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Upper GI Bleed (Effects on concepts (Health promotion (Education about…
Upper GI Bleed
Effects on concepts
Nutrition: Nausea and vomiting
Metabolism: anorexia
Mobility: decreased because the patient is put on bed rest
Tissue integrity/infection: Patient is bleeding--> risk of infection
Elimination: melena--> black tarry stools
Fluid regulation: potential hypovolemia because of blood loss
Oxygenation: Decreased due to loss of RBCs
Perfusion: Decreased due to loss of RBCs
Safety: dizziness due to blood loss--> risk for falls
Pain: abdominal pain--> obstruction
Health promotion
Education about long term NSAID use
Decrease stress
Patho: bleeding from
the upper GI tract
Causes
Bright red--> arterial source above the stomach
Coffee ground emesis--> blood has been in the stomach
Melena--> slow bleed from an upper GI source--> hemoglobin breaks down in the large intestines
Risk Factors
Long term NSAID use
Stress related mucosal disease--> commonly seen in critical patients
Complications
Dehydration
Electrolyte imbalance
Hypovolemia
Anemia
S&S
Melena
Decreased O2 and BP
Tachycardia
Fatigue
Coffee ground emesis
Diagnostic studies
Endoscopy
Lab studies
CBC
BUN
Electrolytes
PT
aPTT
ABGs
Occult blood for emesis and stool
Treatment
Endoscopic therapy to locate bleed
Surgical therapy to stop the bleeding
Drug therapy
PPIs decrease acidity to raise pH for clotting
Epinephrine for acute hemostasis
Vasopressin to increase BP
Nursing Process
Assessment
Abdomen assessment
Assessment of stool or emesis with blood
Rectal bleeding--> assess rectum
Assess pain
Diagnoses
Risk for decreased cardiac output related to loss of blood
deficient fluid volume related to acute loss of blood
Ineffective tissue perfusion
Anxiety
Planning:
No further GI bleeding
Cause of bleeding identified
Experience return to normal hemodynamic state
Implementation
Avoid NSAIDs
Place two IV lines--> one for fluids, one for blood
Place NG tube for decompression
Gradually reintroduce food--> start with clear liquids
Evaluation
No further bleeding
Maintain normal fluid volume
Return to normal hemodynamic state