1. The client/caregiver has a basic under- standing of the anatomy of the esophagus, stomach, and diaphragm.
   1. The diaphragm is a large sheet of muscle that separates the abdomen from the chest cavity.
   2. The esophagus (the food tube) extends down through a small opening in the diaphragm to connect to the stomach.
   3. The stomach lies just below the diaphragm.
2. The client/caregiver can define a hiatal hernia.
   1. Hernias occur when one part of the body protrudes through a gap or opening into another part.
   2. Hiatal hernia occurs when the muscle tissue surrounding this opening becomes weak and the upper part of the stomach bulges through the diaphragm into the chest cavity.
3. The client/caregiver can list factors that may increase the risk of hiatal hernia.
   1. Congenital weakness
   2. Advanced age
   3. Smoking
   4. Prolonged illness
   5. Obesity
   6. Pregnancy
   7. Tumors
   8. Restrictive clothing
   9. Heavy lifting
4. The client/caregiver can recognize the signs and symptoms of hiatal hernia, although the condition frequently exists without symptoms.
   1. Heartburn (burning sensation in the esophagus)
   2. Belching
   3. Regurgitation of sour tasting liquid in the mouth
   4. Difficulty swallowing because of muscle spasms
   5. Chest pain
   6. Symptoms become worse when leaning forward, straining, lifting heavy objects, lying down, and during pregnancy.
5. The client/caregiver can list measures to manage or prevent symptoms.
   1. Nutritional measures
      1. Avoid caffeine, coffee, soda, chocolate, and so forth.
      2. Avoid onions, spicy foods, spearmint, and peppermint.
      3. Limit citrus fruits and tomato-based foods.
      4. Limit fatty foods.
      5. Eat small, frequent meals.
      6. Increase fluids.
      7. Increase fiber to prevent constipation.
   2. Drink water after meals to cleanse the esophagus.
   3. Wait at least 3 hours after eating before going to bed or lying down.
   4. Avoid eating before going to bed at night.
   5. Do not exercise immediately after eating.
   6. Avoid smoking.
   7. Lose weight if you are overweight.
   8. Elevate the head of your bed. Raise the head of the bed 6 to 9 inches. Use blocks to raise the bed or a foam wedge to raise the mattress. Do not use pillows because they will increase pressure on your abdomen.
   9. Avoid wearing tight clothing.
   10. Discuss medications with physician for possible causes of heartburn. Do not use over the counter medications without physician approval.
   11. Reduce stress by relaxation techniques such as deep breathing, meditation, tai chi, or yoga.
   12. Avoid heavy lifting.
   13. Take medications as ordered.
   14. Keep follow-up appointments with physician.
6. The client/caregiver can list possible complications.
   1. Gastroesophageal reflux disease
   2. Ulceration of the herniated portion of the stomach
   3. Gastritis
   4. Lung aspiration
   5. Slow bleeding and iron-deficiency anemia

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. Philadelphia: Mosby Inc.
Cohen, B. J., & Wood, D. L. (2000). Memmler’s the Human Body in Health and Disease (9th ed.). Philadelphia: Lippincott Williams & Wilkins.
Nutrition made incredibly easy. (2003). Springhouse: Lippincott, Williams & Wilkins.
Portable RN: The all-in-one nursing reference. (2002). Springhouse: Lippincott, Williams & Wilkins.
Taylor, C., Lillis, D., & LeMone, P. (2005). Fundamentals of nursing. Philadelphia: Lippincott Williams & Wilkins.
Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com