- Nursing Implementation
- Health Promotion
- Patient with a history of chronic gastritis, cirrhosis, or peptic ulcer disease is at high risk
- Patient who has had previous upper GI bleeding episode is more likely to have another bleed
- Patient on daily low-dose aspirin to reduce cardiovascular disease risk are at risk
- Patient teaching
- Avoidance of gastric irritants
- Alcohol
- Smoking
- Stress-inducing situations
- Take only prescribed medications
- Methods of testing vomitus/stools for occult blood
- Potential need for prophylactic PPI
- Prompt treatment of upper respiratory infection in patient with esophageal varices
- Take drugs that produce gastroduodenal toxicity with meals or snacks
- Avoidance of gastric irritants
- Acute Care
- Place IV lines
- Preferably 2, with 16- or 18-guage needle for fluid and blood replacement
- Administer fluid and blood replacement as ordered
- Accurate I/O record
- Record urine output hourly
- At least 0.5 mL/kg/hr indicates adequate renal perfusion
- Measure urine specific gravity
- Maintain NG patency and position
- CVP line or PAC readings every 1–2 hours
- Observe older adults and patients with history of cardiovascular problems closely
- ECG monitoring
- Vital signs
- Approach in calm, assured manner to decrease anxiety
- Use caution when administering sedatives for restlessness
- Warning sign of shock may be masked by drugs
- Emergency management
- Place IV lines
- Health Promotion
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Assessment Findings |
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Abdominal and GI Findings |
Hypovolemic Shock |
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Interventions |
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Initial |
Ongoing Monitoring |
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- Assess stools and NG output for blood
- Rule out other sources of bleeding
- When vomitus contains blood but stool does not, hemorrhage is considered to be of short duration
- Nutrition
- Observe for symptoms of nausea and vomiting
- Recurrence of bleeding
- Feedings: initially clear fluids given hourly
- Gradually introduce of foods as tolerated
- Hemorrhage that is result of chronic alcohol abuse
- Closely observe for delirium tremens
- Agitation
- Uncontrolled shaking
- Sweating
- Vivid hallucinations
- Closely observe for delirium tremens
- Ambulatory Care
- Patient teaching
- Patient/family taught how to avoid future bleeding episodes
- Made aware of consequences of not adhering to drug therapy
- Emphasize that no drugs other than those prescribed should be taken
- No smoking or alcohol
- Need for long-term follow-up care
- Instruction if an acute hemorrhage occurs in future
- Patient teaching
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- Nursing Evaluation
- The expected outcomes are that the patient with upper GI
- bleeding will
- Have no upper GI bleeding
- Maintain normal fluid volume
- Experience a return to a normal hemodynamic state
- Understand potential etiologic factors and make appropriate lifestyle modifications
