Bleeding Esophageal Varices

Question 1

Pathophysiology

Answer 1

High BP in the liver (__ Portal (Hypertension)_HTN) forces collateral circulation to form. ­all this means is new circulation

Question 2

What 3 places does this form

Answer 2

stomach,

esophagus,

rectum

Question 3

When you see an alcoholic client that is GI bleeding it is usually____ varices.

Answer 3

esophageal

Question 4

Usually no problem until ____

Answer 4

ruptures

Question 5

Explain Esophageal Varices

Answer 5

think about this this high blood pressure in the liver and this exerts pressure all throughout the entire G.I. tract

so now the whole GI tract is full of pressure .

A hemorrhoid is a protruding vessel it has all this pressure behind it and is waiting to blow out! A varices is the same thing as a hemorrhoid but is in the esophagus! You don’t even know you have one into it blows out one day being you are going to begin to droop blood into the stomach Big feud kind of busy so either passed out or vomit! This vomit looks like large amounts of bright red blood!

Question 6

Tx

Answer 6

1. ) Replace blood
2. ) check the VS
3. )Check the CVP
4. )Oxygen
5. ) octreotide
6. ) Balloon Tamponade
7. ) Cleansing enema
8. ) lactulose
9. ) Saline lavage

Question 7

Why give oxygen ?

Answer 7

any time someone is _ anemic_, Oxygen is needed)

Question 8

Why is octreotide (Sandostatin®) given ?

Why is this good ?

Why might this be bad ?

Answer 8

lowers BP in the liver

Because hopefully if you lower the blood pressure in the liver the bleeding should stop!
The bad things it’s causes vasoconstriction in other parts of the body such as the coronary artery’s which can cause rhythm changes and this is because of the decrease blood flow! So you never know what you’re going to be constrict

Question 9

What type of balloon tamponade tube is used ?

Answer 9

Sengstaken­Blakemore Tube

Question 10

What is Balloon Tamponade?

What is it purpose?

It shouldn’t be used more. Then __hrs?

Answer 10

It is an infrequently used emergency procedure that may be used to stabilize clients with severe hemorrhage. It should not be used more than 12 hours.

So it purpose is to To hold ________pressure_ on bleeding varices

Many of the safety implications for the Blakemore tube can be applied to other oropharynx or nasopharynx tubes.

Question 11

Why is a clean enema given ?

Answer 11

to get rid of _blood­Because blood it with increased ammonia levels

Question 12

Why is a Saline lavage given?

Answer 12

to get blood out of my stomach

Question 13

Post op Care:
1) Ileostomy Care:
• It’s going to drain ___________________ all the time.
• Avoid foods hard to digest; rough foods ______________ motility.
• Gatorade® in the summer
• At risk for kidney stones (always a little ___

Answer 13

Ileostomy Care:
It’s going to drain ________liquid__ all the time. Don’t have to
irrigate ileostomies.

Avoid foods hard to digest and rough foods, __hard motility.
because it increases motility

Gatorade® in the summer Because
they’re sweating even more
At risk for kidney stones (always a little ______bit dehydrated_)

Question 14

Colostomy Care:
• What happens as waste moves through the colon?
Water and nutrients are being absorbed and the _____________ is
forming.

Answer 14

Water and nutrients are being absorbed and the ___stool is

forming.

Question 15

Colostomy → ascending and transverse→ semi __________ stools

• Colostomy→ descending or sigmoid→ semi formed or ____________.

Answer 15

Colostomy → ascending and transverse→ semi ____liquid stools

Colostomy→ descending or sigmoid→ semi formed or ___semi form or form because most of the water is gone.

Question 16

Which one do you irrigate? __________________ & ______________
• Why irrigate? ____________________________________________
• When is the best time to irrigate?
Same ______________ everyday
After a __________________________
• The further down the colon the stoma is, the more formed the stool will be because ________________is being drawn out. The stool is more normal.

Answer 16

Which ones do you irrigate? _ descending_ & _ sigmoid

Why irrigate? _For regularity­ you want to keep in regular___

When is the best time to irrigate?
Same _______time_ everyday
because you’re trying to develop a routine After a __meal__

The further down the colon the stoma is, the more formed the stool will be
because ___water__is being drawn out. The stool is more normal.

When you are irrigating an ostomy, you use the same principles as if you were administering an enema.
Anytime you are giving an enema, if the client starts to cramp, ______sttop__ the fluids, lower the bag and/or check the ________temp__ of the fluid.