Question

You review EPIC for Mr. Smith and find that he was admitted to the hospital last night with the diagnosis of bleeding esophageal varices. He is 38 years old, 6’ tall, and weighs 155 lbs. He has a history of alcohol abuse and bipolar disorder. He is on bedrest with bathroom privileges, NPO, and has an IV with lactated ringers running at 125mL/hr. He is a bit confused and has been shivering. His temp is 100.6° F. He is scheduled for a variceal ligation.

Medications: IV octreotide 50 mcg/hr x 3 days Thiamin 100 mg PO every morning MVI tablet each morning Propranolol 20 mg PO BID Lithium 900 mg PO each morning

Labs: Alanine aminotransferase (ALT) – 80 Units/L Aspartate aminotransferase (AST) – 250 Units/L Hgb 6.8 Hct 21 Potassium – 3.3 mEq/L Folate – 3 nmol/L (7-36 nmol/L) Thiamine – 55 nmol/L (70-180nmol/L) Vit B12 – 100 ng/L (130-700 ng/L) Questions: Mr. Smith

1. Why might a person with cirrhosis have esophageal varices?

2. What question would you ask the nurse giving report when he states that the consent form still needs to be signed for the variceal ligation?.

3. What would the nurse need to check before hanging the octreotide drip?

4. What vital signs would be important to monitor for this patient?

5. What are possible causes for confusion and shivering for this patient?

6. What assessments would be needed to rule out some of the causes for confusion and shivering?

Answer 1

1.Cirrhosis of liver is a causative factor for esophageal varices.This happens because the blood normally flows via the liver but in cirrhosis of liver this blood flow is affected thereby the excess blood flows via the veins present in the esophagus.When this happens the veins can not meet the excess blood flow causing inflammation or swelling and thus leading to rupture of veins and bleeding .The condition is termed to be esophageal varices.

2.When a consent is not taken the following questions can be raised

• Is the patient explained in detail about the procedure?
• Is the patient mentally sound to sign a consent?
• Is the patient in fear to accept a consent?

3.The following things has to be assessed by a nurse before hanging the octreotide drip are

• Check for any allergic reaction or any previous transfusion
• Mix the medicine completely with the solution
• Make sure only 50mcg/hr is transfused
• Check patients vital signs and blood sugar value
• Calculate the rate of flow
• Assess th drop for any colour change or sediments in the drip before starting
• Administer in room temperature

4.The following vitals signs are necessary to be checked

• Heart rate:The patient may have decrease in heart rate
• Respiratory rate:shortness of breath is a side effect of the medication
• Hypertension :due to vasoconstriction