Gastrointestinal Bleed Nursing

Gastrointestinal GI Bleed Nursing Diagnosis Interventions and Care Plans

Gastrointestinal GI Bleed NCLEX Review Care Plans

Nursing Study Guide for GI Bleeding

Gastrointestinal (GI) bleeding is a condition that involves bleeding in one or many parts of the digestive tract.

GI bleeding is not a disorder in itself; rather, it is a symptom of many GI disorders, including peptic ulcer disease, inflammatory bowel disease, and gastric cancer.

GI bleeding is usually suspected when there is blood in the urine or stool.

GI bleeding can be mild, moderate or severe, and could be fatal.

Signs and Symptoms of GI Bleeding

  • Visible blood in the stool, or black, tarry-colored stool
  • Rectal bleeding
  • Hematemesis, or vomiting of blood
  • Fainting
  • Lightheadedness
  • Fatigue
  • Abdominal pain
  • Chest pain

Causes of GI Bleeding

  1. Causes of Upper GI Bleeding. Peptic ulcers on the stomach lining and small intestines are the most common reasons behind upper GI bleeding. Enlarged veins in the esophagus, known as esophageal varices, as well as esophagitis can also show symptoms of bleeding through hematemesis or black, tarry stools.
  2. Causes of Lower GI Bleeding. Diverticulitis, the formation, inflammation and infection of small and bulging pouches in the GI tract, can result to GI bleeding. Ulcerative colitis and Crohn’s disease can also lead to GI bleeding as they can cause the inflammation of colon, rectum, and GI lining. Benign or cancerous tumors can cause weakening of the digestive tract, which may lead to GI bleed. Hemorrhoids, anal fissures, and colon polyp formation can also cause bleeding.

Complications of GI Bleeding

  1. Anemia and Hypovolemia. Severe and/or chronic GI bleeding can lead to the loss of blood volume (hypovolemia) and red blood cells which contain hemoglobin and iron (anemia). If left untreated, anemia and hypovolemia can be fatal.
  2. Shock. Losing more than 20% of the blood volume due to severe GI bleeding can lead to hypovolemic shock. This can lead to significant organ failure, which includes the brain, liver, and kidneys, as well as gangrene of the limbs due to lack of blood supply.

Diagnosis of GI Bleeding

  • Stool test – inspection of stool including visible blood in it, or having a black, tarry appearance; analysis of the sample to for fecal occult blood test to determine any GI bleeding
  • Blood tests – complete blood count (CBC) may reveal a low hemoglobin count; hematinics or iron studies may show low iron levels; biochemistry, may show poor liver function and kidney function
  • Nasogastric lavage – insertion of an NG tube from the nose into the stomach in order to aspirate stomach contents and analyze them
  • Imaging – abdominal CT scan can be used to visualize the abdomen
  • Endoscopy, colonoscopy, and flexible sigmoidoscopy -– insertion of a long tube with a small camera on its end in order to visualize the GI tract
  • Capsule endoscopy – swallowing a small capsule containing a camera that takes pictures while it travels down the GI tract
  • Balloon-assisted enteroscopy – used to visualize parts of the small intestines that the doctor cannot view using endoscopy
  • Angiography – insertion of a contrast in an artery and taking X-rays to look and treat the bleeding blood vessels

Treatment for GI Bleeding

  1. Treatment during a GI diagnostic procedure. The physician may be able to remove the polyps the cause GI bleeding as he/she performs the colonoscopy. The doctor can also treat bleeding peptic ulcers while the patient undergoes endoscopy.
  2. Medications. Upper GI bleeding can benefit from PPI medications, which reduces the product of stomach acid. Antacids that do not contain aspirin are helpful in neutralizing stomach acid.  H2-receptor blockers reduce the production of stomach acid. 
  3. IV Fluids and blood transfusion. Severe or prolonged GI bleeding may cause anemia and hypovolemia. This requires intravenous fluid therapy and may also need blood transfusion to replace the lost blood volume and red blood cells.

Nursing Care Plans for GI Bleeding

  1. Nursing Diagnosis: Fluid Volume Deficit related to blood volume loss secondary to GI bleeding as evidenced by hematemesis, HB of 70, skin pallor, blood pressure level of 85/58, and lightheadedness

Desired Outcome: The patient will have an absence of GI bleeding, a hemoglobin (HB) level of over 100, blood pressure level within normal range, full level of consciousness, and normal skin color

InterventionsRationales
Assess vital signs, particularly blood pressure level.Hypovolemia due to GI bleeding may lower blood pressure levels and put the patient at risk for hypotensive episodes that lead to shock.
Commence a fluid balance chart, monitoring the input and output of the patient. Include episodes of vomiting, gastric suctioning, and other gastric losses in the I/O charting.To monitor patient’s fluid volume accurately.
Start intravenous therapy as prescribed. Electrolytes may need to be replaced intravenously.     Encourage oral fluid intake of at least 2000 mL per day if not contraindicated.To replenish the fluids and electrolytes lost from vomiting or other gastric losses, and to promote better blood circulation around the body.
Educate the patient (or guardian) on how to fill out a fluid balance chart at bedside.To help the patient or the guardian take ownership of the patient’s care, encouraging them to drink more fluids as needed, or report any changes to the nursing team. 
Administer blood transfusion as prescribed.To increase the hemoglobin level and treat anemia and hypovolemia related to GI bleeding.
Gastrointestinal Bleed Care Plan 1
  • Nursing Diagnosis: Acute Pain related to abdominal muscle spasms secondary to bleeding peptic ulcers, as evidenced by  pain score of 10 out of 10, verbalization of chest pain or heartburn after eating, guarding sign on the chest or abdomen

Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.

InterventionsRationale
Administer prescribed medications that alleviate the symptoms of heart burn/ stomach pain.Antacids that do not contain aspirin are helpful in neutralizing stomach acid. H2-receptor blockers reduce the production of stomach acid. Proton-pump inhibitors work by reducing the amount of stomach acid.  
Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.  To monitor effectiveness of medical treatment for the relief of heartburn and stomach pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.  
Teach the patient on how to perform non-pharmacological pain relief methods such as deep breathing, massage, acupressure, biofeedback, distraction, music therapy, and guided imagery.To reduce stress levels, thereby relieving the acute pain caused by bleeding ulcers.
Consider putting the patient in an “NPO” or nothing per orem/ nothing by mouth status as ordered.To allow the stomach lining to heal, and to prepare the patient for diagnostic procedure.
Prepare the patient for endoscopy.The endoscopist can diagnose and treat bleeding peptic ulcers while the patient undergoes endoscopy.
Gastrointestinal Bleed Care Plan 2

Other Nursing Diagnoses:

  • Fatigue
  • Deficient Knowledge
  • Anxiety

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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