Increases gastric emptying and improves LES pressure
Does not affect gastric acid secretion or heal esophageal tissue
Take before meals
Observe for neurologic or psychotropic side effects (restlessness, anxiety, ataxia, hallucinations)
Involves the protrusion of the stomach through the esophageal hiatus of the diaphragm into the thorax
Also referred to as diaphragmatic hernia and esophageal hernia
Sliding Hiatal Hernia
Most common type
Hernia usually moves into and out of the thorax during changes in position or intra-abdominal pressure.
Etiology: weakening of the diaphragm.
May develop esophageal reflux.
Volvulus (twisting) and obstruction do occur rarely.
Paraesophageal, or rolling Hiatal Hernia
Esophageal junction remains in place, but fundus and greater curvature of stomach roll up through the esophageal hiatus
Risk of volvulus (twisting), obstruction, and strangulation are high.
Paraesophageal, or rolling Hiatal Hernia cont.
Etiology: anatomic defect occurring when the stomach is not properly anchored below the diaphragm
Reflux is not usually present.
Other Etiological Factors
Many factors involved
Weakening of muscles in diaphragm
Increased intra-abdominal pressure
Other Etiological Factors cont
Hiatal Hernia: Assessment
Worsening of symptoms after eating
Hiatal Hernia: Assessment cont.
Feeling of fullness after eating
Breathlessness after eating
Feeling of suffocation
Worsening of symptoms in a recumbent position
Detailed history is important to differentiate cardiac chest pain from hiatal pain caused by reflux.
Hiatal Hernia: Diagnostic test
Upper GI or Barium Swallow: X-ray study allows examination of esophagus after swallowing a thick barium solution.
EGD may be performed to view both the esophagus and gastric lining.
Hiatal Hernia: Diagnostic test Nursing Responsibilities:
Before the test:
NPO for at least 8 hrs
Assess pt's ability to swallow
After the test: prevent contrast medium impaction
Give plenty of fluids.
Administer mild laxative or stool softener; stools may be chalky white for 24 to 72 hr.
Hiatal Hernia: Nonsurgical Management
Management Similar to GERD:
Drug therapy—antacids, histamine receptor antagonists
Hiatal Hernia: Nonsurgical Management patient teaching
Nutrition therapy—avoid eating in the late evening and avoid foods associated with reflux
Weight reduction, if appropriate
Hiatal Hernia: Nonsurgical Management patient teaching cont.
Elevate head of bed 6 inches for sleep, remain upright for several hours after eating, avoid straining, lifting and vigorous exercise, and avoid nonbinding clothing.
Hiatal Hernia: Surgical Management
Laparoscopic Nissen Fundoplication (LNF) is the surgery commonly used for hiatal hernia.
Several hiatal hernia repair procedures are used, each involves reinforcement of the LES by fundoplication. The surgeon wraps a portion of the stomach fundus around the distal esophagus to anchor it and reinforce the LES.
laparoscopic Nissen fundoplications (LNF): Pre-op & Post-op
Post-op care: The nursing priority is to observe for respiratory problems, bleeding. and infection
Provide health teaching (chart 57-6, p. 1253).
Assess for complications: (chart 57-7, p. 1254)
Gas bloat syndrome
Esophageal tumors can be benign or malignant, usually malignant.
Esophageal Tumors Primary risk factors:
Heavy alcohol intake
Long-term, untreated GERD
Barrett's esophagus (replacement of normal distal squamous epithelium with columnar epithelium as a result of chronic exposure of the esophagus to stomach acid) is ultimately malignant.
Assessment & Clinical Manifestations
Ask pt: change in appetite, wt. loss
Ask pt: clinical manifestations----- dysphagia, odynophagia, regurgitation, vomiting, foul breath, chronic hiccups, pulmonary complications, chronic cough, and hoarseness.
Esophageal Cancer: Diagnostic Tests
Esophageal Ultrasound with fine needle aspiration to examine the tumor tissue.
Imbalanced Nutrition: Less Than Body Requirements related to impaired swallowing
Risk for Aspiration related to impaired swallowing secondary to esophageal strictures.
Nutrition Therapy: Administration of food and fluids to support metabolic processes of a patient who is malnourished or at high risk for becoming malnourished.
Nursing Interventions cont
Collaboration with dietitian
Sitting position for eating and remain upright
Encourage semisoft food if lack of saliva
Monitor food & fluid intake (calorie count)
Swallowing Therapy: Facilitating swallowing and preventing complications of impaired swallowing.
Swallowing exercise program per speech therapist.
Assist patient to place food at back of mouth and unaffected side.
Monitor for s/s of aspiration.
Esophageal Cancer: Surgery Postoperative Care
Highest postoperative priority—respiratory care
Nasogastric tube management (chart 57-10, p. 1260)