Wow haven’t been over here writing in this blog for a while now.  Not since my disastrous start to my first clinical day!

My second clinical day, was great.  I brought my A game, was on time (early even), prepared and ready to go.  My patient was one with a ventral hernia.  The patient was very nice and was patient with me as I muddled through my head to toe assessment.  I watched he/she throw up (I say he/ she because I want to keep identifying information out of it as much as possible.) and then he/she left for surgery near noon time and I didn’t see them for the rest of my time on the floor.

For the rest of the time we were on the floor I was helping my fellow student nurses. We left the floor at 4pm for our break and then started post conference at 4:30 as planned.   Our instructor talked about Care Plans.  And she talked about it in such a way that a light bulb finally went on in my head regarding these elusive care plans that I didn’t really get until this point.  Sure they taught us about it last semester but I didn’t understand, really.  So I am thankful for that lession.

We also talked about head to toe assessment which was helpful.

My pathophysiology report for that week was on the Ventral hernia.  This is part of it….

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Ventral Hernia

A ventral hernia (or incisional hernia) is a bulge that appears at the site of a former surgical incision site. This results in a bulge or a tear in the area where the abdominal muscles have weakened.  This bulge is usually palpable when the patient is standing and usually needs surgical repair or support. It is a common post operative complication. There is the possibility that it can become strangulated or incarcerated necessitating surgical repair.

Signs and Symptoms:  abdominal bulge, Pain (sharp or dull), nausea and vomiting. The hernia itself is tender, and the overlying skin may be erythematous; peritonitis may develop depending on location, with diffuse tenderness, guarding, and rebound. These hernias may sometimes only be seen when abdominal pressure is increases as in coughing.

Cause:  A hernia occurs when part of an organ, (usually the bowel or intestine) protrudes through a weak point or tear in the thin muscular wall that holds the abdominal organs in place.  In this case, the patient asserts that she was being treated for bronchitis and had a forceful coughing spell which made the hernia occur. Patients who develop incisional hernias are often elderly or obese, with multiple comorbid diseases placing them at substantial risk for further surgical management.