Care focuses on maintaining a patent airway, preventing aspiration of regurgitated food and mucus, providing emotional support, and providing adequate nutrition. Implement interventions to maintain airway patency if there is any suspicion it is at risk. Use the jaw thrust or chin lift, or insert an oral or nasal airway. Prevent aspiration of regurgitated food and mucus by positioning the patient carefully, with her or his head elevated or turned to one side. Recommend that the patient sleep with the head elevated (using pillows or bed blocks) to reduce esophageal reflux and nocturnal choking. Show the patient how to use massage to empty any visible outpouching to the neck to prevent aspiration during sleep.

Education, rather than medical or surgical intervention, may become the treatment of choice. Provide the patient with information on lifestyle changes to reduce symptoms. Teach appropriate nutrition. Advise the patient to explore textures and quantities of foods to determine which cause the least discomfort. Recommend that the patient consider semisoft and soft foods, and advise adding fiber to the diet to stimulate peristalsis of the gastrointestinal (GI) system, reducing lower GI tract pressure on the esophagus. Recommend food supplements between meals to prevent weight loss and malnourishment, and advise the patient to drink fluids intermittently with meals to aid in propulsion of the food bolus through the esophagus. Teach the patient to concentrate on the act of eating to maximize each phase of the process of ingesting food and fluids, moistening the mouth before eating to facilitate chewing and swallowing. Explain how to use Valsalva's maneuver to increase esophageal pressure, thus facilitating food bolus movement beyond the hypopharyngeal sphincter. Recommend that the patient sit upright when eating or

340 Esophageal Diverticula drinking to facilitate gravitational flow through the esophagus, and advise remaining upright for at least 2 hours after eating.

Advise taking adequate fluids (>15 mL) with medications to prevent chemical esophageal irritation. Recommend eliminating oral drugs immediately before bedtime to decrease the risk of deposits in diverticula that can create ulceration. Advise the patient to avoid food or fluids within 3 to 4 hours of bedtime to reduce nocturnal symptoms.

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