Medical Surgical Hiatal Hernia #4

Question

Which client is at most risk for hiatal hernia?

Answers

  1. A 49-year-old male with a BMI of 29.
    • Rationale:

      This answer is not correct because the client meets none of the criteria that puts the client at high risk for hiatal hernia. The client is under 50 years old and his BMI indicates he is “overweightâ€ but not obese. BMI of 30 and higher indicates obesity.

  2. A 38-year-old female with hyperemesis gravidarum.
    • Rationale:

      This answer is correct because she possesses possibly 3 risk factors for hiatal hernia. The client has hyperemesis gravidarum, which is extreme and persistent nausea and vomiting during pregnancy. Hiatal hernia can be caused by straining from vomiting and also by pregnancy due to the fetus pressing against the stomach and causing weak diaphragm muscles. Another potential risk factor is constipation. Though constipation is not mentioned, if the client is experiencing persistent vomiting, she most likely will be dehydrated, which is a risk factor for constipation. Also, the hormone fluctuations during pregnancy causes constipation as well. So here we have a client who is most likely straining from vomiting and constipation.

  3. A 60-year-old emergency dispatcher.
    • Rationale:

      This answer is not correct since this client has a sedentary job. The client’s only risk factor is being over 50 years old.

  4. A 50-year-old with constipation and diverticulosis.
    • Rationale:

      This answer is not correct because this client has only two risk factors, less than the client in answer #2. The client is 50-years-old and has constipation.

Overview

Hiatal hernia is when a part of the stomach breaches through the diaphragm and into the thorax. Risks for hiatal hernia include advanced age over 50 years, pregnancy, obesity, tumors, ascites, and heavy lifting.

Explanation

Learning Outcomes

Hiatal hernia is when a part of the stomach breaches through the diaphragm and into the thorax. Risks for hiatal hernia include advanced age over 50 years, pregnancy, obesity, tumors, ascites, and heavy lifting. Obesity is considered a BMI of 30 or higher. A pregnant woman has a fetus pressing against the stomach which can weaken the diaphragm muscles. Anything that causes abdominal pressure can cause a hiatal hernia. Anything that causes persistent straining can also cause a hernia. Abdominal pressure and persistent straining contributes to the above factors mentioned that make a person at risk for a hiatal hernia.

Test Taking Tip

Use critical thinking skills. When you have knowledge of illness processes, your brain will connect the dots. Pregnant clients (fetus pressing on stomach); with persistent vomiting (straining); can lead to dehydration, which can lead to constipation (additional straining) places the client at higher risk for hernia.

Video Rationale