Portal Hypertension
Portal blood flow backed
up into esopagheal
anastomoses
Diagram Key (Beta)
Disease Process
Signs & Symptoms
As variceal pressure
increases blood vessel
swells
Esopagheal Varices
- CT Scan,
- Physical
Exam, and
- Hx Taking
Bigger Varices
Nursing Dx
Nursing
Responsibilities
Diagnostic Tests
Complication
Medication
Dilation of veins
Increase vessel size
Decrease wall thickness
Increase vessel tension
Risk for Bleeding r/t secondary to
esophageal varices aeb swollen lymph
nodes
1. Assess vital signs and observe for
any signs of bleeding such as
melena and hematemesis.
2. Perform a focused assessment on
the abdominal region, particularly
checking for ascites.
3. Administer drugs that can reduce
portal hypertension, as prescribed.
4. Explain what endoscopic band
ligation means, its risks and its
benefits. Prepare the patient for the
procedure.
Red wave
Markor Cherry
Red Spot
- Endoscopy
- Capsule
Endoscopy
PROGNOSIS:
-
Variceal Rupture
Octreotide
Vassopressin
Beta Blocking Agents:
Propanolol, nadolol,
carvedilol
Upper GI bleed
Blood loss in circulation
Tachycardia
hypotension
SOB
Weakness
Lightheadedness
Anemia
Blood oxidized and
vomitted or passed
trhough GI
Death
Hematemesis
Melena
Decreased Cardiac Output related
to bleeding secondary to
esophageal varices as evidenced
by tachycardia, hematemesis,
shortness of breath, weakness
and ligtheadedness.
1. Assess and monitor the patient?s
vital signs and mental status.
Taking note of the patient?s heart
rate, blood pressure, capillary
refill, peripheral pulses, and
state of consciousness.
2. Assess the patient?s breathing
pattern and oxygen saturation.
Check for coughing or choking
signs.
3. Assess the patient for signs of
increased bleeding such as
hematemesis (vomiting of blood)
and melena (black tarry stool).
Note the characteristic, amount,
and frequency.
4. Assess the patient?s weight at
the same time every day. Record
intake and output
5. Encourage deep breathing
exercises and diaphragmatic
breathing. Instruct to breathe
deeply and slowly using the
diaphragm and then exhale
slowly through the mouth.
6. Administer oxygen as ordered.
7. Administer medications such as
non-selective beta-adrenergic
blockers, somatostatin,
vasopressin, or nitrates as
ordered.Prepare blood products
for blood transfusion and
anticoagulants as ordered.
8. Prepare the patient for a
procedure such as an
endoscopy, ultrasound, and
computed tomography scan as
indicated.
9. Educate the patient and
significant others about warning
signs such as cardiac,
respiratory, and mental status
changes. Instruct to seek
treatment promptly.
Blood loss too rapid to
be oxidized before
emesis or passage of gi
Coffee ground
emesis
Nausea and vomiting
Weight loss
Loss of appetite
Imbalanced Nutrition: Less than
Body Requirements related to
digestive tract bleeding secondary to
esophageal varices, as evidenced
by hematemesis, weight loss,
nausea and vomiting, loss of
appetite.
1. Explore the patient?s daily
nutritional intake and food habits
(e.g. meal times, duration of each
meal session, snacking, etc.)
2. Create a daily weight chart and a
food and fluid chart. Discuss with
the patient the short term and
long-term nutrition and weight
goals related to peptic ulcer
disease.
3. Help the patient to select
appropriate dietary choices and
limit alcohol intake.
4. Refer the patient to the dietitian.
5. Encourage soft foods such as
bananas and yogurts.
Bright red
blood per
rectum
IF TREATED:
variceal ligation is effective in
controlling first-time bleeding
episodes in about 90% of patients.
Liver transplant severe cirrhosis
and/or repeated episodes of
bleeding varices
IF NOT TREATED:
Death