Nursing Diagnosis of Paraesophageal Hernia

Paraesophageal hernia is a medical diagnosis that indicates a portion of the stomach has pushed up through a hole in the diaphragm and is sitting in the chest cavity next to the esophagus. It is a subtype of hiatal hernia. The term nursing diagnosis refers to standardized nursing language developed by NANDA to allow nurses to identify patient issues in a way that can be consistently communicated across clinical settings. RNs cannot make medical diagnoses, but they do make nursing diagnoses.

Types

• A patient with a paraesophageal hernia may have chest pain, indigestion, trouble swallowing, nausea and/or vomiting. The nurse will assess her patient to find out which symptoms he has, and then select appropriate nursing diagnoses. She may identify symptom-specific ones such as "pain: chronic" or "nausea." She may also select nursing diagnoses that reflect the impact of those symptoms, such as "nutrition, imbalanced: less than body requirements" for a patient who is limiting his food intake to reduce his pain and nausea.

Function

• The nursing process is a universal framework to provide consistent nursing care for a patient over time. The nurse begins with assessment, and then uses the findings from that assessment to identify nursing diagnoses. From there, he plans, implements and evaluates patient care. Once a nurse has identified a nursing diagnosis of "pain: chronic," he will plan and implement strategies to reduce that pain. For example, he can educate his patient about acidic foods that increase the chest pain.

Significance

• When the first nurse goes off-duty and another nurse takes over the patient's care, she can read the nursing diagnosis and immediately know to continue teaching the patient about appropriate diet choices. She can ask the patient how the plan to reduce acidic foods is working, and suggest other ideas such as limiting caffeine. Knowing the patient also has a nursing diagnosis of "nutrition, imbalanced: less than body requirements," the nurse can calculate the patient's food intake for the day to see whether the dietary changes are working.

Effects

• While there are common symptoms in patients with paraesophageal hernias, some patients only have one to two symptoms. By using nursing diagnoses, nurses caring for a particular patient will have a clear and consistent picture of the issues to address. Everyone is working on the same issues, so care is much more effective and efficient.

Benefits

• When a nurse establishes nursing diagnoses for a patient with a paraesophageal hernia, she lays the groundwork for the rest of the nursing process. At the end of her shift, she can evaluate the care she's delivered by determining if a nursing diagnosis still applies. When she teaches her patient to reduce acidic foods and the chest pain goes away, the nursing diagnosis of "pain: acute" is no longer applicable. The nurse can clearly document the positive impact of her care.