Esophageal Varices : Definition : Causes : Signs & Symptoms : Complications : Nursing Care :

 

Esophageal Varices

🔹 Definition

  • Esophageal varices are enlarged and swollen veins in the lower esophagus (the tube that connects throat to stomach).
  • They usually develop when blood flow to the liver is blocked (commonly due to cirrhosis). This blockage increases pressure in the portal vein → called portal hypertension.
  • The veins become fragile and may rupture, leading to life-threatening bleeding.

🔹 Causes

  • Liver cirrhosis (most common cause).
  • Chronic alcohol use.
  • Viral hepatitis (B, C).
  • Fatty liver disease.
  • Blood clot in the portal vein.

🔹 Signs & Symptoms

  • Often no symptoms until rupture occurs.
  • Before rupture:
    • Enlarged veins seen on endoscopy.
    • Sometimes mild discomfort.
  • After rupture (acute bleed):
    • Vomiting blood (hematemesis).
    • Black, tarry stools (melena).
    • Signs of shock → rapid heartbeat, low BP, pale skin, confusion.

🔹 Complications

  • Massive gastrointestinal bleeding.
  • Hypovolemic shock.
  • Death (if untreated).
  • Hepatic encephalopathy (due to poor liver function).

📌 Nursing Care Plan for Esophageal Varices

1. Nursing Diagnosis: Risk for Bleeding

Goal: Patient will remain free from active bleeding.

Interventions:

  • Monitor for signs of bleeding (vomiting blood, melena, low BP, tachycardia).
  • Avoid procedures that may cause trauma (e.g., NG tube insertion unless essential).
  • Administer prescribed medications:
    • Vasopressin, Octreotide → to reduce portal pressure.
    • Beta-blockers (propranolol) → to prevent variceal bleeding.
  • Prepare for endoscopic therapy (band ligation, sclerotherapy).
  • Maintain 2 large-bore IV lines for rapid blood transfusion if needed.
  • Keep blood products (plasma, packed cells) ready.

2. Nursing Diagnosis: Risk for Shock (due to hemorrhage)

Goal: Maintain adequate tissue perfusion and hemodynamic stability.

Interventions:

  • Monitor vital signs closely (BP, HR, RR, SpO₂).
  • Assess for signs of hypovolemia (restlessness, diaphoresis, cold extremities).
  • Administer IV fluids and blood transfusions as ordered.
  • Maintain bed rest to reduce oxygen demand.
  • Collaborate with physician for possible balloon tamponade (Sengstaken-Blakemore tube) if endoscopy not available.

3. Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements

Goal: Patient will maintain adequate nutritional status.

Interventions:

  • Assess dietary intake and weight regularly.
  • Provide soft, non-irritating diet (to prevent esophageal trauma).
  • Avoid alcohol, spicy foods, very hot foods.
  • Consider enteral/parenteral nutrition if patient cannot tolerate oral intake.
  • Collaborate with dietitian for high-calorie, high-protein diet (if liver function permits).

4. Nursing Diagnosis: Anxiety (related to risk of rebleeding and procedures)

Goal: Patient will verbalize decreased anxiety and demonstrate coping strategies.

Interventions:

  • Provide clear explanations of procedures.
  • Offer emotional support to patient and family.
  • Encourage relaxation techniques (deep breathing, guided imagery).
  • Involve family members in care planning.

5. Nursing Diagnosis: Deficient Knowledge (about condition and prevention)

Goal: Patient/family will verbalize understanding of disease, treatment, and preventive measures.

Interventions:

  • Educate about avoiding alcohol, NSAIDs, and straining (which increase bleeding risk).
  • Explain importance of medication compliance (beta-blockers, follow-up endoscopies).
  • Teach to recognize warning signs of bleeding (vomiting blood, black stools).
  • Encourage routine follow-up for liver disease management.

 

Nursing Care Plan (NCP) – Esophageal Varices

Nursing Diagnosis

Goals / Expected Outcomes

Nursing Interventions

Rationales

Evaluation

Risk for Bleeding related to fragile esophageal varices

Patient will remain free from signs of active bleeding (hematemesis, melena) during hospitalization.

- Monitor for hematemesis, melena, hypotension, tachycardia.
- Avoid unnecessary NG tube insertion.
- Administer vasopressin/octreotide as prescribed.
- Prepare for endoscopic ligation or sclerotherapy.

Early detection allows immediate intervention.
Trauma may rupture varices.
Vasopressors reduce portal hypertension.
Endoscopy controls bleeding.

Patient remained stable with no active bleeding; early signs promptly managed.

Risk for Shock related to potential hemorrhage

Patient will maintain hemodynamic stability (BP > 90 mmHg systolic, HR < 100 bpm, urine output > 30 ml/hr).

- Monitor vital signs every 15–30 min.
- Insert two large-bore IV lines.
- Administer IV fluids and blood transfusion as ordered.
- Maintain bed rest, elevate legs if hypotensive.

Frequent monitoring detects shock early.
IV access allows rapid resuscitation.
Fluids and transfusions restore volume.
Bed rest conserves energy, improves circulation.

Patient remained hemodynamically stable; no progression to hypovolemic shock.

Imbalanced Nutrition: Less Than Body Requirements related to altered intake and esophageal irritation

Patient will maintain weight and demonstrate adequate nutritional intake.

- Monitor daily weight and dietary intake.
- Provide soft, non-irritating diet.
- Avoid alcohol, hot/spicy/rough foods.
- Collaborate with dietitian for diet plan.

Monitoring ensures adequate intake.
Soft diet prevents esophageal trauma.
Alcohol/irritants increase bleeding risk.
Dietitian support ensures optimal nutrition.

Patient maintained stable weight; reported tolerance to soft diet.

Anxiety related to hospitalization and fear of rebleeding

Patient will verbalize reduced anxiety and demonstrate coping strategies.

- Provide emotional support, clear explanations of procedures.
- Encourage relaxation techniques (deep breathing, guided imagery).
- Involve family in care.

Reduces fear of the unknown.
Relaxation lowers anxiety and stress.
Family support improves coping.

Patient verbalized decreased anxiety and used relaxation techniques.

Deficient Knowledge related to lack of information about condition and prevention

Patient/family will verbalize understanding of disease, treatment, and preventive measures before discharge.

- Teach patient to avoid alcohol, NSAIDs, heavy lifting.
- Explain importance of medication adherence (beta-blockers).
- Instruct on warning signs of bleeding (vomiting blood, black stools).
- Emphasize follow-up care for cirrhosis.

Avoiding irritants reduces risk of bleeding.
Compliance lowers portal pressure.
Early recognition improves outcomes.
Long-term monitoring prevents https://healthwalletfittness.blogspot.com/

Patient/family demonstrated understanding of discharge instructions and prevention strategies.

 

Disclaimer: For Informational Purposes Only

This information is intended for general educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.

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