Writing Assignment #7
ITT Technical Institute/Breckinridge School of Nursing
Jennifer Kyte APRN, MSN
May 7th, 2012
The plan of care for a patient with esophagogastric balloon tamponade tubes is formulated around the primary nursing diagnosis of ineffective airway clearance related to aspiration of blood (Ackley, B., Ladwig, G., 2011) Bleeding often stop spontaneously, but if it does not, a Sengstaken-Blakemore or Minnesota tube is inserted to provide constant pressure at the source of bleeding of the varices by using a balloon tamponade. For continued bleeding, a nasogastric tube may be inserted and connected to continuous low suction with periodic lavages. Intra-arterial infusion of vasopressin or therapeutic embolization into the left gastric artery during arteriography has also shown to be effective in controlling bleeding in some patients. Other techniques to stop bleeding include endoscopy with electrocoagulation for hemostatsis or transcatheter embolization with an autologous blood clot or artificial material, such as a gelatin sponge. On rare occasions the patient may require surgery to suture the laceration. If the patient has excessive blood loss, the nurse should institute protocols to support the circulation such as the administration of intravenous (IV) fluids and blood component therapy. With continued or massive bleeding the patient may need to be supported with blood transfusions and admitted to an intensive care unit (ICU) for close observation. A major cause of morbidity and mortality in patients with active gastrointestinal (GI) bleeding is aspiration of blood with subsequent respiratory compromise. This is usually seen in patients with inadequate gag reflexes or those who or are unconscious or obtunded. Constant observation to ensure a patent airway is vital. The patient must be checked every eight hours for the presence of a gag reflex. The head of the bed should be maintained in a high fowler position unless otherwise contraindicated. Should the patient need to be placed in a flat position it should be done in a side lying position to avoid aspiration. Bed rest should be encouraged and physical activity should be kept to a minimum to limit oxygen consumption. Patient care and schedule of procedures should be clustered together to allow for ample rest periods so the patient does not overtire. Nauseating, noxious stimuli should be avoided in an attempt to keep the patient from vomiting. Vomiting will increase the pressure on the esophageal varices causing them to bleed and possibly rupture. Nutrition in the patient can be supported by eliminating foods and fluids that cause gastroesophageal discomfort. The patient with esophagogastric balloon tamponade tubes should avoid caffeinated beverages, alcohol, carbonated drinks, and extremely hot or cold food or beverages. Educating the patient and the patient’s family should help with understanding the treatments and procedures. Patient education needs to be at a level that is consistent with the patient’s educational level and which also takes into account the state of anxiety the patient may be experiencing. Discharge teaching should begin upon admission and should include teaching the patient to avoid foods and fluids that cause discomfort or irritation. The nurse must determine that the patient understands the use and need for compliance of any prescribed medications, including dosage, route, action or effect and side effects. The nurse must also review with the patient the signs and symptoms of recurrent bleeding and the need to seek medical care and to make sure that there is a clear understanding by having the patient verbalize it back. Upon discharge the patient will also be given a phone number for the patient to use should complications arise. Fatal complications occur frequently during use of the Sengstaken-Blakemore tube for treatment of bleeding esophageal...
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