Page 183 - Critical Care Notes

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■ Note amount and color of feces. Hematest stool prn. Monitor CBC, PT, PTT,
and blood chemistries.
■ Insert Foley catheter. Monitor intake and output. Assess fluid and elec-
trolyte balance.
■ Administer high-dose proton pump inhibitors to maintain gastric pH
>6.0. Histamine antagonists are not recommended. Consider misoprostol
(prostaglandin analog), anticholinergics, or mucosal protective agents.
■ Administer IV or intra-arterial vasopressin (Pitressin) with caution. Consider
octreotide (Sandostatin), terlipressin, ornipressin, or somatostatin, especial-
ly if varices suspected.
■ If coagulopathy is present (↑ PTT), administer vitamin K 10 mg IV and fresh
frozen plasma.
■ Administer tranexamic acid (Cyklokapron) if excessive bleeding and
decreased fibrinolysis.
■ A specific protocol of medications is ordered if patient is H. pylori positive.
■ Provide emotional support to patient and family. Relieve anxiety and pain.
■ Prepare patient for possible endoscopic or surgical procedures:
■ Laser phototherapy
■ Endoscopic thermal or injection therapy
■ Intra-arterial embolization
■ Vagotomy, pyloroplasty, or total or partial gastrectomy
Complications
■ Gastric perforation → sudden and severe generalized abdominal pain with
rebound tenderness and board-like abdominal rigidity
■ Reduced cardiac output, including hypovolemic shock
■ Nausea, vomiting, and diarrhea; pulmonary aspiration
■ Altered nutritional status with nutritional deficits; aspiration
■ Infection; fever, ↑ WBC and ↑ HR; sepsis
Esophageal Varices
Esophageal varices are dilated, distended, tortuous veins in the esophagus.
They may also occur in the proximal stomach. These varices most commonly
result from portal hypertension (>10 mm Hg) secondary to hepatic cirrhosis
caused by the consumption of large amounts of alcohol. Severe liver disease →
blood coagulation abnormalities → bleeding.

GI