A client with a history of asthma and bronchitis arrives at the clinic with shortness of breath, productive cough with thickened, tenacious mucus, and the inability to walk up a flight of stairs without experiencing breathlessness.
Which action is most important for the nurse to instruct the client about self-care?

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:

Colloidal oatmeal-based lotions can be soothing and moisturizing for dry, itchy skin, but they are not effective in treating the inflammation and scaling associated with psoriasis.

They do not address the underlying hyperproliferation of skin cells that is characteristic of psoriasis.

While they may provide temporary relief of symptoms, they are not a long-term solution for managing the condition.

Choice B rationale:

Topical corticosteroids are the mainstay of treatment for psoriasis.

They work by reducing inflammation, slowing the growth of skin cells, and easing itching and scaling. They come in a variety of strengths and formulations, including creams, ointments, gels, and foams.

The type of corticosteroid and the strength of the medication will depend on the severity of the psoriasis and the location of the lesions.

It's important to follow the healthcare provider's instructions for use carefully, as overuse of topical corticosteroids can lead to side effects such as thinning of the skin and rebound flares.

Choice C rationale:

Topical analgesics, such as lidocaine or benzocaine, can be used to temporarily relieve pain and itching associated with psoriasis.

However, they do not address the underlying inflammation and scaling, and they should not be used as a primary treatment for the condition.

They may be used as adjunctive therapy in conjunction with topical corticosteroids or other psoriasis medications.

Choice D rationale:

Topical antifungal medications are used to treat fungal infections of the skin, such as athlete's foot or ringworm. They are not effective in treating psoriasis, which is an autoimmune condition rather than a fungal infection.

Using a topical antifungal medication for psoriasis could potentially worsen the condition or lead to other skin problems.