Upper Gastrointestinal Bleeding : Nursing Management

Nursing Management

  • Nursing Assessment
    • Subjective Data
      • Important Health Information
        • Past health history:
          • Precipitating events before bleeding episode
          • Previous bleeding episodes and treatment
          • Peptic ulcer disease
          • Esophageal varices
          • Esophagitis
          • Acute and chronic gastritis
          • Stress-related mucosal disease
        • Medications:
          • Aspirin
          • Nonsteroidal anti-inflammatory drugs
          • Corticosteroids
          • Anticoagulants
      • Functional Health Patterns
        • Health perception–health management:
          • Family history of bleeding
          • Smoking
          • Alcohol use
        • Nutritional-metabolic:
          • Nausea
          • Vomiting
          • Weight loss
          • Thirst
        • Elimination:
          • Diarrhea
          • Black, tarry stools
          • Decreased urine output.
          • Sweating
        • Activity-exercise:
          • Weakness
          • Dizziness
          • Fainting
        • Cognitive-perceptual:
          • Epigastric pain
          • Abdominal cramps
        • Coping–stress tolerance:
          • Acute or chronic stress
    • Objective Data
      • General
        • Fever
      • Integumentary
        • Clammy, cool, pale skin. Pale mucous membranes, nail beds, and conjunctivae. Spider angiomas, jaundice, peripheral edema
      • Respiratory
        • Rapid, shallow respirations
      • Cardiovascular
        • Tachycardia, weak pulse, orthostatic hypotension, slow capillary refill
      • Gastrointestinal
        • Red or “coffee-ground” vomitus.
        • Tense, rigid abdomen, ascites.
        • Hypoactive or hyperactive bowel sounds.
        • Black, tarry stools
      • Urinary
        • Decreased urine output, concentrated urine
      • Neurologic
        • Agitation, restlessness. Decreasing level of consciousness
      • Possible Diagnostic Findings
        • Decreased hematocrit and hemoglobin, hematuria. Guaiac-positive stools, emesis, or gastric aspirate. Decreased levels of clotting factors, ↑ liver enzymes, abnormal endoscopy results
  • Nursing Diagnoses
    • Risk for decreased cardiac output related to loss of blood
    • Deficient fluid volume related to acute loss of blood and gastric secretions
    • Ineffective peripheral tissue perfusion related to loss of circulatory volume
    • Anxiety related to upper GI bleeding, hospitalization, uncertain outcome, source of bleeding
  • Nursing Planning
    • The overall goals are that the patient with upper GI bleeding will
      • Have no further GI bleeding
      • Have the cause of the bleeding identified and treated
      • Experience a return to a normal hemodynamic state
      • Experience minimal or no symptoms of pain or anxiety

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