Medical Surgical Hiatal Hernia #5

Question

This nurse is performing a medical interview for a client with a hiatal hernia who complains that antacids are not helping her symptoms. What information in the client’s medical history will alert the nurse to look closer at medication management?

Answers

  1. A diagnosis of overactive bladder.
    • Rationale:

      This answer is correct because overactive bladder is treated with anticholinergics. Anticholinergics block the action of acetylcholine which causes delayed stomach emptying. Delayed stomach emptying increases the gastroparesis symptoms in clients with hiatal hernia.

  2. Client is status post-thyroidectomy.
    • Rationale:

      This answer is not correct because the thyroid has no direct link with a hiatal hernia. A thyroidectomy is removal of the thyroid gland.

  3. Client takes polyethylene glycol with success.
    • Rationale:

      This answer is not correct since the client takes polyethylene glycol “with successâ€. There is no indication in this answer that the client experiences straining with constipation, which can lead to worsening symptoms of hiatal hernia.

  4. The client is a smoker.
    • Rationale:

      This answer is not correct because although smoking encourages reflux of stomach acid, smoking is not a main cause of hiatal hernia. Smoking will not worsen symptoms of hiatal hernia more than an anticholinergic medication that delays stomach emptying.

Overview

Hiatal hernia is when a part of the stomach breaches through the diaphragm and into the thorax. Treatment consists of medications that neutralize stomach acid or prevent stomach acid. There are certain drugs that can worsen the symptoms of hiatal hernia, such as anticholinergics used to treat overactive bladder.

Explanation

Learning Outcomes

Hiatal hernia is when a part of the stomach breaches through the diaphragm and into the thorax. Treatment consists of medications that neutralize stomach acid or prevent stomach acid. There are certain drugs that can worsen the symptoms of hiatal hernia. Anticholinergics block the action of acetylcholine which causes delayed stomach emptying. Delayed stomach emptying increases the gastroparesis symptoms in clients with hiatal hernia. It is best for the client with a hiatal hernia to have an empty stomach to lessen symptoms. Smoking encourages reflux of stomach acid; however, the medications prescribed for this will typically control these symptoms.

Test Taking Tip

Know your pharmacology as it relates to certain diagnoses!

Video Rationale