HIATAL HERNIA
A Case Study Presented to the
Faculty of the Nursing Department
San Pedro College
Davao City
MR. MARC JADE ADLAWAN, RN
In Partial Fulfillment of
The Requirements in NCM 216-RLE
GASTROINTESTINAL / METABOLISM NURSING ROTATION
BY:
JUNNESSA DALE LELIS, ST.N.
ALEXIS KHALYL MONTEJO, ST.N.
CHRISTINE M. PADASDAO
FIONA SOTITO, ST.N.
CLARISSA S. TORRES, ST.N.
April 5, 2021
TABLE OF CONTENTS
Page Number
A. INTRODUCTION
I. OBJECTIVES
II. ANATOMY AND PHYSIOLOGY
III. PATHOPHYSIOLOGY
A. ETIOLOGY
B. SYMPTOMATOLOGY
C. DISEASE PROCESS
D. NARRATIVE
B. MEDICAL MANAGEMENT
A. PHARMACOLOGICAL
I. SURGICAL MANAGEMENT
II. NURSING MANAGEMENT
A. A. NURSING CARE PLAN
I. PROGNOSIS
II. DISCHARGE PLANNING
III. RELATED NURSING THEORY
IV. REVIEW OF RELATED STUDIES/LITERATURE
V. REFERENCES
SCHEMATIC DIAGRAM
PRECIPITATING FACTORS
PREDISPOSING FACTORS Obesity
Straining
Age (50 or older) Pregnancy
Heavy lifting
Ehlers Danlos syndrome
Smoking
Gender (female) Cough
Trauma
Surgery
Ascites
Chronic esophagitis
Increased pressure in the
abdominal cavity
Upward movement of
pressure
Reaches the diaphragmatic
opening
A
A
Postprandial
Substernal fullness
chest pain Compromises the
integrity of the
DIAGNOSTIC TOOLS diaphragmatic
Physical Assessment: opening DIAGNOSTIC TOOLS
PQRST pain assessment Physical Assessment
Alteration in BP, HR, RR Belching and bloating may
Grimaced face, irritability may Pressure overcomes be observed
be noted muscle strength Uncomfortable feeling of
Factors that alleviate pain fullness after eating as
Nursing Diagnosis: verbalized by the client
Acute pain related to tissue
injury and increased intra-
abdominal pressure
Lower portion of Greater curvature
the esophagus of the stomach
slips through the slips through
experience
precipitate or increase the pain
Reduce or eliminate factors that
possible, during painful activities.
techniques before, after, and if
Teach the use of nonpharmacologic
Nursing
scheduled doses until the pain is relieved
administered and titrated in ATC
opioid and nonopioid; SEVERE - opioid is
MODERATE- opioid, or a combination of
as ordered (MILD- nonopioid analgesics;
Provide pharmacologic pain management
Medical
hiatus
eating
after
short walk
to take a
may help
moving. It
Get
slowly
drink
Eat
and beer.
d
carbonate
Avoid
Nursing
MANAGE
MENT
drinks
Upper portion of
and
MANAGEMENT
C
the stomach
follows
B
B C
R
git
ROLLING HIATAL ROLLING HIATAL n
HERNIA HERNIA DIAGNOSTIC TOOLS
Physical assessment
Nausea, vomiting
Burning sensation in the
MIXED HIATAL chest
Sour taste in the mouth
HERNIA
Gagging or chocking
Medical
X-ray, endoscopy,
ambulatory acid probe test,
esophageal motility testing
Nursing Diagnosis
Risk for aspiration r/t
Stricture Pressure VS. esophageal compromise
esophageal sphincter affecting the lower
esophageal sphincter
Injury
Backflow of gastric MANAGEMENT
materials to the Medical
Administer medications as
Scar formation esophagus
ordered (antacids, H2RAs and
proton pump inhibitors)
Nursing
Avoid tight-fitting clothing and
D Gastric acid irritates the foods that trigger heartburn
esophageal lining Avoid lying down after a meal.
Wait at least three hours.
Elevate the head of bed.
Avoid large meals. Instead eat
many small meals throughout
the day.
D
Dysphagia
DIAGNOSTIC TOOLS Occult
Physical Assessment bleeding, DIAGNOSTIC TOOLS
Unable to swallow anemia Physical assessment
Bringing food back up
Black-tarry or even
(regurgitation)
Decrease Incarcerate obstructio Decrease maroon stool
Coughing or gagging
functionin d hernia n flexibility Low blood pressure,
when swallowing
g Irregular heartbeats,
Medical
Shortness of breath
X-ray with a contrast
Pale skin
material (barium X-ray),
Fatigue, weakness
endoscopy, Fiber-optic Decrease Medical
endoscopic evaluation of Decrease diaphragmat Decrease Complete blood count
swallowing (FEES), digestion ic expansion capacity (CBC)
imaging scans
Fecal occult blood test
Capsule endoscopy
Imaging tests
MANAGEMENT Weight
Medical malnutriti
loss Decrease
Administer medications on respirator MANAGEMENT
as ordered (antacids, y effort Medical
H2RAs and proton pump IV fluids, blood transfusion
inhibitors) Nursing
Surgical Encourage oral fluid intake
E MANAGEMENT
Laparoscopic Nissen of at least 2L per day if not
DIAGNOSTIC TOOLS Medical
fundoplication (LNF) contraindicated
Physical Assessment Enteral feedings, protein
Nursing Monitor intake and output
a lack of growth and low supplements
regularly
Try eating smaller, body weight Nursing
more-frequent meals. loss of fat, muscle mass, Provide good oral hygiene and
Be sure to cut food into and body tissue dentition
Provide companionship during
smaller pieces, chew Medical
mealtime.
food thoroughly and eat Serum electrolytes, CBC,
Provide a pleasant
more slowly. serum albumin
environment.
E
If treated
If not treated
MEDICAL MANAGEMENT
IV fluids, enteral feeding, blood transfusion for
replacement
Proton pump inhibitors and H2 blockers antagonists to Respiratory Chronic Strangulated
reduce stomach acid production complications regurgitation hiatal hernia
Antacids to help neutralize stomach acid or reflux
Analgesics to relieve pain
SURGICAL MANAGEMENT
Laparoscopic Nissen fundoplication (LNF) blood being
NURSING MANAGEMENT stopped from
Teach the use of nonpharmacologic techniques before, flowing freely to the
after, and if possible, during painful activities. Barrett’s Recurrent tissue
Reduce or eliminate factors that precipitate or increase esophagus aspiration
the pain experience
Avoid carbonated drinks and beer.
Eat and drink slowly Esophageal Respiratory Tissue death
Get moving. It may help to take a short walk after eating cancer tract infections and gangrene
Avoid lying down after a meal. Wait at least three hours.
Elevate the head of bed.
Avoid large meals. Instead eat many small meals
throughout the day.
DEATH
PROGNOSIS
Most people with hiatal hernias have few, if any, symptoms.
PROGNOSIS
More bothersome symptoms usually are controlled with
medications which includes the medications mentioned above. If left untreated, hiatal hernia will progress and cause a
Thus, with prompt treatment and patient’s compliance, hiatal lot of complications that may lead to death. In this case, it
hernia would have a good prognosis. will have a poor prognosis.
