Gastrointestinal Bleeding (1&2) – Flashcards
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GI bleed
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refers to any bleeding that starts in the gastrointestinal tract that extends from the mouth to the anus
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Upper GI
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mouth to the proximal part of the ligament of Treitz (duodenojejunal junction)
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Lower GI
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anything distal to the ligament of Treitz
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Esophageal origin
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*chronic esophagitis* -GERD -esophageal varices due to cirrhosis -alcohol -cigarettes -cancers (mouth, tongue, esophagus)
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Stomach and duodenal origin
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-ulcers (peptic, gastric, duodenal) -hemorrhagic gastritis -mucosa-irritating drugs (NSAIDS, aspirin, corticosteroids, anticoagulants) -gastric cancer -stress related mucosal diseases -physiological stress ulcers
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Lower GI bleeding
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-cancer (colon, rectal) -hemorrhoids -polyps -diverticulosis/diverticulitis -ulcerative colitis
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Types of GI Bleeds
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-occult bleeding (micro bleeding; only detected in lab tests) -obvious bleeding (macro bleeding)
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Obvious Bleeding
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-hematemesis (vomiting blood) -melena (dark/sticky feces)
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Bleeding origins
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*determines severity* -venous -capillary -arterial (profuse, bright red)
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Other characteristics of GI bleeding
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-acute -insidious
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Diagnostics for GI bleeding
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-abdominal CT scan -abdominal MRI scan -abdominal x-ray -Upper/Lower GI series -endoscopy: EDG -angiography -bleeding scan (tagged red blood scan) -capsule endoscopy: enteroscopy -labs (CBC/BMP, inc WBC, BUN, serum electrolytes, dec hemoglobin, ABGs, coags, hemoccult, gastroccult, urinalysis)
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Emergency assessment and management
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-oxygen administration -assess for s/s of shock -assess for s/s perforation and peritonitis -IV insertion, foley catheter -IV fluids & blood products
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Goal of collaborative care
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to achieve coagulation or thrombosis in bleeding vessel
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Endoscopic hemostasis therapy tools
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-thermal (heat) probe -electrocoagulation probe (multipolar and bipolar) -argon plasma coagulation (APC) -variceal ligation, injection sclerotherapy, and balloon tamponade
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Banding procedure
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hemostasis is achieved in bleeding varices by the endoscopic application of rubber bands onto the bleeding sites
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Balloon tamponade
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a balloon is inflated within the esophagus or stomach to apply pressure on bleeding blood vessels, compress the vessels, and stop the bleeding. *patient must be intubated for procedure*
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When is surgery indicated for GI bleeding?
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when bleeding continues regardless of therapy provided and site of bleeding has been identified
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Laparoscopic surgical therapy
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-devascularization -wedge excision of lesion
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Drug therapy
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-antacids -H2 receptor blockers -proton pump inhibitors -mucosal protectants -vasopressin -octreotide (Sandostatin) -epinephrine
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Nursing assessment of GI bleed
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-subjective & objective data -assess for s/s of complications -document findings accurately in real time
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Nursing diagnosis for GI bleed
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-decreased cardiac output -deficient fluid volume -ineffective peripheral tissue perfusion -anxiety -knowledge deficit
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Overall goals for GI bleed
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-no further GI bleeding -cause of bleeding identified and treated -return to normal hemodynamic state -minimal or no symptoms of pain/anxiety -patient education and discharge instructions by teach back
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Interventions for GI bleed
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-prompt treatment -monitor vitals, LOC, IV therapy, urine output, NG tube and suction maintenance, fluid overload, ECG monitoring, lab results -monitor for recurrence of bleeding -NPR-clears-ADAT -patient education
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Evaluation after GI bleed
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-experience absence/tolerable levels of pain to be comfortable -understand potential etiologic factors and make appropriate lifestyle modifications
