The nurse will implement which nursing actions when caring for a client recently diagnosed with a hiatal hernia? Select all that apply.

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11ecbb05_c9a1_3b50_b433_a747d4e79152_MD0009_00 Conditions that increase intraabdominal pressure (eg, pregnancy, obesity, ascites, tumors, heavy lifting) and weaken the muscles of the diaphragm may allow a portion of the stomach to herniate through an opening in the diaphragm, causing a hiatal hernia. A sliding hernia occurs when a portion of the upper stomach squeezes through the hiatal opening in the diaphragm. A paraesophageal hernia (rolling hernia) occurs when the gastroesophageal junction remains in place but a portion of upper stomach folds up along the esophagus and forms a pocket. Paraesophageal hernias are a medical emergency. Although hiatal hernias may be asymptomatic, many clients experience signs and symptoms commonly associated with gastroesophageal reflux disease (GERD), including heartburn, dysphagia, and pain caused by increased intraabdominal pressure or supine positioning. Interventions to reduce herniation include the following: Diet modification-avoid high-fat foods and those that decrease lower esophageal sphincter pressure (eg, chocolate, peppermint, tomatoes, caffeine). Eat small, frequent meals, and decrease fluid intake during meals to prevent gastric distension. Avoid consumption of meals close to bedtime and nocturnal eating (Option C). Lifestyle changes-smoking cessation, weight loss (Option B). Avoid lifting or straining (Option E). Elevate the head of the bed to approximately 30 degrees-this can be done at home using pillows or 4 - 6 inch blocks under the bed (Option A). (Option D) Wearing a girdle or tight clothes increases intraabdominal pressure and should be avoided. Educational objective: Hiatal hernias occur due to a weakening diaphragm and increased intraabdominal pressure. Nursing interventions to prevent hiatal hernias are similar to those used for gastroesophageal reflux disease (GERD), and they focus on decreasing intraabdominal pressure.

The Nurse Will Implement Which Nursing Actions When Caring for a Client