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OR Nurse:
doi: 10.1097/01.ORN.0000369297.32772.1f
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Nissen fundoplication for repair of hiatal hernia

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INSTRUCTIONS Nissen fundoplication for repair of hiatal hernia

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Nissen fundoplication for repair of hiatal hernia

GENERAL PURPOSE: To provide the registered professional nurse with an overview of Nissen fundoplication and the perioperative patient care required. LEARNING OBJECTIVES: After reading this article and taking this test, you will be able to: 1. Explain the anatomy/physiology and risks associated with hiatal hernias. 2. Describe the indications and surgical techniques for the Nissen fundoplication. 3. Identify pre- and postoperative testing and patient care requirements.

1. A hiatal hernia is defined as the

a. stomach's prolapse through an esophageal diaphragmatic hiatus.

b. esophagus' prolapse into the stomach's fundus.

c. recurrent complications of GERD.

d. reflux-associated complications of slow gastric emptying.

2. The patient most likely to suffer a hiatal hernia is a

a. 24-year-old man.

b. 36-year-old woman.

c. 65-year-old man.

d. 72-year-old woman.

3. Acquired hiatal hernias are classified as

a. Type I or sliding.

b. traumatic or nontraumatic.

c. paraesophageal or Type II.

d. paraesophageal or rolling.

4. Type I hiatal hernias are caused by the

a. gradual widening and weakening of the diaphragmatic hiatus.

b. cardia portion of the stomach moving away from the esophageal sphincter.

c. posterior mediastinum gradually widening into the esophagus.

d. cardia portion of the stomach moving into the gastroesophageal sphincter.

5. Type I hiatal hernias are most often diagnosed

a. when patients present with severe gastric distress.

b. after excessive weight gain.

c. after excessive weight loss.

d. during diagnostic tests for other problems.

6. Type I hiatal hernias create gastric acid problems because they

a. increase the pressure on the LES.

b. increase the production of gastric acids.

c. affect the antireflux mechanisms.

d. increase the length of the LES.

7. The patient most likely to suffer from Barrett esophagus is a

a. 40-year-old Asian.

b. 55-year-old black female.

c. 65-year-old white male.

d. 70-year-old white female.

8. Patients with Barrett esophagus have an increased risk of

a. gastric bleeding.

b. dumping syndrome.

c. developing Type II hiatal hernias.

d. esophageal adenocarcinoma.

9. A proton pump inhibitor acts by

a. strengthening the LES.

b. stopping gastric acid secretion.

c. closing the gastroesophageal flap.

d. slowing gastric emptying.

10. Criteria for surgical correction of hiatal hernia include all except

a. lifelong therapy of more than 10 years will be required.

b. presence of an incompetent LES.

c. presence of abnormal acid exposure in the esophagus.

d. presence of poor esophageal body function.

11. The main purpose of Nissen fundoplication is to

a. reconstruct the diaphragmatic hiatus.

b. remove the diaphragmatic hiatus.

c. widen the LES.

d. lower the resting pressure of the LES.

12. One of the outcomes of Nissen fundoplication is

a. increased intra-thoracic length of the LES.

b. reduced intra-abdominal length of the LES.

c. reduced resting pressure of the LES.

d. increased speed of gastric emptying.

13. Which test is not indicated before Nissen fundoplication?

a. barium swallow with fluoroscopy

b. esophageal pH monitoring

c. flat plate of the abdomen

d. manometry of the LES.

14. During the surgery, a penrose drain is placed around the esophagus to

a. immobilize the left crus.

b. secure the phrenoesophageal membrane.

c. facilitate creation of the wrap.

d. retract the esophageal fat pad.

15. Intraoperatively, the most common complication of Nissen fundoplication is

a. hemorrhage.

b. pneumothorax.

c. venous thrombosis.

d. paraesophageal collapse.

16. Closing the hiatus anteriorly in the Nissen fundoplication

a. reduces postoperative dysphagia.

b. is called the floppy Nissen.

c. prevents movement of the wrap into the mediastinum.

d. requires use of absorbable biologic meshes.

17. After laparoscopic surgery, the patient's initial diet order is

a. N.P.O. for 24 hours.

b. liquids.

c. pureed foods.

d. soft foods.

18. Discharge patient education includes all except

a. no heavy lifting for 2 months.

b. no smoking.

c. no chewing gum.

d. no carbonated beverages.

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