Medical Surgical Nursing

Assessment and Diagnostic Findings

 Endoscopy is used to identify the bleeding site, along with barium swallow,

ultrasonography, CT, and angiography.

 Liver function tests

Medical Management

 Bleeding from esophageal varices can quickly lead to hemorrhagic shock and is

an emergency. This patient is critically ill, requiring aggressive medical care

and expert nursing care, and is usually transferred to the intensive care unit for

close monitoring and management.

1. PHARMACOLOGIC THERAPY

 In an actively bleeding patient, medications are administered initially because

they can be obtained and administered quickly; other therapies take longer to

initiate. Vasopressin (Pitressin) may be the initial mode of therapy because it

produces constriction of the splanchnic arterial bed and a resulting decrease in

portal pressure.

 Combination of vasopressin and nitroglycerin (administered by the intravenous,

sublingual, or transdermal route) has been effective in reducing or preventing

the side effects (constriction of coronary vessels and angina) caused by

vasopressin alone. Somatostatin and octreotide (Sandostatin) have been reported

to be more effective than vasopressin in decreasing bleeding from esophageal

varices

2. BALLOON TAMPONADE

 To control hemorrhage in certain patients, balloon tamponade may be used. In

this procedure, pressure is exerted on the cardia (upper orifice of the stomach)

and against the bleeding varices by a double-balloon tamponadeThe tube has

four openings, each with a specific purpose: gastric aspiration, esophageal

aspiration, inflation of the gastric balloon, and inflation of the esophageal

balloon. The balloon in the stomach is inflated with 100 to 200 mL of air. An x-

ray confirms proper positioning of the gastric balloon. Then the tube is pulled

gently to exert a force against the gastric cardia.

Dangers and complication of tamponade balloon

 Displacement of the tube and the inflated balloon into the oropharynx can cause

life-threatening obstruction of the airway and asphyxiation.

 This may occur if a patient pulls on the tube because of confusion or

discomfort.