Medical Surgical Esophageal varices #5

Question

The nursing student is inquiring about what will be done to stop the internal bleeding associated with bleeding esophageal varices. Which intervention does the charge nurse properly schedule for the client to help stop ruptured esophageal varices that are profusely bleeding?

Answers

  1. Carotid massage
    • Rationale:

      This answer is not correct because carotid massage is not an appropriate intervention to stop esophageal varices profusely bleeding. Carotid massage is a bedside intervention sometimes performed on clients with heart tachyarrhythmias to decrease the heart rate and restore adequate perfusion. Nevertheless, it is not an appropriate intervention and will not stop esophageal variceal bleeding.

  2. Antibiotics
    • Rationale:

      This answer is not correct because antibiotics will not stop esophageal bleeding. Antibiotics may be given if esophageal bleeding is minimal or has been stopped since the opening can be at risk of infection. It is not the priority intervention since stopping the bleeding is priority.

  3. Balloon tamponade
    • Rationale:

      This answer is correct because balloon tamponade is utilized generally as an emergency intervention to stop profuse bleeding of esophageal varices. The bleeding can become life threatening quickly and swift interventions are needed to stop bleeding, support fluid volume status of the body, and sustain life. Various interventions may be used in addition to balloon tamponade, including fluids and volume expanders to maintain fluid volume in the blood stream and use of vasopressors to maintain the person’s blood pressure and perfusion while the balloon tamponade is being performed.

  4. Tracheostomy
    • Rationale:

      This answer is not correct because a tracheostomy is not indicated for esophageal variceal bleeding. Only if the airway is swollen shut or other airway compromise occurs would this intervention be needed. Furthermore, tracheostomy would not “stop” esophageal variceal bleeding. Balloon tamponade is utilized generally as an emergency intervention to stop profuse bleeding of esophageal varices.

Overview

Balloon tamponade is a procedure that is performed when a client has profusely bleeding esophageal varices to place pressure on the site and help stop bleeding.

Explanation

Learning Outcomes

Esophageal varices are swollen, bulging veins located in the lower esophagus. This occurs as the result of increased blood pressure in the portal vein. The hypertension in the portal vein is associated with liver damage related to cirrhosis of the liver. The varices can be easily damaged, then rupture, and bleed. Interventions and treatments used to prevent bleeding include use of beta blockers to reduce pressure in the portal vein and endoscopic band ligation, which applies pressure to high risk varices to the varices so that it can not bleed. If the client is bleeding from ruptured varices, this can be life threatening. Balloon tamponade can be performed to apply pressure to the varices by blowing up a balloon to apply pressure directly on the bleeding varices.

Test Taking Tip

Read the question! Interventions may be used during the course of treatment for a condition but make sure the answers line up with the specific question being asked.

Video Rationale