Upper GI Bleed

Upper GI Bleed

1. Pathophysiology: Severity of bleed depends on the origin. It can be venous, capillary, or arterial. If it is arterial, blood is bright red and indicated there has not been contact with gastric HCI acid secretion. If it is coffee-ground like, the blood has been in contact with the stomach for awhile.

2. S&S: Hematemesis, Melema, nausea, abdominal pain & rigidity. The nurse should assess LOC, vital signs, skin color & cap refill

   • Sometimes the patinet can go into hypovolemic shock from blood loss. S&S include: low BP, rapid weak pulse, increased thirst, cold & clammy skin, restlessness

3. Nursing Dx: Risk for decreased cardiac output r/t loss of blood, Deficient fluid volume r/t acute loss of blood & gastric secretions, Ineffective peripheral tissure perfusion r/t loss of circulatory volume, anxiety r/t upper GI bleeding, hospitalization, uncertain outcome, source of bleeding

   • Interventions: Teach about avoiding known gastric irritants, smoking cessation, only take prescribed medications, severe coughing or sneezing can cause pressure on varices and could result in hemorrage, measure I&O daily, taking medications with meals helps with irritation (less irritation)

4. Collaborative Care: Monitor pts with hx of cardiovascular problems for fluid overload and pulmonary edema (cardio), Auscultate breath sounds and monitor respiratory effort (RT). A nutritionist might be needed if having trouble with N/V, intolerance with eating, anorexia, surgical consult needed sometimes

5. Dx Studies: Endoscopy, angiography, CBC, BUN, serum electrolytes, PT, PTT, liver enzymes, ABGs, type and cross match for possible infusions, vomitus, stools, Urinalysis