CHAPTER 7 Gastrointestinal System^293
- Restrict alcohol intake to prevent further damage.
- Administer vitamin supplements—folate, thiamine, multivitamin.
- Administer diuretics to reduce excess fluids:
- furosemide
- spironolactone
- Paracentesis to remove ascitic fluid.
- Monitor electrolytes for imbalance.
- Monitor coagulation profile (PT, PTT, INR).
- Administer lactulose to promote removal of ammonia in the gut.
- Administer antibiotics to destroy the normal GI flora which decreases pro-
tein breakdown and the rate of ammonia production:- neomycin sulfate
- metronidazole
- Shunt placement:
- Peritoneovenous—moves ascitic fluid from abdomen to superior vena
cava. - Portocaval—diverts venous blood flow from liver to decrease portal and
esophageal pressures. - Transjugular intrahepatic portal systemic—nonsurgical procedure per-
formed in interventional radiology—sheath placed into jugular and hepatic
vein; needle threaded through sheath and pushed into portal vein through
the liver; balloon enlarges the tract and stent maintains.
- Peritoneovenous—moves ascitic fluid from abdomen to superior vena
- Gastric lavage.
- Esophagogastgric balloon tamponade for control of bleeding from esophageal
varices. - Administer blood products as needed for patients with bleeding esophageal
varices. - Sclerotherapy for esophageal variceal bleeding.
NURSING DIAGNOSES
- Ineffective breathing pattern
- Excess fluid volume
- Risk for infection