local, regional, and national executive leadership settings. The student has ongoing participation and advancement in executive leadership roles and activities throughout the practicum, creating a well-prepared future nurse executive leader.

After completing practicum hours related to the Health Systems: Administration/Executive Leadership coursework, the Leader in Residence engages in dedicated residency hours to continue to experience domains within nursing leadership competencies like communication, professionalism, and relationship building. During residency hours, time is spent with the completion of a small quality improvement project for the Csomay Center, along with any other administrative projects identified by the Center Director and Center Coordinator. The Leader in Residence is fully integrated into the Csomay Center's Leadership Team during this phase, assisting the Center Coordinator in creating agendas and leading meetings. Additional participation includes active involvement in community engagement activities and presenting at or attending a national conference as a representative of the Csomay Center. The Leader in Residence must mentor a master’s in nursing student during the final year of the DNP Residency.

Implementation of the DNP Leader in Residence Program

PDSA Cycle: Do

Immersive experience. In this case study, the DNP Leader in Residence was fully immersed in a wide range of center activities, providing valuable opportunities to engage in administrative projects and observe executive leadership roles and skills during practicum hours spent at the Csomay Center. Throughout the program, the Leader in Residence observed and learned from multidisciplinary leaders at the national, regional, and university levels who engaged with the Center. By shadowing the Csomay Center Director, the Leader in Residence had the opportunity to observe executive leadership objectives such as fostering innovation, facilitating multidisciplinary collaboration, and nurturing meaningful relationships. The immersive experience within the center’s activities also allowed the Leader in Residence to gain a deep understanding of crucial facets such as philanthropy and community engagement. Active involvement in administrative processes such as strategic planning, budgeting, human resources management, and the development of standard operating procedures provided valuable exposure to strategies that are needed to be an effective nurse leader in the future.

Active participation. The DNP Leader in Residence also played a key role in advancing specific actions outlined in the center's strategic plan during the program including: 1) the creation of a membership structure for the Csomay Center and 2) successfully completing a state Board of Regents application for official recognition as a distinguished center. The Csomay Center sponsored membership for the Leader in Residence in the Midwest Nurse Research Society (MNRS), which opened doors to attend the annual MNRS conference and engage with regional nursing leadership, while fostering socialization, promotion of the Csomay Center and Leader in Residence program, and observation of current nursing research. Furthermore, the Leader in Residence participated in the strategic planning committee and engagement subcommittee for MNRS, collaborating directly with the MNRS president. Additional active participation by the Leader in Residence included attendance in planning sessions and completion of the annual report for GeriatricPain.org , an initiative falling under the umbrella of the Csomay Center. Finally, the Leader in Residence was involved in archiving research and curriculum for distinguished nursing leader and researcher, Dr. Kitty Buckwalter, for the Benjamin Rose Institute on Aging, the University of Pennsylvania Barbara Bates Center for the Study of the History of Nursing, and the University of Iowa library archives.

Suggested Evaluation Strategies of the DNP Leader in Residence Program

PDSA Cycle: Study

Assessment and benchmarking. To effectively assess the outcomes and success of the DNP Leader in Residence Program, a comprehensive evaluation framework should be used throughout the program. Key measures should include the collection and review of executive leadership opportunities experienced, leadership roles observed, and competencies mastered. The Leader in Residence is responsible for maintaining detailed logs of their participation in center activities and initiatives on a semester basis. These logs serve to track the progression of mastery of AONL competencies by benchmarking activities and identifying areas for future growth for the Leader in Residence.

Evaluation. In addition to assessment and benchmarking, evaluations need to be completed by Csomay Center stakeholders (leadership, staff, and community partners involved) and the individual Leader in Residence both during and upon completion of the program. Feedback from stakeholders will identify the contributions made by the Leader in Residence and provide valuable insights into their growth. Self-reflection on experiences by the individual Leader in Residence throughout the program will serve as an important measure of personal successes and identify gaps in the program. Factors such as career advancement during the program, application of curriculum objectives in the workplace, and prospects for future career progression for the Leader in Residence should be considered as additional indicators of the success of the program.

The evaluation should also encompass a thorough review of the opportunities experienced during the residency, with the aim of identifying areas for potential expansion and enrichment of the DNP Leader in Residence program. By carefully examining the logs, reflecting on the acquired executive leadership competencies, and studying stakeholder evaluations, additional experiences and opportunities can be identified to further enhance the program's efficacy. The evaluation process should be utilized to identify specific executive leadership competencies that require further immersion and exploration throughout the program.

Future Innovation of DNP Leader in Residence Programs in Non-traditional Healthcare Settings

PDSA Cycle: Act

As subsequent residents complete the program and their experiences are thoroughly evaluated, it is essential to identify new opportunities for DNP Leader in Residence programs to be implemented in other non-health care system settings. When feasible, expansion into clinical healthcare settings, including long-term care and acute care environments, should be pursued. By leveraging the insights gained from previous Leaders in Residence and their respective experiences, the program can be refined to better align with desired outcomes and competencies. These expansions will broaden the scope and impact of the program and provide a wider array of experiences and challenges for future Leaders in Residency to navigate, enriching their development as dynamic nurse executive leaders within diverse healthcare landscapes.

This case study presented a comprehensive overview of the development and implementation of the DNP Leader in Residence program developed by the Barbara and Richard Csomay Center for Gerontological Excellence. The Leader in Residence program provided a transformative experience by integrating key curriculum objectives, competency-based learning, and mentorship by esteemed nursing leaders and researchers through successful integration into the Center. With ongoing innovation and application of the PDSA cycle, the DNP Leader in Residence program presented in this case study holds immense potential to help better prepare 21 st century nurse leaders capable of driving positive change within complex healthcare systems.

Acknowledgements

         The author would like to express gratitude to the Barbara and Richard Csomay Center for Gerontological Excellence for the fostering environment to provide an immersion experience and the ongoing support for development of the DNP Leader in Residence program. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

  • American Association of Colleges of Nursing. The essentials: core competencies for professional nursing education. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf . Accessed June 26, 2023.
  • American Organization for Nursing Leadership. Nurse leader core competencies. https://www.aonl.org/resources/nurse-leader-competencies . Accessed July 10, 2023.
  • Warshawsky, N, Cramer, E. Describing nurse manager role preparation and competency: findings from a national study. J Nurs Adm . 2019;49(5):249-255. DOI:  10.1097/NNA.0000000000000746
  • Van Diggel, C, Burgess, A, Roberts, C, Mellis, C. Leadership in healthcare education. BMC Med. Educ . 2020;20(465). doi: 10.1186/s12909-020-02288-x
  • Institute for Healthcare Improvement. Plan-do-study-act (PDSA) worksheet. https://www.ihi.org/resources/Pages/Tools/PlanDoStudyActWorksheet.aspx . Accessed July 4, 2023.
  • Taylor, M, McNicolas, C, Nicolay, C, Darzi, A, Bell, D, Reed, J. Systemic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety. 2014:23:290-298. doi: 10.1136/bmjqs-2013-002703

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IMAGES

  1. SOLUTION: Hiatal Hernia Normal Anatomy Case Study Presentation

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  2. (PDF) Amyand’s Hernia: Case Study And Review of Literature

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  3. Hiatal Hernia Case Study

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  4. Hernia Repair Case Study

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  5. Case study on inguinal hernia

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COMMENTS

  1. Hernia Nursing Diagnosis and Nursing Care Plan

    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.

  2. 3 Umbilical and Inguinal Hernia Nursing Care Plans

    1. Managing Postoperative Pain 2. Preventing Injury and Swelling 3. Initiating Patient Education and Health Teachings 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.

  3. The Effect of Nursing Intervention on Patients with Inguinal Hernia and

    In the case of increased abdominal pressure such as coughing or ... In order to evaluate and verify the effect and practical value of the nursing intervention for inguinal hernia patients based on medical data analysis proposed in this study, a questionnaire survey was made to let these patients evaluate the nursing quality and personnel ...

  4. Nursing care of Inguinal Hernias

    An inguinal hernia is a protrusion of the abdominal contents through the inguinal canal, often into the groin or scrotum. They are a very common problem and patients may complain of pain or discomfort when coughing, exercising or during bowel movements.

  5. A case report of incarcerated inguinal hernia: Amyand's hernia with

    Presentation of case A 87-year-old male presented in the emergency department due to a persistent right inguinal pain. Clinical examination revealed a tender right groin mass. Under the diagnosis of an right inguinal hernia, an operation was taken. Intraoperatively, an inflamed appendix and a part of the cecum were found in the hernia sac.

  6. PDF A 68-Year-Old Woman with Paraesophageal Hernia

    all associated with hiatal hernia formation1. Sliding hiatal hernias are very common, and most don't require surgery. A paraesophageal hernia is differentiated from a sliding, or axial, hiatal hernia by the location of the gastroesophageal (GE) junction. In a pure paraesophageal hernia (i.e., type II hernia), the gastroesophageal junction is

  7. Inguinal Hernias: Diagnosis and Management

    In the United States, 1.6 million groin hernias are diagnosed annually, and 700,000 are repaired surgically. 2 The lifetime prevalence of groin hernias is 27% in men and 3% in women. 3 The ...

  8. Evidence-Based Hernia Treatment in Adults

    Inguinal hernia is diagnosed by physical examination. Surgery is not necessarily indicated for a primary, asymptomatic inguinal hernia in a male patient, but all inguinal hernias in women should be operated on. For hernias in women, and for all bilateral hernias, a laparoscopic or endoscopic procedure is preferable to an open procedure.

  9. Case Study: Repair Surgery for Patient with Hernia and Abdominal Damage

    Case Study: Repair Surgery for Patient with Hernia and Abdominal Damage Treating a patient after a complicated hernia repair led to surgical complications and chronic pain A 55-year-old woman with a history of Crohn's disease presented after having multiple hernia surgeries.

  10. Case study on inguinal hernia

    Oct 17, 2013 • 246 likes • 134,070 views Health & Medicine Business This is a case study done by me as a part of my in-service education progamme in my institution...hope this may help all nurses who wants to do a case study. 1 of 50 Download Now Recommended Umbilical hernia Abdulaziz Bagasi Umbilical hernia Basil Wilson

  11. Inguinal bladder hernia: a case report

    Abstract. Inguinal hernia is a common disorder that requires urgent and adequate surgical management. Multiple organs may be associated with inguinal hernias, but bladder involvement is rarely seen. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower ...

  12. Case study

    WEEK 16. The patient re-attends his GP complaining of persistent pain and some swelling in the left groin. He is referred back to the surgical unit. An MRI reveals no problem related to the mesh and no recurrence of the hernia. The surgeon advises Mr K that there appears to be some fatty infiltration of the inguinal canal (cord lipoma) and this ...

  13. Identifying clinically relevant sliding hiatal hernias: a population

    Abstract. Objectives: The clinical relevance of small to moderate sliding hiatal hernias is controversial. The aims of the present study were to (1) investigate which symptoms are associated with sliding hiatal hernias and (2) define the length of a sliding hiatal hernia at which gastrointestinal symptoms occur.

  14. Amyand's hernia: A case report and review of the literature

    Presentation of case A 59-year-old male with a history of a previously reducible right inguinal hernia presented to the Emergency Department with acute abdominal pain, right groin mass. Computed tomography (CT) confirmed a right incarcerated inguinal hernia with herniated loops of bowel within the right inguinal region.

  15. Case Report on Nursing Management of a Client with Hiatus Hernia

    After the physical examination, history collection and investigations he was diagnosed as case of hiatus hernia.The study's main focus is on professional management and excellent nursing care, which may be able to give the holistic care that hiatus hernia requires while also efficiently treating the difficult case.

  16. Nursing care of patients with Hernia

    1. Abdelrahman Alkilani, RN. BSN. MSN- Year 1 Nursing Care of Patients with Hernia. 2. • Define Hernia. • Enumerate the different types of Hernias. • State the clinical manifestations of Hernias • Discuss the pathophysiology of Hernia • State the complications of Hernias. • Describe the diagnostic tests required for patients with ...

  17. Case Study: Endometriosis or Hernia?

    Only 13 cases of left-sided inguinal endometriosis have been reported in the literature to date, the group said. The condition can present with symptoms common to various other inguinal conditions ...

  18. Indirect Inguinal Hernia CASE Study

    OPEN HERNIA REPAIR In this procedure, which might be done with local anesthesia and sedation or general anesthesia, the surgeon makes an incision in the groin and pushes the protruding tissue back into the abdomen. The surgeon then sews the weakened area, often reinforcing it with a synthetic mesh (hernioplasty).

  19. Hiatal Hernia Nursing Care Plan

    Management for hiatal hernias depends on the type of hernia and the severity of the symptoms. The goals of treatment include prevention of reflux of gastric contents, improved esophageal clearance, and reduction in acid production. The following are nursing diagnoses associated with hiatal hernia. Acute Pain.

  20. The management of hiatal hernia: an update on diagnosis and treatment

    Hiatal hernia (HH) occurs quite frequently in the general population and is characterized by a wide range of non-specific symptoms, most of them related to gastroesophageal reflux disease. Treatment can be challenging at times, depending on the existence of complications.

  21. Hernia

    Hernia | Case Study. 1. HERNIA MOHAMMAD MATOUQ ALGHAMDI - PHARM.D INTERNSHIP SURGICAL ROTATION. 2. HERNIA A hernia is a protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it, such as the abdominal wall.

  22. Nursing Care Plan & Diagnostics: Hiatal Hernia Case Study

    Nursing Care Plan & Diagnostics: Hiatal Hernia Case Study Exclusively available on IvyPanda Overview with cultural considerations My patient is a 30-year old white American, who was hospitalized with complaints about sharp and acute pain in his neck and shoulders.

  23. Case Report: 21 Cases of Umbilical Hernia Repair Using a Laparoscopic

    Methods: From 2019 to 2020, 21 patients (81.8% men) with an umbilical hernia underwent a laparoscopic cephalic approach plus a posterior sheath and extraperitoneal approach, performed by two surgeons specializing in abdominal wall surgery, in two academic hospitals.

  24. Driving change: a case study of a DNP leader in residence program in a

    View as pdf A later version of this article appeared in Nurse Leader, Volume 21, Issue 6, December 2023.. Background. The American Association of Colleges of Nursing (AACN) published the Essentials of Doctoral Education for Advanced Practice Nursing in 2004 identifying the essential curriculum needed for preparing advanced practice nurse leaders to effectively assess organizations, identify ...