Esophageal varices are abnormally enlarged veins in the esophagus that develop when portal vein blood flow is blocked, most commonly due to cirrhosis. These dilated vessels can rupture and cause life-threatening bleeding, requiring immediate medical intervention and careful nursing management.
Causes (Related to)
Esophageal varices develop due to various underlying conditions and risk factors:
- Portal hypertension
- Liver cirrhosis
- Chronic alcohol abuse
- Hepatitis B or C
- Thrombosis of portal or splenic veins
- Schistosomiasis
- Budd-Chiari syndrome
- Right-sided heart failure
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Hematemesis (vomiting blood)
- Melena (black, tarry stools)
- Abdominal pain
- Weakness and fatigue
- Chest pain or discomfort
- Difficulty swallowing
- Anxiety about bleeding
Objective: (Nurse assesses)
- Hematemesis
- Tachycardia
- Hypotension
- Pallor
- Cold, clammy skin
- Decreased hemoglobin and hematocrit
- Altered mental status
- Ascites
- Spider angiomas
- Jaundice
Expected Outcomes
- The patient will maintain stable vital signs
- No episodes of acute bleeding
- The patient will demonstrate an understanding of dietary restrictions
- The patient will comply with the medication regimen
- The patient will recognize early warning signs of bleeding
- The patient will maintain adequate nutrition
- The patient will demonstrate proper management of ascites
Nursing Assessment
Monitor Vital Signs
- Check blood pressure, heart rate, and respiratory rate frequently
- Assess for signs of shock
- Monitor oxygen saturation
- Document orthostatic changes
Assess for Bleeding
- Monitor for hematemesis
- Check stool color and consistency
- Assess skin color and temperature
- Monitor hemoglobin and hematocrit levels
Evaluate Nutritional Status
- Monitor weight
- Assess dietary intake
- Check for muscle wasting
- Monitor albumin levels
- Assess for vitamin deficiencies
Monitor Fluid Status
- Check for ascites
- Assess peripheral edema
- Monitor intake and output
- Evaluate skin turgor
- Check for jugular vein distention
Assess Mental Status
- Monitor consciousness level
- Check orientation
- Assess for hepatic encephalopathy
- Document behavior changes
Nursing Care Plans
Nursing Care Plan 1: Risk for Bleeding
Nursing Diagnosis Statement:
Risk for Bleeding related to portal hypertension and fragile esophageal varices as evidenced by elevated portal pressure and presence of varices on endoscopy.
Related Factors:
- Portal hypertension
- Coagulopathy
- Thrombocytopenia
- History of variceal bleeding
- Alcohol use
Nursing Interventions and Rationales:
- Monitor vital signs q2h or as ordered
Rationale: Early detection of bleeding episodes - Maintain IV access with large-bore catheter
Rationale: Ensures rapid fluid/blood administration if needed - Keep emergency supplies readily available
Rationale: Enables quick response to bleeding - Assess for bleeding precursors
Rationale: Allows early intervention
Desired Outcomes:
- The patient will remain free from bleeding episodes
- The patient will maintain stable vital signs
- The patient will demonstrate knowledge of bleeding precautions
Nursing Care Plan 2: Deficient Knowledge
Nursing Diagnosis Statement:
Deficient Knowledge related to lack of exposure to information about esophageal varices management as evidenced by questions about the condition and verbalized misconceptions.
Related Factors:
- Limited previous exposure to information
- Misinterpretation of information
- Complexity of treatment regimen
- Language or cultural barriers
Nursing Interventions and Rationales:
- Provide education about condition and management
Rationale: Improves self-care abilities - Teach warning signs of bleeding
Rationale: Enables prompt recognition of complications - Demonstrate proper medication administration
Rationale: Ensures treatment compliance
Desired Outcomes:
- The patient will verbalize understanding of the condition
- The patient will demonstrate proper self-care techniques
- The patient will identify warning signs requiring medical attention
Nursing Care Plan 3: Imbalanced Nutrition
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than Body Requirements related to dietary restrictions and impaired liver function as evidenced by weight loss and decreased muscle mass.
Related Factors:
- Restricted sodium intake
- Poor appetite
- Impaired protein metabolism
- Nausea
- Early satiety
Nursing Interventions and Rationales:
- Monitor nutritional intake
Rationale: Ensures adequate nutrition - Provide small, frequent meals
Rationale: Improves nutrient absorption - Collaborate with dietitian
Rationale: Optimizes nutritional plan
Desired Outcomes:
- The patient will maintain a stable weight
- The patient will demonstrate improved nutritional intake
- The patient will follow prescribed dietary restrictions
Nursing Care Plan 4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to the threat of bleeding and uncertain prognosis as evidenced by expressed concerns and increased tension.
Related Factors:
- Fear of bleeding
- Uncertain prognosis
- Complex medical regimen
- Lifestyle changes
Nursing Interventions and Rationales:
- Assess anxiety level
Rationale: Guides intervention selection - Provide emotional support
Rationale: Reduces anxiety - Teach relaxation techniques
Rationale: Helps manage stress
Desired Outcomes:
- The patient will report decreased anxiety
- The patient will use effective coping strategies
- The patient will verbalize understanding of condition management
Nursing Care Plan 5: Ineffective Health Management
Nursing Diagnosis Statement:
Ineffective Health Management related to complexity of therapeutic regimen as evidenced by difficulty following treatment plan.
Related Factors:
- Complex medication schedule
- Dietary restrictions
- Lifestyle modifications
- Limited support system
Nursing Interventions and Rationales:
- Develop a simplified care routine
Rationale: Improves adherence - Provide written instructions
Rationale: Reinforces teaching - Include family in education
Rationale: Strengthens support system
Desired Outcomes:
- The patient will demonstrate adherence to treatment plan
- The patient will maintain follow-up appointments
- The patient will avoid complications
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Diaz-Soto MP, Garcia-Tsao G. Management of varices and variceal hemorrhage in liver cirrhosis: a recent update. Therap Adv Gastroenterol. 2022 Jun 20;15:17562848221101712. doi: 10.1177/17562848221101712. PMID: 35757384; PMCID: PMC9218432.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Schoenfeld PS, Butler JA. An evidence-based approach to the treatment of esophageal variceal bleeding. Crit Care Clin. 1998 Jul;14(3):441-55. doi: 10.1016/s0749-0704(05)70010-5. PMID: 9700441.
- Seo YS. Prevention and management of gastroesophageal varices. Clin Mol Hepatol. 2018 Mar;24(1):20-42. doi: 10.3350/cmh.2017.0064. Epub 2017 Dec 18. PMID: 29249128; PMCID: PMC5875194.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
