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NSG 210 Test 3 Study Guide

Ingestion of ammonia salts serum ammonia levels may

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Unformatted text preview: emoved. Pt is at high risk for aspiration & obstruction of the airway Nursing measures include frequent oral care, low suction & ax of respiratory distress caused from procedure or sedatives Pt may have an NG tube inserted  ­Endoscopic Sclerotherapy: a sclerosing agent is injected through a fiberoptic endoscope into the bleeding varices to promote thrombosis & eventual sclerosis (scabbing). Used to treat acute hemorrhage, but not a preventative measure Post ­procedure, monitor pt for bleeding, perforation of esophagus, aspiration pneumonia, & esophageal stricture. Make sure pt can swallow. If bleeding reoccurs, a balloon tamponade or banding procedure will be used  ­Esophageal Banding Therapy: a modified endoscope w/ an elastic rubber band are placed directly onto the bleeding varices. The bleeding varice is suctioned into the tip of the endoscope, the rubber band is slipped over the tissue, causing necrosis, ulceration & eventual sloughing of the varice. Has replaced sclerotherapy as the tx of choice for bleeding esophageal varices Complications include superficial ulceration, dysphagia, transient chest discomfort & esophageal strictures Band ligation in combination w/ drug therapy is considered most effective.  ­TIPS procedure: (discussed above in more detail)  ­Surgical procedures may be considered as second ­line management (rescue therapy) for pts in which all other tx have failed. The TIPS procedure has largely replaced the use of surgical decompressive shunts & ligation procedures.  ­Other rescue therapies include secondary endoscopic procedures & balloon tamponade Interventions  ­NG insertion to monitor for recurring bleeding  ­Monitor VS & assess pt’s nutritional & neurologic status (ax of this assists in dx HE)  ­...
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