Nursing care of the patient with endoscopy in Esophageal varices bleeding shock

Abstract

Background : Esophageal varices are the cause of gastrointestinal bleeding in the great majority. The course of portal hypertension in patients with liver cirrhosis often is complicated by variceal. Most patients bleed from esophageal varices that were found 50-60% of cirrhosis and 1 in 3 cause of dead. The goal of treatment is to stop acute bleeding as soon as possible, and treat varices with medicines, endoscopy and operation. Bleeding must be controlled quickly to prevent shock and death.

Objective : Acase study hypertension in patients the esophayeal varices bleeding.

Case study : A 46-year-old male that refer from Pattana Nikhom Hospital with fresh bleeding about 1 bowl and worse conscious.      A physician referred him to King Narai Hospital because he did not feel better after he got the blood transfusion, then he was worse of sign and symptoms, hypotension, more swelling in the abdomen and right leg. Early admission to King Narai hospital, his blood pressure was 80/40, pulse pressure was 116, respiratory rate was 24, temperature was 36.6 degrees Celsius, Hct was 17%, Sengstaken-Blakemore Tube was inserted. Later, O₂ Saturation was 98% that O₂ cannular 3 lit/min was used, and PRC 3 unit, Intravenous fluid vein drip and emergency endoscopy appointment were gotten. Antrum ulcer and Esophageal varices were seen that made Argon Plasma Coagulation (APC) and 3 band ligations were done. Then, he was recurrent bleeding, Hepatic encephalopathy, worse conscious, low respiration, oxygen saturation of approximately 85%. Endotracheal intubation with Birdûs respirator was done to prevent hypoxemia, got blood transfusion (PRC 6 unit, FFP 6 unit, Platelet concentration 5 unit) to improve hypovolemic shock, antacid drug, Duphalac solution to treat hepatic encephalopathy. Nursing care that were used to evaluate hypoxemia, hypovolemic shock, monitor before, during, and after endoscopy, prevent complication, increase self care behavior at hospital and home. Finally, he was discharged from King Narai Hospital and follow up appointment took place in 1 month at Pattana Nikhom hospital. Length of stay (LOS) was 7 days and total cost of care were 48,286 baht.

Result : The patient improved of bleeding, Hepatic encephalopathy, swelling in the abdomen and right leg. Furthermore, he had disease self-management knowledge in Esophageal varices and alcoholic cirrhosis. Furthermore, he was consulted to reduce alcohol consumption clinic.