GI Bleed Nursing Diagnosis and Nursing Care Plan

GI Bleed Nursing Care Plans Diagnosis and Interventions

GI Bleed NCLEX Review and Nursing Care Plans

Gastrointestinal Bleed also referred to as a GI bleed is a condition that involves bleeding in one or many parts of the digestive tract.

A GI bleed 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.

A GI bleed is usually suspected when there is blood in the stool.

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

Signs and Symptoms of GI Bleed

  • 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 A GI Bleed

  1. Causes of Upper GI Bleed. 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 Bleed. Diverticulitis, the formation, inflammation and infection of small and bulging pouches in the GI tract, can result in 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 A GI Bleed

  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 A GI Bleed

  • Stool test – inspection of stool, 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 Bleed

  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 Diagnosis for GI Bleed

GI Bleed Nursing Care Plan 1

Nursing Diagnosis: Fluid Volume Deficit related to blood volume loss secondary to GI bleeding as evidenced by hematemesis, 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 13, blood pressure level within normal range, alert and orientated, and normal skin color

Nursing Interventions for GI BleedRationales
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.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.

GI Bleed Nursing Care Plan 2

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.

Nursing Interventions for GI BleedRationale
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.

GI Bleed Nursing Care Plan 3

Fatigue 

Nursing Diagnosis: Fatigue related to low hemoglobin level secondary to GI bleed as evidenced by lack of energy to maintain daily physical activity.

Desired Outcomes:

  • At the end of the span of care, the patient will be able to verbalize less feeling of fatigue and be able to fully perform his or her daily tasks with ease.
  • The patient will also be able to demonstrate and apply efficient ways to conserve his or her energy to prevent further fatigue.
  • The patient will show active participation in interventions and interest when it comes to learning ways to prevent fatigue in the future.
Nursing Interventions for GI BleedRationale
1.     Take initial vital signs of the patient, most especially the blood pressure.It is important to have baseline vital signs of the patient for comparison in case there are unusualities reported. Patients diagnosed with gastrointestinal bleeding have low hemoglobin levels to which they frequently feel tired. GI bleeding will also cause the patient to have low blood pressure and place them at greater risk for hypovolemia, and if not immediately treated, may lead to shock.
2.     Know the specific cause of a patient’s fatigue.There are different causes of fatigue, but the most common underlying reason is anemia. A Patient with gastrointestinal bleeding is mostly anemic with hemoglobin levels below12.0 g/dL, and the body does not have enough oxygen delivery cells to keep up with its demands.
3.     Determine the patient’s ability to perform the daily task to assess the level of fatigue.When the patient is experiencing fatigue, they cannot perform their activities of daily living. Assessing the patient will help identify the need for further assistance in doing their activities of daily living.
4.     Help the patient create a feasible daily schedule of their task. Take some resting periods in between activities.Even though the patient feels fatigued, they still need to continue doing their tasks and activities of daily living. Assist them in making a schedule, and stress the importance of rests in between to avoid getting exhausted immediately and finish the task in a day.
5.      Teach the patient and the caregiver about energy-saving techniques, clustering of tasks, and learning to delegate work to others.There are tasks that the patient needs to do and activities that can delegate to others. Teach them to prioritize what needs to be accomplished first so that the patient will not be overwhelmed with work. Let the caregiver or a family member know that they must be there to assist the patient.
6.     Encourage the patient to need rest and sleep as they can and avoid doing any strenuous activities that might trigger fatigue.One of the best interventions for fatigue is letting the patient take enough rest and sleep since the body is still recovering and taking time to heal. It will also help the body’s red blood cells to deliver enough oxygenated blood.
7.     Advise patients to do resistance and aerobic exercises safe to perform at home. Seek consultation and approval from your attending physician before exercising at home.To slowly regain the patient’s energy, it is advised to the client to do resistance and aerobic exercises that are safe and done at home. Some studies have proven the effectiveness of a workout to combat fatigue and stress.
8.     Comply doctor’s request to have the patient monitor their hemoglobin levels every 3 months.Clients with gastrointestinal bleeding are prone to develop anemia, and the only diagnostic that can determine that is through complete blood count. The doctor might suggest the patient undergo a blood transfusion; they may do so.
9.     Refer patients to a nutritionist to ensure that the daily food and nutritional intake are achieved. Food also helps to fight fatigue through consuming energy-enriched food.Nutritionists are the best people to consult regarding the right food and nutrition. If the patient is inactive in gastrointestinal bleeding, they are advised not to eat dark-colored food to differentiate blood in the feces.
10.  Instruct the patient to avoid spicy food that might upset their stomach further.Spicy food is a known gastric irritant that upsets the gastric lining and stomach that will cause further fatigue and does not promote rest to the patient.  Instruct and advise the patient to eat only bland and non-irritant food.

GI Bleed Nursing Care Plan 4

Deficient Knowledge

 Nursing Diagnosis: Deficient Knowledge related to lack of health teachings secondary to GI bleed as evidenced by failure to have a medical check-up with an attending physician.

Desired Outcomes:

  • At the end of the span of care, the patient will be able to know and understand the different causes of gastrointestinal bleeding and its corresponding treatment available.
  • The patient will also verbalize and implement the advised therapeutic interventions for gastrointestinal bleeding. And lastly,
  • The patient will be able to do some lifestyle and diet modification to avoid or lessen the chance of the reoccurrence of gastrointestinal bleeding.
Nursing Interventions for GI BleedRationale
Assess the patient’s knowledge about gastrointestinal bleeding and its underlying causes.Gastrointestinal bleeding is a sign and symptoms in the body that means something is wrong. There are a lot of underlying causes that need medical attention.
Ask the patient when and how the GI bleeding started.Gathering pertinent information about a patient’s condition will be of great help when giving health teachings. The patient will be able to further understand their condition since they
3. Make sure the patient knows what symptoms of GI bleeding must be reported to their healthcare provider.   Identifying the signs and symptoms of gastrointestinal bleeding can improve the chances of swift treatment.  
4. Consider the available treatment options for GI bleeding, as well as the rationale for using them.     If antibiotics are used correctly, and acid-suppressing medications are used as directed, GI bleeding can heal quickly.  
5. Discuss the lifestyle changes that need to be modified to avoid further complications or bleeding.  To prevent recurrent GI bleeding development and complications during the healing phase, it is imperative to modify lifestyle behaviors such as drinking alcohol, caffeine, and overusing aspirin or other nonsteroidal anti-inflammatory drugs.  
6. GI bleeding medication must be maintained according to the prescribed regimen. Educate the patient about the risks of not adhering to doctor’s recommendations.     The treatment often lasts for a long time after being discharged from the hospital. Individuals with certain medical conditions may have to use medications for the rest of their lives, even after treatment.
7. If appropriate, the nurse may also provide information about smoking cessation or alcohol rehabilitation.   It is possible to reduce GI bleeding incidences by stopping these social habits. That is why this intervention is beneficial.  
8. Examine the current state of knowledge of the patient about GI bleeding and its management.     Knowing the patient’s baseline knowledge provides a good starting point for a teaching plan that will not overwhelm them. By doing so, the nurse will identify what topics deserve the earliest attention.
9.  Determine whether there the patient has an interest in learning more about GI bleeding.    Sudden deteriorating health conditions and hospitalization can interfere with a person’s ability to take in and process information. Timing is critical in teaching, and the nurse needs to adapt to the patient’s situation and perceptions.
10. Patient involvement in determining treatment regimens for GI bleeding should be encouraged.      Patient autonomy is enhanced by deciding on the regimen of treatment for GI bleeding.
11. Consider possible obstacles that might impede learning about GI bleeding.  A patient with a handicap or an economic disadvantage, such as an inability to read or write, may have difficulty learning. Taking this information into account can help to tailor care to an individual.  
12. Questions about GI bleeding should be encouraged by the physician.  Patients can participate in learning by asking questions. It indicates that the patient takes the material seriously and is interested in learning. Patients participate in their care by asking questions and suggesting topics to be discussed next.  
13. The patient should be informed about the severity of complications from GI bleeding.  The patient will recognize signs and symptoms of gastrointestinal bleeding and be prepared to seek treatment.

GI Bleed Nursing Care Plan 5

Anxiety

Nursing Diagnosis: Anxiety related to stress secondary to the occurrence of gastrointestinal bleeding (GI bleed) as evidenced by a verbalized feeling of helplessness about the health crisis and difficulty of concentrating.

Desired Outcome: The patient will be able to learn several ways to reduce anxiety that is brought about by gastrointestinal bleeding.

InterventionRationale
Determine whether GI bleeding is causing anxiety in the patient.   Anxiety is not readily apparent in patients who present with GI bleeding.  
Anxiety in the patient should be acknowledged. Do not invalidate the patient’s feelings and concerns about GI bleeding.   A patient’s anxiety is validated when they are acknowledged, and their condition is accepted when they are acknowledged.  
Provide the patient with a safe environment to express fears about his condition. Make the patient feel comfortable to open up.   A healthy relationship is based on open communication, which helps to reduce anxiety and stress in patients.
Do not use complicated language or lengthy statements when giving patient instructions.   In moderate to severe anxiety cases, patients may find it difficult to follow complicated or lengthy instructions. In light of this, the patient needs to be made aware of all his medications and GI bleeding risks.  
A quiet environment can help reduce sensory stimuli.             Since the patient is anxious about his condition, excessive conversations, noise, and equipment around him may trigger an anxiety attack.  
Assist patients with their emotional well-being.   Patients with GI bleeding will benefit from emotional support by feeling less stressed and more relaxed.  
Aid the patient in reducing anxiety using biofeedback, positive imagery, and behavior modification.   By learning these methods, patients can cope with anxiety due to episodes of GI bleeding in various ways.  
Keep an eye out for physical symptoms, such as tachypnea, palpitations, dizziness, headache, tingling sensations, as well as behavioral cues, such as restlessness, irritability, lack of eye contact, and combative behavior.     It is possible to perceive the level of fear the patient is experiencing. For instance, the patient may feel out of control of the situation or panic. These symptoms are, however, also related to physical conditions.
Ensure concerns are expressed verbally. Engage in active listening so that patients can convey their feelings.     It establishes the therapeutic relationship between the patient and the therapist. During counseling, the patient is assisted in coping with feelings clarifying misconceptions.
Be empathetic to the patient’s concerns and acknowledge that GI bleeding is a frightening health situation.     Validating that a patient’s usual fears can help them feel less alone when expressing their fears.
Give accurate, concrete information about what is being done, including standard procedures and sensations to expect.This intervention encourages the patient in planning their care, reducing unnecessary anxiety.
Create a calming and peaceful atmosphere for patients.    Stress can be alleviated by removing the patient from the outside world, improving their ability to cope.
Ensure to encourage the significant other (SO) to remain with the patient if they can. Be prompt when answering a call. If necessary, touch and eye contact might be employed.    This intervention reduces the fear of facing a terrifying health condition such as GI bleeding.
Allow significant others (SO) to share feelings and worries and be positive and realistic at all times.This intervention helps the significant other deal with emotions passed on to patients. Encourages a helpful attitude that aids rehabilitation.
Guided imagery and visualization are examples of relaxation techniques that can be used to help patients calm down.    It is a good idea to practice relaxation techniques to lessen worry and fear. These skills are vital to rehabilitation and prevention of recurrence because the patient with GI bleeding may have difficulties relaxing.
Assist the patient in recalling and implementing effective coping mechanisms from the past.    Reassurance and a sense of self-control can be established in dealing with the current fear by encouraging successful behaviors.
Encourage and assist the patient in evaluating their personal dietary and exercise habits.  In order to prevent a recurrence of the ulcer problem, changes may be required.  
The patient and family should be informed about the signs and symptoms of anxiety.  Patients and families can intervene sooner by recognizing anxious reactions brought about by his condition (GI bleeding).
The nurse must educate the patient on how to relieve stress and resolve certain situations or circumstances related to GI bleeding through guided visualizations, meditation, or music.    Patients could be anxious because of health issues. Thus, anxiety can be reduced with guided visualization, meditation, or music.

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. (2022). 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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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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