Hesi Exam Adult Health 2 Exam with questions and correct
answers (verified answers) already graded A+| latest update
What is a hiatal hernia?
When the upper part of the stomach bulges through the diaphragm into the chest
cavity
What are the 2 types of hiatal hernias?
-sliding (most common)
-paraesophageal
What is a sliding hiatal hernia?
upper stomach gastroesophageal junction displaced upwards and slides in and out
of thorax
What is a paraesophageal hernia?
-GE junction is normal; fundus protrudes into thorax
Clinical manifestations of hiatal hernias (6)
-can be asymptomatic
-pyrosis (heartburn)
-regurgitation
-dysphagia (difficulty swallowing)
-intermittent epigastric pain
-N/V/weight loss
Causes/risk factors of hiatal hernias
-increased pressure on the opening of the diaphragm (obesity, pregnancy, injury to
area, lifting heavy, repetitive vomiting)
-more common in women than men
Assessment and Dx of hiatal hernias
-X-ray, barium swallow, esophagogastroduodenoscopy (EGD), esophageal
manometry, chest CT
What are complications of hiatal hernias? (4)
,hemorrhage, obstruction, volvulus (strangulation), GERD
Management of hiatal hernias (4)
-frequent small feedings that can pass esophagus easily
-pt should not recline for 1 hr after eating (prevent reflex)
-elevate HOB 4-8 inches to prevent hernia from sliding upward
-surgical hernia repair (typically for pt w/ symptomatic GERD)
What is GERD
gastric content contents backflow into the esophagus due to the lower esophageal
sphincter not closing properly
Incidence/Risk factors for GERD (8)
-tobacco/caffeine/ETOH consumption
-H. pylori gastric infection
-increases w/ age
-IBS
-obstructive airway disorders (asthma, COPD, cystic fibrosis)
-Barrett esophagus
-peptic ulcer disease
-angina
Clinical manifestations of GERD
-pyrosis and regurgitation (hallmark symptoms)
-dyspepsia (indigestion)
-dysphagia (dif. swallowing)
-hypersalivation
-esophagitis
-symptoms of an MI
Complications of GERD (4+)
-Barrett's esophagus
,-Aspiration --> pneumonia
-Dental erosion
-Ulcers / Cancer / damage to pharynx, larynx, esophagus
What is the gold standard of assessing/diagnosing GERD? What are other
ways?
Gold standard: Ambulatory pH monitoring
Other: Barium swallow, endoscopy, history and physical
What dietary education/patient positioning should a patient with GERD
have?
-Low-fat diet, avoid spicy/acidic food
-Avoid caffeine, tobacco, beer, milk, peppermint/spearmint, carbonated beverages
-Avoid eating or drinking 2 hours before bedtime
-Elevate HOB 30 degrees
-Place bed on 6-8' blocks
What is Barrett's esophagus?
-The lining of the esophageal mucosa is altered due to excessive exposure to
stomach acid
-Precursor to esophageal adenocarcinoma
Clinical manifestations of Barrett's esophagus?
GERD, frequent pyrosis, symptoms of PUD or esophageal structures
Advantages of enteral nutrition (5)
-Perserve GI integrity
-Perserve the normal sequence of intestinal and hepatic metabolism
-Maintain fat metabolism and lipoprotein synthesis
-maintain normal insulin and glucagon rations
-Safe and cost effective
Disadvantages of enteral nutrition (5)
, -Risk for aspiration
-Feeding intolerance
-Risk for infection
-Can increase blood glucose level
-Tubes can kink/clog and leak, risking skin breakdown
What are signs of feeding intolerance? (4)
-Abdominal cramps
-N/V/D
-Diaphoresis
-Aspiration
How long can enteral feeding be hung?
How often do you change the tubing?
-To avoid bacterial contamination, do not hang more than 4-8 hrs of feeding in an
open system
-Change tubing every 24 hrs
How do you administer medications with enteral feeding?
-Do not mix feedings with medications. Stop the feeding, flush the tube, administer
medications, flush tube again, and resume feed.
What should the HOB always be during enteral feeding?
At least 30 degrees
How long can TPN hang for?
TPN: 24 hours
Complications of TPN (8)
-Pneumothorax
-Air embolism
-Clotted cath line
-Cath line displacement
-Hyperglycemia
-Sepsis
-Fluid volume overload
-Rebound hypoglycemia
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