Nursing 213

N213: Health Differences Across the Lifespan 3 Study Guide

Hiatal Hernia A hiatal hernia happens when the stomach protrudes up through the esophageal hiatus to the mediastinal cavity. It can also occur in the area of the diaphragm. It is caused by a defective diaphragm and increased intra-abdominal pressure. Factors affecting this disorder are pregnancy, coughing, abdominal strain, ascites, and obesity. The most common kind is the sliding hiatal hernia, which happens when the esophageal junction and stomach slide in and out of the thoracic cavity as the patient lies down and sits back up. The least common type is the paraesophageal hernia, where only the stomach protrudes up through the diaphragm. Hiatal hernia is most common in women as they age. This condition has complications, such as esophageal irritation, strangulation of the hernia (no blood supply), gangrene, disruption in lung or heart functions, and hemorrhage. Signs and symptoms of sliding hiatal hernia: • Regurgitation • Reflux • Heartburn • Dysphagia (trouble swallowing) Signs and symptoms of paraesophageal hernia: • Absence of reflux • Feeling of fullness after meals • Obstruction • Hemorrhage • Strangulation perforation Nursing assessment for hiatal hernia: • Ask patient when heartburn occurs: at night, after eating, or in the reclining position • Assess pain levels, location of pain, and duration; ask if chest painoccurs • Ask about history of reflux, diet history, and anything used to treat at home • Review laboratory and radiological studies: o CBC o Upper abdominal x-rays with barium swallow o Upper endoscopy with possible biopsies o Fluoroscopy Nursing diagnosis for hiatal hernia: • Pain related to displacement of stomach and esophagus • Altered nutrition with less than body requirements related to heartburn, dysphagia, and a feeling of fullness • Knowledge deficit related to the condition and treatment plan

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