A client is recovering from the surgical removal of glass in the right eye.
Which intervention should the nurse implement immediately following the procedure?

Rationale for Choice A:

Direct (sliding) hiatal hernias: These are the most common type of hiatal hernia. They occur when the upper part of the stomach slides upward through the diaphragm into the chest cavity. This displacement disrupts the normal function of the lower esophageal sphincter (LES), which is a ring of muscle that acts as a valve between the esophagus and stomach. The LES is responsible for preventing stomach contents from refluxing back into the esophagus.

Esophageal reflux: When the LES is weakened or impaired, stomach acid, pepsin, and bile can flow back into the esophagus, causing a burning sensation known as heartburn, regurgitation of food or sour liquid, and irritation of the esophageal lining.

Prevention of esophageal reflux: Nursing actions aimed at preventing esophageal reflux are crucial in the management of hiatal hernias. These actions include:

Elevate the head of the bed: This helps to keep stomach contents below the level of the esophagus, reducing the risk of reflux. Avoid eating large meals: Large meals put more pressure on the stomach, which can increase the likelihood of reflux.

Avoid lying down after eating: Lying down can allow stomach contents to flow back into the esophagus more easily. Avoid foods that trigger reflux: Common triggers include fatty foods, spicy foods, acidic foods, caffeine, and alcohol.

Maintain a healthy weight: Excess weight can increase abdominal pressure and contribute to reflux.

Consider medications: If lifestyle changes are not enough to control reflux, medications such as antacids, H2 blockers, or proton pump inhibitors may be prescribed.

Rationale for Choice B:

Maintaining intact oral mucosa: This is not a primary goal in the care of a client with a hiatal hernia. While oral hygiene is important for overall health, it does not directly address the issue of esophageal reflux.

Rationale for Choice C:

Increasing intestinal peristalsis: This is not a relevant goal for a hiatal hernia. Hiatal hernias primarily affect the upper digestive tract, not the intestines.

Rationale for Choice D:

Promoting effective swallowing: This is not the most important goal in the care of a client with a hiatal hernia. While swallowing difficulties can occur in some cases, they are not the primary concern. The priority is to prevent esophageal reflux and its associated complications.

Choice A rationale:

Tiotropium is a long-acting bronchodilator, not a rescue inhaler for sudden shortness of breath.

It takes several hours to reach its full effect and is not designed to provide immediate relief during acute symptoms.

Using tiotropium for sudden shortness of breath could delay the use of a more appropriate rescue medication, potentially worsening the situation.

Choice B rationale:

While tiotropium can help reduce mucus production and make secretions easier to clear, this is not its primary mechanism of action.

The client's statement focuses on a potential side effect rather than demonstrating a clear understanding of the medication's intended purpose.

Choice C rationale:

The frequency of inhaler use depends on the specific medications prescribed. Some inhalers are used daily, while others are used only as needed for symptoms.

It's essential to follow the healthcare provider's instructions for each inhaler to ensure proper use and avoid potential drug interactions.

Choice D rationale:

This statement correctly reflects the appropriate use of tiotropium.

It's typically taken once daily via a handihaler device to maintain open airways and prevent COPD symptoms. Regular daily use is crucial for optimal effectiveness.