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Nursing Care Plan for Gastrointestinal Bleeding

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					                  Nursing Care Plan for Gastrointestinal Bleeding
Gastrointestinal Bleeding

Bleeding from the gastrointestinal tract may cause significant blood loss. The bleeding may be from
either the upper or lower gastrointestinal tract. Upper gastrointestinal bleeds are commonly from
ulcers, esophageal varices, neoplasms, arteriovenous malformations, Mallory-Weiss tears secondary to
vomiting, or anticoagulant use.




Lower gastrointestinal bleeds are commonly due to fissure formation, rectal trauma, colitis, polyps,
colon cancer, diverticulitis, vasculitis, or ulcerations.

PROGNOSIS

The amount and speed of blood loss coupled with the patient’s age and comorbidities account for the
prognosis. The greater the loss of blood, the harder it is for the system to overcome the stress. Multiple
transfusions to replace the lost blood increase the patient’s risk for a reaction. Patients with blood-
clotting disorders have a greater risk of a significant bleed. Patients may go into shock if the amount of
blood loss is great, as they become hemodynamically unstable.

SIGNS AND SYMPTOMS

•   Hematemesis—vomiting of blood (red, maroon, coffee ground)
•   Melena—black, tarry stool
•   Hematochezia—red or maroon blood rectally


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•   Orthostatic changes—drop in BP of at least 10 mmHg with position changes
•   Tachycardia as body attempts to circulate lesser blood volume
•   Pallor due to decrease in circulating blood volume
•   Lightheadedness
•   Diaphoresis (sweating)
•   Nausea

INTERPRETING TEST RESULTS

•   Positive fecal occult blood.
•   Hemoglobin drops.
•   Hematocrit drops.
•   Anemia (iron deficiency) with chronic slow bleed.
•   Nasogastric aspirate positive with upper GI bleed.
•   Anoscopy, sigmoidoscopy, or colonoscopy may show site of lower GI bleed.
•   Arteriography may show site of bleed.
•   Bleeding scan may show site of bleed with radioisotope-tagged RBCs.

TREATMENT

•   Maintain IV access.
•   Administer isotonic fluids like normal saline.
•   Monitor serial hemoglobin and hematocrit levels.
•   Type and cross match for 3 to 6 units depending on amount of blood loss.
•   Transfuse packed RBCs, type-specific when possible (type O negative when type-specific
    unavailable—no time to get results back from lab yet).
•   May need to administer albumin or fresh frozen plasma, depending on amount of units transfused
    and comorbidities such as cirrhosis or clotting disorders.
•   Endoscopic procedures to treat ulcer topically, with injectable or laser treatment.
•   Esophageal varices may be treated by tamponade with Blakemore-Sengstaken tube.
•   Surgery indicated when bleeding uncontrolled.

NURSING DIAGNOSES

•   Deficient fluid volume
•   Decreased cardiac output
•   Anxiety

NURSING INTERVENTION

•   Monitor vital signs for changes—drop in BP, increase in pulse or respiration.
•   Monitor intake and output.
•   Replace volume lost.
•   Monitor abdomen for bowel sounds, tenderness, distention.



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•   Maintain large bore IV (14- to 18-gauge) access.
•   Assess IV site for signs of redness or swelling.
•   Monitor lab results—drop in lab values may lag behind blood loss.
•   Monitor during blood transfusion as per institution protocol for checking blood unit, patient
    identity, frequency of vital signs, and documentation.




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Description: Nursing Care Plan for Gastrointestinal Bleeding