Bleeding Esophageal Varices Flashcards
Pathophysiology
High BP in the liver (__ Portal (Hypertension)_HTN) forces collateral circulation to form. all this means is new circulation
What 3 places does this form
stomach,
esophagus,
rectum
When you see an alcoholic client that is GI bleeding it is usually____ varices.
esophageal
Usually no problem until ____
ruptures
Explain Esophageal Varices
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!
Tx
- ) Replace blood
- ) check the VS
- )Check the CVP
- )Oxygen
- ) octreotide
- ) Balloon Tamponade
- ) Cleansing enema
- ) lactulose
- ) Saline lavage
Why give oxygen ?
any time someone is _ anemic_, Oxygen is needed)
Why is octreotide (Sandostatin®) given ?
Why is this good ?
Why might this be bad ?
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
What type of balloon tamponade tube is used ?
SengstakenBlakemore Tube
What is Balloon Tamponade?
What is it purpose?
It shouldn’t be used more. Then __hrs?
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.
Why is a clean enema given ?
to get rid of _bloodBecause blood it with increased ammonia levels
Why is a Saline lavage given?
to get blood out of my stomach
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 ___
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_)
Colostomy Care:
• What happens as waste moves through the colon?
Water and nutrients are being absorbed and the _____________ is
forming.
Water and nutrients are being absorbed and the ___stool is
forming.
Colostomy → ascending and transverse→ semi __________ stools
• Colostomy→ descending or sigmoid→ semi formed or ____________.
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.
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.
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.
