Lower GI Bleed

Lower GI Bleed

1. Priority #1: Assess for hypovolemia

   • Goal: Re-establish normal fluid
   • AD: dehydration, sunken eyes, decreased skin turgor, and weight loss. NA: monitor vitals signs, check I & O, encourage/initiate fluids, obtain labs, and teach to watch for signs/symptoms of dehydration. E: vitals will be back to normal baseline, improved skin turgor, intake will equal output, and skin will be back to baseline color.
   • Meds: IV of LR at 125 mL/hr; IV bolus of 500 mL 0.9% NS; 2 units packed RBCs; IV midazolam & morphine sulfate initiated for sedation prior to colonoscopy
   • Labs: CBC, CMP, PT/INR. Hgb: 7.8, Hct: 23%. Patient likely bleeding for a while and will need blood transfusion. Other orders may include C.Diff and guaiac collection.

2. Priority #2: initiate oxygen therapy

   • Goal: No further need for oxygen, activity level increased
     • AD: assess O2 levels, shortness of breath, labs, and activity level. NA: monitor O2 levels, assess ABGs, listen to heart & lung sounds, use a non-rebreather mask. E: No longer needing to be on oxygen, able to tolerate activity, vital signs back to baseline, and lab values back to baseline.
   • Meds: 5 L O2 via nasal cannula; increase to non-rebreather at 15 L due to becoming hypoxic
   • Labs: ABGs show respiratory alkalosis & hypoxemia. Initiation of oxygen.

3. Priority #3: Educate on lower GI bleed

   • Goal: Patient is able to watch for signs and symptoms and avoid triggers
   • AD: Patient unaware of sigsn/symptoms and causes. Assess symptoms and avoid triggers such as NSAIDs. NA: educate patient on avoiding NSAIDs, discontinue use of long-term Prednisone if able, and notify PCP of any blood in stool. E: Discuss what symptoms to watch out for, use teach back method on education that was presented.
   • Meds: esomeprazole for suppression of gastric secretions.