Upper Gastrointestinal Bleeding (Sherpath)
A patient presents with sudden upper GI bleeding and signs of shock. Place the treatments in the order in which they are indicated.
1. IV Ringer's solution 2. Pantoprazole administration 3. Endoscopy 4. Epinephrine
Which patient would be most at risk for upper GI bleeding?
A heavy smoker who is taking aspirin daily Smoking is a cause of chronic esophagitis, which is a risk factor for upper GI bleeding. In addition, aspirin, a salicylate, is a risk factor for upper GI bleeding.
A patient presents with sudden, bright red vomitus, is experiencing fatigue and dyspnea, and is hypotensive. What is the priority action that should be taken to address the needs of this patient?
Administer IV lactated Ringer's solution Emergency care for the patient with GI bleeding consists of fluid replacement using lactated Ringer's solution, or whole blood, packed RBCs, or plasma. After stabilization of the patient, a cause for bleeding can be assessed and specifically treated
A patient presents with blood-tinged emesis. An endoscopy does not reveal a cause for the blood. What is the next step in assessing this patient?
Angiography If an endoscopy does not reveal the cause for upper GI bleeding, an angiography should be the next diagnostic tool.
A patient presents with melena associated with pallor, tachypnea, and decreased urine output. Which action is a priority during collaborative care of this patient?
Begin IV fluids The symptoms the patient is experiencing are signs of hypovolemic shock. The priority nursing action would be to begin IV fluids to prevent the patient from declining.
A patient has a gastrointestinal bleed. Which assessment findings would alert the nurse to melena?
Black tarry stool Melena is characterized by black tarry stool.
A patient with upper GI bleeding has a blood pressure of 110/60, a temperature of 98.8° F, and a heart rate of 98 bpm. The patient does not require volume repletion. What is the next step in nursing management of this patient?
Conduct a focused assessment A focused GI assessment would include assessing bowel sounds and abdominal pain and distension, which would provide more information of the patient's diagnosis.
Which action will allow the nurse to monitor the patient with an upper GI bleed for adequate fluid replacement therapy?
Document urine output hourly Urine output is one of the best measures for assessing fluid balance.
nursing assessments the nurse will perform include:
Elevate the head of the bed Observe and auscultate breath sounds, along with respiratory efforts Monitor cardiac rhythm Frequently assess vital signs Monitor alcoholics closely for increased risk of bleeding and withdrawal Observe for signs of alcohol withdrawal such as agitation, sweating, uncontrolled shaking, and vivid hallucinations
A patient with a massive GI hemorrhage and a history of heart disease presents to the emergency department. Which immediate action is indicated for this patient?
Fluid replacement with packed RBCs Fluid replacement with packed RBCs is the preferred method for fluid replacement to avoid fluid overload and may be preferred in a patient with heart disease.
A patient has noticed possible blood in the stool but has no other obvious symptoms of GI bleed. Which test is used to determine if this patient has an upper GI bleed?
Guaiac test The guaiac test is used to identify occult blood in the stool and would be appropriate for investigating suspected blood in the stool in the context of minimal symptoms.
Which assessments should be made before administering a sedative in a restless patient with upper GI bleeding?
Heart rate Blood pressure Respiratory rate
A patient with a massive upper GI hemorrhage who loses 1600 mL of blood may exhibit which symptoms?
Heart rate 110 bpm Tachycardia, or a rapid heart rate, is a symptom of shock and may be experienced after a massive hemorrhage.
A patient with stomach cancer presents with upper GI bleeding. The patient has a history of arthritis, anemia, and diabetes. Which medication is the most likely cause of the patient's upper GI bleeding?
Hydrocortisone Use of corticosteroids, such as hydrocortisone, can increase the risk for GI bleeding.
Which information would the nurse include in the discharge teaching for a patient with an upper GI bleed?
Managing reflux Peptic ulcers are a major risk factor for GI bleeding. The patient should be informed of the risks for peptic ulcer development and how to avoid them.
A patient presents with bloody emesis and is incoherent. The patient smells strongly of alcohol. What action will the nurse take after immediate care is provided?
Monitoring for delirium tremens Bleeding due to chronic alcohol use should be considered in a patient smelling of alcohol. The patient should be monitored closely for withdrawal symptoms, including delirium tremens.
Acute Nursing Care
NG tube assessment Frequently assess the NG tube position and aspirates contents for blood. If using the lavage technique, use 50-100 mL of fluid to instill within the stomach. The fluid can be aspirated or drained by gravity. When aspirating contents from the stomach, stop aspirating if resistance if felt. The tip of the NG tube may be next to the stomach lining. Stool assessment Assess the patient's stools for blood (hematochezia, black tarry, bright red). Prolonged bleeding results in black tarry stools. Be sure to assess the patient for menses and bleeding hemorrhoids to rule out sources of blood in the stool. When vomitus contains blood but the stool contains no gross or occult blood, the hemorrhage is considered to have been of short duration. Oral nourishment Once oral intake is started, observe the patient for symptoms of nausea and vomiting and a recurrence of bleeding. Clear fluids should be started first and given hourly until tolerance is determined. Gradual introduction of foods follows if the patient exhibits no signs of discomfort.
A patient with a massive GI hemorrhage from an esophageal tear has a heartrate of 105 bpm, blood pressure 75/45, and is exhibiting signs of agitation. The patient's status has not improved in the last 36 hours despite multipolar electrocoagulation treatment. What is the indicated treatment for this patient?
Surgery Surgery to repair the tear is indicated for patients with an identified source of bleeding who remain in shock longer than 24 hours.
Which medication may be most appropriate for a patient with minor symptoms presenting with upper GI bleeding due to a peptic ulcer?
Tagamet H2-receptor blockers such as Tagamet reduce stomach acid and would be an appropriate treatment for a patient with a bleeding peptic ulcer.
A patient comes to the clinic complaining of bright red bloody emesis. What information can be obtained from observing the stool of the patient?
The duration of the bleed When emesis contains bright red blood but the stool contains no gross or occult blood, the hemorrhage is considered to have been of short duration.
Which goals are appropriate for a patient with upper GI bleeding?
The patient will experience minimal anxiety The patient will have no further GI bleeding The patient will experience a return to a normal hemodynamic state