A pregnant client at 28 weeks gestation reports experiencing severe heartburn that interferes with her sleep and daily activities. Which nursing intervention should the nurse recommend first?
1Advise eating small, frequent meals and avoiding lying down for 2-3 hours after eating✓ 정답
2Recommend increasing fluid intake during meals to help with digestion
3Suggest taking a proton pump inhibitor before bedtime
4Advise lying on the left side immediately after meals to promote digestion
해설
Heartburn in pregnancy is managed first with lifestyle modifications like small, frequent meals and avoiding lying down after eating, as these are safe and effective non-pharmacological interventions. Other options are less appropriate as initial recommendations.
Clinical Judgment
This question asks about the priority nursing intervention for severe heartburn in a third-trimester pregnant woman. The key point is that non-pharmacological lifestyle modification is the primary and safest approach. The mother has already taken an over-the-counter (OTC) antacid with minimal effect, indicating a need for more fundamental management. Option 1's 'small, frequent meals' and 'not lying down after eating' are direct, evidence-based interventions that reduce gastric distension and use gravity to prevent gastroesophageal reflux. The other options are either ineffective (Options 2, 4) or involve pharmacological intervention (Option 3), which does not align with the principle of trying non-pharmacological interventions first.
Memory Tip:
First-line for Heartburn is Lifestyle! Remember the acronym FHL: First-line Heartburn Lifestyle modification.
KR vs US:
In Korea, folk remedies or herbal medicine are sometimes considered first for heartburn, but in NGN/US nursing, systematic lifestyle modification is applied as the first step according to Evidence-Based Practice. Additionally, recommending a prescription drug (PPI) as in Option 3 falls outside the independent scope of nursing judgment.
Clinical Practice Guide
Stepwise approach to managing pregnancy-related heartburn: 1) Lifestyle/dietary modifications (small frequent meals, avoiding trigger foods (greasy foods, coffee, chocolate, etc.), standing or sitting for 2-3 hours after meals, elevating the head of the bed by 15 cm). 2) Use of non-systemic antacids (calcium/magnesium preparations). 3) Considering drug therapy such as H2 blockers or PPIs in consultation with a physician.
Caution:
In SATA (Select All That Apply) questions asking for the "first/initial/priority intervention," beware of the trap where you must choose the most basic, safe, and non-invasive option among several correct interventions. Option 2 (increasing fluid intake during meals) can increase gastric volume and worsen reflux.
Heartburn — A burning sensation in the chest or throat caused by stomach acid flowing back into the esophagus. Common during pregnancy due to relaxation of the lower esophageal sphincter by progesterone and mechanical pressure from the uterus.
Gastroesophageal Reflux Disease — Frequent reflux of the contents into the esophagus, causing symptoms or complications. Pregnancy is a common trigger for GERD.
Lower Esophageal Sphincter — A muscular sphincter at the junction of the esophagus and stomach. When it relaxes, acid reflux occurs. Progesterone reduces the tone of this muscle.
Progesterone — A hormone that significantly increases in secretion during pregnancy. It relaxes smooth muscles to suppress uterine contractions while also relaxing the lower esophageal sphincter (LES), which is a major cause of heartburn.
Antacids — Medications that neutralize stomach acid. During pregnancy, calcium or magnesium preparations are generally considered safe, but aluminum-containing preparations should be avoided for long-term use.