Esophageal Varices for Certified Emergency Nursing (CEN)
Included In This Lesson
Outline
Esophageal Varices
Definition/Etiology:
Dilated submucosal esophageal veins that become tortured leading to an increased risk of rupture
Causes:
- Liver disease
- Cirrhosis = (scarring of the liver)
- Portal HTN = (portal vein is the main vein that runs to the liver. More scarring = increased pressure)
Pathophysiology:
Liver scarring causes increased pressure in the vein, vein travels to the path of least resistance which is usually the esophageal veins. Pressure increases in the esophageal veins leading to dilation and potentially rupture.
Clinical Presentation:
- Vomiting blood
- Abd pain
- Possible Jaundice
- Hx of alcoholism or liver disease
- Black/ tar like stool from swallowing small amt of blood
- If they have been bleeding, patient shows shock symptoms:
- tachycardia
- low BP
- pale/clammy skin
- irregular breathing
Collaborative Management:
- Stabilize
- Hypovolemic shock
- Fluids
- Blood transfusion (make sure type and cross completed)
- Labs – may show anemia, dehydration, elevated AST/ALT, thrombocytopenia
- Treatment – Upper endoscopy, band ligation, monitor BP to prevent rebleeding (vasoconstrictors as needed)
Evaluation | Patient Monitoring | Education:
- Hemodynamic monitoring
- 70% chance of rebleeding, monitor for additional bleeding
- Need good outpatient follow up
- If they abuse ETOH/ avoid any further use
Linchpins: (Key Points)
- Caused from portal HTN
- Monitor for hypovolemic shock
- Esophageal band ligation
- Rebleed likely
- Rupture = patient can go into hypovolemic shock/ bleed out
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Meseeha, M., & Attia, M. (2022). Esophageal varices. In StatPearls [Internet]. StatPearls Publishing
- Portal hypertension. Johns Hopkins Medicine. (2022, April 19). Retrieved October 16, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/portal-hypertension
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System