Answer :
The correct procedure to lower portal pressure in a patient with continued bleeding from esophageal varices despite pharmacologic and endoscopic therapy is a transjugular intrahepatic portosystemic shunt (TIPS) procedure.
When a patient with bleeding esophageal varices does not respond to initial treatments such as pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with variceal banding, a more invasive intervention is required to decrease the portal pressure. The TIPS procedure is designed to create a shunt between the portal and systemic circulations, thereby reducing the portal pressure and controlling the variceal bleeding.
The TIPS procedure involves the following steps:
1. The patient is taken to the interventional radiology suite.
2. The patient is sedated, and local anesthesia is administered.
3. The radiologist accesses the internal jugular vein.
4. A catheter is threaded through the vein into the hepatic vein.
5. Using imaging guidance, a needle is then passed through the liver parenchyma to access the portal vein.
6. A stent is placed to create a shunt between the hepatic vein and the portal vein.
7. The stent is dilated to a predetermined diameter to reduce the portal pressure.
The TIPS procedure is effective in managing refractory variceal bleeding by decompressing the portal venous system and reducing the pressure within the esophageal varices. It is a minimally invasive alternative to surgical shunts and has a lower morbidity and mortality rate. The nurse must prepare the patient for the procedure by ensuring that informed consent has been obtained, that the patient's coagulation status is optimized, and that the patient is adequately hydrated. Post-procedure care includes monitoring for complications such as infection, bleeding, and hepatic encephalopathy, as well as ensuring that the patient receives appropriate follow-up to monitor the function of the shunt.
To lower the portal pressure the nurse needs to prepare for transjugular intrahepatic portosystemic shunting (TIPS).
TIPS is an effective treatment to control bleeding when all other methods fail to do so. In this method, a tube or stent is inserted into the blood vessels with lower blood pressure. This helps to restore the flow of blood effectively and bleeding gets stopped.
Portal pressure is the pressure in the veins that carry blood from the portal system of the body. The portal system includes the digestive organs like the stomach, pancreas, intestines, etc. and the vein carries the blood into the liver.
To know more about portal pressure, here
brainly.com/question/12747208
#SPJ4
