A client has a hiatal hernia. The client is 5 feet 3 inches tall and weighs 160 pounds. When the nurse discusses prevention of esophageal reflux, what should be included?
a. "Increase your intake of fat with each meal."
b. "Lie down after eating to help your digestion."
c. "Reduce your caloric intake to foster weight reduction."
d. "Drink several glasses of fluid during each of your meals."
Answer: c. "Reduce your caloric intake to foster weight reduction."
Weight reduction decreases intraabdominal pressure, thereby decreasing the tendency to reflux into the esophagus. Fats decrease emptying of the stomach, extending the period that reflux can occur; fats should be decreased. Lying down after eating increases the pressure against the diaphragmatic hernia, increasing symptoms. Drinking several glasses of fluid during each meal will increase the pressure; fluid should be discouraged with meals.
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