A nurse is instructing a patient recently diagnosed with a hiatal hernia. Which of the following statements made by the patient indicates an understanding of this condition?

"I will avoid eating for at least two hours before bed."
"I will avoid lifting heavy objects."
"I will eat small meals and avoid spicy food."


• In order to decrease gastric reflux, the patient should eat small, bland meals.

• Patients should be instructed to sit up for at least an hour after a meal and to avoid eating anything for at least two hours before bed.

• The patient should avoid heavy lifting to minimize intra-abdominal pressure.

• A hiatal hernia is the protrusion of the upper portion of the stomach into the chest.   In a hiatal hernia, part of the stomach and/or the gastroesophageal junction slips through the opening in the diaphragm (called the hiatus) and into the chest. This can cause gastric reflux, Barrett's esophagus, and increase the risk of developing esophageal cancer.

• There are two types of hiatal hernias:

• Sliding hiatal hernias allow part of the stomach and the gastroesophageal junction to slip into the chest. These are common in smokers, patients with obesity, and women older than 50. Activities or conditions that increase pressure and worsen these hernias include heavy coughing, straining while defecating, sudden physical exertion, and pregnancy.
• Paraesophageal hernias are more likely to cause severe symptoms because a small portion of the stomach becomes trapped in the diaphragm and chest, pinched in the gastroesophageal junction.
• Patients with hiatal hernias will not see any visible signs. A visible lump near the groin may be associated with an inguinal hernia.

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