Medical-surgical Nursing Demystified

CHAPTER 7 Gastrointestinal System^311

NURSING INTERVENTION

• Monitor vital signs.


• Assess abdomen for bowel sounds, tenderness, ascites.


• Plan appropriate rest for patient in acute phase.


• Monitor intake and output.


• Assess mental status for changes due to encephalopathy.


• Assist patient to:
  
  
  • Plan palatable meals; remember that breakfast is generally the best toler-
    ated meal.
  
  
  • Avoid smoking areas—intolerance to smoking.
  
  
  
  

Hiatal Hernia

WHAT WENT WRONG?

This is also known as a diaphragmatic hernia. A part of the stomach protrudes up
through the diaphragm near the esophagus into the chest. Patients may be asymp-
tomatic or have daily symptoms of gastroesophageal reflux disease (GERD). The
hernia may be a sliding hiatal hernia which allows movement of the upper portion
of the stomach including the lower esophageal sphincter up and down through
the diaphragm. These patients typically have symptoms of GERD. Another type
of hiatal hernia is a rolling hernia in which a portion of the stomach protrudes up
through the diaphragm, but the lower esophageal sphincter area remains below the
level of the diaphragm. These patients do not generally suffer from reflux.

PROGNOSIS

Lifestyle modifications may help control the symptoms of hiatal hernia. Some
patients who do not get adequate control of symptoms or are refractory to treat-
ment may need surgery to correct the movement through the diaphragm.

HALLMARK SIGNS AND SYMPTOMS

• Sliding hernia:
  
  
  • Heartburn
  
  
  • Difficulty swallowing (dysphagia)
  
  
  
  

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