GI Bleed Flashcards
Upper Gastrointestinal Bleeding: Esophageal Origin
chronic esophagitis-GERD, irritating medications, alcohol, cigarettes, esophageal varices
Upper Gastrointestinal Bleeding: Stomach and Duodenal Origin
Bleeding peptic ulcers caused by: NSAIDS, ASA, corticosteroids (irritate and disrupt mucosal barrier
melena
Black tarry stools, indicative of an upper GI bleed
small amounts of blood in gastric secretions
occult bleeding
Diagnostics for a GI Bleed?
- Diagnosed by Endoscopy (EGD)
- Angiography
- CBC-low H/H
- BUN-elevated
- Electrolytes-loss of electrolytes through emesis/stool
- PT-increased risk for bleeding
- Liver enzymes
- ABG - monitor resp status
- Blood type/cross match-blood type
- Occult bleeding-assess stool/emesis
- UA-looking for dehydration
Liver failure increases the risk of _________ (GI related).
esophageal varices
Why would the BUN be elevated in a GI bleed?
due to blood proteins broken down by GI tract
GI bleeds are diagnosed by?
Endoscopy (EGD)
Nursing Assessments for a GI Bleed?
- Monitor VS q15-30 min
- Emphasis on ABC’s & early identification of Shock
- Assess LOC, BP, HR, peripheral pulses and perfusion, presence or absence of neck vein distension, abdominal assessment
- Frequent Resp, CV, GI, I&O assessments
GI BLEED Treatment
- Patient is NPO
- Hydrate (Insert 2 large bore IV’s)
- Isotonic crystalloid fluids (LR)
- Blood transfusions
- Watch for fluid overload
- Monitor urine output
- IV infusion or IV push Proton Pump Inhibitor (Protonix)
1st line tx for GI bleed?
Endoscopic hemostasis - hopefully within 24hrs of the bleed
Nursing Interventions: Teaching for GI Bleed
- Smoking cessation
- Avoid alcohol, stress, OTC drugs
- Medication adherence
- S/S of upper and lower GI bleed
- Side effects of medications (ASA, NSAIDS, COUMADIN)
- Potential for bleeding even with low dose aspirin taken daily
Inflammation and breakdown of the normal gastric mucosal barrier by HCL acid and pepsin
Gastritis
Gastritis Caused by?
- Drugs-ASA, NSAIDS
- Diet-alcohol, spicy
- Microorganisms-H-Pylori
- Environmental-Smoking
- Pathophysiologic
- hiatal hernia, stress
- Other- NG tube, EGD
S/S of Acute Gastritis?
- anorexia
- N/V
- epigastric tenderness
- feelings of fullness
- hemorrhage is associated with alcohol and may be only symptom
Gastritis is diagnosed by ?
endoscopy (EGD) with biopsy
Treatment of Gastritis?
NPO, IVF, Possible NG Tube, PPI
Nursing Interventions: Teaching for Gastritis?
- diet modification (Individualize)
- Decrease alcohol intake
- Smoking cessation
- Tx H-Pylori,
Erosion of the GI mucosa from the digestive action of HCL acid and pepsin
Peptic Ulcer Disease (PUD)
Peptic Ulcer Disease (PUD) is caused by?
- H. Pylori
- alcohol
- nicotine
- stress
- ASA & NSAIDS
Manifestations of Duodenal Ulcers?
- Mid-epigastric pain may radiate to back
- Burning or cramping 2-5 hours after eating –relief obtained with antacids and food
- More common in men esp. 35 -45 age group
Manifestations Gastric Ulcers
High epigastric dyspepsia occurring 1-2 hours after eating
Food aggrevated deep ulcers
More prevalent in women & older adults
Higher mortality rate
Duodenal Ulcer Risk factors
- H. pylori
- alcohol
- smoking
- COPD
- Chronic Renal Failure
Gastric Ulcer Risk factors
H. Pylori, bile reflux, smoking, medications
Peptic Ulcer Disease is diagnosed by?
Endoscopy (EGD) with biopsy
Diagnostics for Peptic Ulcer Disease?
- Barium Contrast Study
- Lab test
- CBC
- H/H
- Similar to GI bleed if hemorrhage or perforation present
- WBC
- Liver enzymes
- Amylase
- Stool Studies
Nursing Interventions for Peptic Ulcer Disease?
- Advance diet as tolerated
- start with clear liquids
- Teach:
- Avoid foods that cause gastric distress (spicy, acidic)
- Alcohol and smoking cessation
- Side effects of OTC medications
- Drug therapy
- Decrease stress
- S/S of recurrence
Drug therapy for Peptic Ulcer Disease?
- PPI or H2 receptor blockers,
- antacids
- antibiotics if H. Pylori present
Complications of Peptic Ulcer Disease?
- Hemorrhage (most common)
- Vomiting of blood, change in VS
- Perforation (most lethal- may cause infection)
- Gastric outlet obstruction
Signs of perforation of a Peptic Ulcer?
- Sudden severe pain,
- rigid abdomen
- found with knees drawn in
- grunting respirations
Signs of a Gastric outlet obstruction with a Peptic Ucler?
N/V, abdominal distention despite having NG tube
Treatment of PUD Complications: hemorrhage?
- NPO
- IVF
- Hemorrhage (if present)
- Stop Bleeding
- Restore blood volume
Treatment of PUD Complications - Perforation (if present)?
- NPO
- IVF
- Stop bleeding
- Surgical intervention
- Restore blood volume
- Antibiotics-delay OR to get antibiotics started
Treatment of PUD Complication - Gastric outlet obstruction (if present)?
- NPO
- IVF
- NG to decompress stomach
- Fluid and electrolytes
partial removal of the lower 2/3 of the stomach
Gastrectomy
severing of the vagus nerve
Vagotomy
englargement of the pyloric sphincter
Pyloroplasty
Vagotomy
- severing of the vagus nerve
- Decreases gastric acid secretion
Gastrectomy
partial removal of the lower 2/3 of the stomach
Pyloroplasty
englargement of the pyloric sphincter
- Mid-epigastric pain may radiate to back
- Burning or cramping 2-5 hours after eating –relief obtained with antacids and food
- More common in men esp. 35 -45 age group
S/S of a duodenal ulcer
- Sudden severe pain, rigid abdomen, found with knees drawn in, grunting respirations
signs of perforation of a Peptic Ulcer
- High epigastric dyspepsia occurring 1-2 hours after eating
- Food aggrevated deep ulcers
- More prevalent in women & older adults
- Higher mortality rate
Manifestations Gastric Ulcers
