# Perioperative nursing management of an adult patient with giant right-sided Bochdalek hernia: a case report

## TL;DR

This case report describes successful perioperative nursing care for a rare giant right-sided diaphragmatic hernia in an adult, leading to full recovery.

## Contribution

Presents a novel individualized perioperative nursing approach for a rare adult diaphragmatic hernia.

## Key findings

- Multidisciplinary individualized care reduced complications in a complex hernia repair.
- Dynamic temperature and positioning management prevented perioperative hypothermia and pressure injuries.
- Postoperative pulmonary rehabilitation and airway management ensured full recovery.

## Abstract

Adult right-sided Bochdalek hernia is extremely rare and poses unique perioperative nursing challenges, especially with intrathoracic displacement of abdominal organs.

A 19-year-old male presented with exertional dyspnea. Imaging revealed a giant right-sided diaphragmatic hernia containing part of the liver, gallbladder, and colon, with approximately 70% compression of the right lung.

A multidisciplinary team developed individualized perioperative plans. Prehabilitation based on self-efficacy theory was implemented, including respiratory training, nutritional support. During surgery, a surgical risk early-warning and rapid response system was established. Precise intraoperative pressure injury risk assessment and dynamic positioning management were implemented. Continuous dynamic temperature monitoring and individualized target temperature management were applied to prevent perioperative hypothermia. Postoperative care focused on airway management,sequential respiratory support, early gastrointestinal function monitoring, and progressive pulmonary rehabilitation.

The patient was discharged after 32 days without major complications. Follow-up at 3, 6, and 12 months showed full recovery and no recurrence.

Comprehensive, individualized perioperative nursing interventions can optimize recovery and outcomes in complex adult right-sided diaphragmatic hernia repair.