Nursing 213

N213: Health Differences Across the Lifespan 3 Study Guide Nursing interventions for hiatal hernia: • Assess pain levels and administer medications per MDorder: o Cholinergics: Urecholine (bethanechol) , which o Reglan (metoclopramide): Strengthens the muscle tone and lessens reflux; Reglan and other prokinetic drugs, like Cisapride, are not used for long-term therapy due to multiple and severe side effects o Antacids/H2 blockers • Encourage patient to eat small, frequent meals to prevent reflux; discourage spicy, greasy, or other foods that may irritate the esophagus • Encourage patient to cut down or quit smoking; decrease or stop alcohol intake • Raise head of bed 12 inches to reduce intra-abdominal pressure and lower the incidence of reflux • Teach patient to dress in loose clothing and splint abdomen with coughing and straining • Possibly prepare patient for surgery; this may be needed in cases of bleeding, strangulation of hernia, or stricture Expected outcomes for hiatal hernia: • Patient verbalizes decreased pain levels and increased comfort • Demonstrates compliance with diet/lifestyle modifications to reduce reflux • Verbalizes understanding of condition and treatment plan Inguinal Hernia This occurs when an intestinal hernia protrudes through the opening to the inguinal canal. This happens when abdominal muscles become weak due to injury, malformation at birth, heavy lifting, exercise, coughing, straining, pregnancy, age related conditions, and obesity. If the condition happens before birth, it can be seen in boys during the seventh month of pregnancy as the peritoneal sac descends before the testicle descends. Inguinal herniation happens at the weakest point of the abdominal wall and has two forms: direct and indirect. • Direct inguinal hernia: The hernia occurs at the rectus muscles and the inguinal ligament. This type is 80% of hernias. • Indirect inguinal hernia: The hernia occurs at the inguinal canal and the inguinal ring. It may go into the scrotum. There are complications for untreated inguinal hernias including strangulation and incarceration, causing necrosis and intestinal obstruction. These are medical emergencies requiring immediate medical attention. strengthens the esophageal sphincter

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