Esophageal Varices NCLEX Review Care Plans
Nursing Study Guide for Esophageal Varices
Esophageal varices are veins that are abnormally enlarged and are usually found on the lower two-thirds of the esophagus.
They arise from the blockage of the portal vein of the liver. Instead of flowing through the portal vein, the blood flows through the smaller blood vessels, which eventually causes venous enlargement, leakage, or even rupture.
The treatment plan for esophageal varices is mainly focused on the prevention or stoppage of their rupture and bleeding.
Signs and Symptoms of Esophageal Varices
Unless they are bleeding, esophageal varices may not present any signs or symptoms. A patient with bleeding esophageal varices may show:
- Hematemesis or vomiting large amounts of blood
- Black, tarry or bloody stools
- Loss of consciousness due to severe bleeding
Esophageal varices related to liver disease may have the following symptoms:
- Jaundice or yellow coloration of eyes and skin
- Ascites or abdominal fluid buildup
- Getting easily bruised
Causes and Risk Factors of Esophageal Varices
Liver disease cause scarring of the liver tissue known as cirrhosis of the liver. The liver scar tissues facilitate the backing up of the blood flow, thus increasing the pressure in the liver’s portal vein.
This condition is known as portal hypertension. To compensation for the increased pressure, the blood is forced to flow in smaller veins, including those veins that are found in the esophagus’ lowest part.
Their small size means that they cannot accommodate a large volume of blood. The veins may balloon, rupture, and bleed in time.
Aside from liver cirrhosis, thrombosis or the formation of blood clot in the portal vein or splenic vein may cause esophageal varices.
Parasitic infection of the liver, such as schistosomiasis found in Asia, Africa, Caribbean countries, and South America, can cause liver damage and lead to the formation of esophageal varices.
Alcohol abuse may lead to the rupture and bleeding of esophageal varices.
Complications of Esophageal Varices
Bleeding is the most life-threatening complication of esophageal varices. Internal bleeding may result to shock due to loss of a significant amount of blood, and this is fatal.
Another complication of esophageal varices is the increased risk for another rupture and bleeding episode of other varices.
Diagnosis of Esophageal Varices
- Physical examination and history taking – to check for any hematemesis, black tarry or blood stools, as well as to explore any alcohol abuse or history of liver disease
- Endoscopy – to visualize the gastrointestinal system, looking for any dilation of veins and any presence of red spots or red streaks which may indicate a very high risk of rupture and bleeding. Treatment of bleeding esophageal varices can also be done during this exam.
- Capsule endoscopy – to perform endoscopy but with the use of a capsule that has a camera in it. The patient swallows this like a pill, and the camera takes images of the GI tract as it goes down. This is more expensive than the usual endoscopy, but can be helpful for those who cannot tolerate the endoscope tube
- Imaging – CT scan and ultrasound Doppler of the portal and splenic veins
Treatment of Esophageal Varices
- Portal vein drugs. Beta blockers such as propanolol and nadolol can help treat portal hypertension by lowering the blood pressure in the portal vein. These reduce the risk for esophageal varices rupture and bleeding. After a bleeding episode, drugs like vasopressin and octreotide can be prescribed for up to 5 days to reduce the blood flow in the portal vein.
- Endoscopic band ligation. This procedure can be done while the patient is undergoing endoscopic exam and the doctor finds out that there are esophageal varices that are bleeding, or at high risk of rupture and bleed in the future. The doctor uses an elastic band to tie off the veins that are bleeding.
- Balloon tamponade. To stop the bleeding, this procedure involves inflating a balloon temporarily (for up to 24 hours) in order to place pressure on the esophageal varices.
- Transjugular intrahepatic portosystemic shunt (TIPS). This procedure is used to create a diversion of the blood flow away from the portal vein by means of making a shunt or an opening between the hepatic vein and the portal vein.
Nursing Care Plans for Esophageal Varices
- Nursing Diagnosis: Risk for Bleeding secondary to esophageal varices
Desired Outcome: The patient will be able to avoid having any frank or occult bleeding and will remain hemodynamically stable.
|Assess vital signs and observe for any signs of bleeding such as melena (black, tarry or bloody stools) and hematemesis (vomiting of blood).||To check for any signs of rupture and bleeding of esophageal varices. Hypotension, tachypnea, and tachycardia may indicate internal bleeding or hemorrhage.|
|Perform a focused assessment on the abdominal region, particularly checking for ascites.||Ascites is one of the symptoms of esophageal varices. This can manifest as distended abdomen, feeling of fullness, and rapid weight gain.|
|Administer drugs that can reduce portal hypertension, as prescribed.||Medications such as propanolol and nadolol are called beta blockers, and they can help treat portal hypertension by lowering the blood pressure in the portal vein. This reduces the risk for esophageal varices rupture and bleeding.|
|Explain what endoscopic band ligation means, its risks and its benefits. Prepare the patient for the procedure.||To inform the patient, gain consent for the procedure, and prepare the patient physically and mentally towards the intervention. Endoscopic band ligation can reduce the risk of rupture and bleed in the future. The doctor uses an elastic band to tie off the veins that are bleeding.|
- Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to digestive tract bleeding secondary to esophageal varices, as evidenced by hematemesis, weight loss, nausea and vomiting, loss of appetite and dizziness/ lightheadedness
- Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.
|Explore the patient’s daily nutritional intake and food habits (e.g. meal times, duration of each meal session, snacking, etc.)||To create a baseline of the patient’s nutritional status and preferences.|
|Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term nutrition and weight goals related to peptic ulcer disease.||To effectively monitory the patient’s daily nutritional intake and progress in weight goals.|
|Help the patient to select appropriate dietary choices and limit alcohol intake.||To promote ulcer healing and healthy food habits. Alcohol abuse can cause liver cirrhosis, which can eventually lead to portal hypertension and formation of esophageal varices.|
|Refer the patient to the dietitian.||To provide a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed disease.|
|Encourage soft foods such as bananas and yogurts.||To reduce irritation of the esophagus and ensure that the patient receives the right amount of nutrition.|
Other nursing diagnoses:
- Risk for Shock
- Disturbed Body Image
- Deficient Knowledge
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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