GI Bleed Worksheet

Question 1

Mean Arterial Pressure,

Answer 1

average blood pressure within the arteries throughout a single cardiac cycle - an indicator of overal perfusion;

Question 2

MAP Calculation,

Answer 2

D+((S-D)/3)

Example: (D)80+((S)120-(D)80)/3) = 93.3;

Question 3

Esophageal Varices,

Answer 3

enlarged and swollen veins in the esophagus wherein blood has pooled often caused by interrupted flow to the liver via a clot or scar tissue. They can leak or burst causing potentially fatal bleeding;

Question 4

Melena,

Answer 4

dark sticky poop caused by partially digested blood;

Question 5

Hematochezia,

Answer 5

bright red blood in stool - indicating lower GI bleed between colon and anus;

Question 6

Mallory-weiss tear,

Answer 6

longitudinal tear in inner lining of esophagus caused by high pressure exertion such as that caused by forceful vomiting
violent coughing
or straining;

Question 7

Stress ulcer,

Answer 7

mucosal defect from physiologic stress such as shock
sepsis
trauma
or chronic illness

usually found in fundic mucosa as opposed to antrum and duodenum - where a peptic ulcer would be found;

Question 8

NG Tube insertion,

Answer 8

elevate HOB
measure from nose to ear lobe and then to xyphoid process - mark it
lube tube
Pt flex neck down
insert and encourage pt to swallow and small sips
secure
withdraw gastric secretions
test pH
get xray;

Question 9

KUB Xray,

Answer 9

kidneys ureters bladder
looking for calculi
size shape and position of kidneys
finds abnormalities of the urinary tract

contraindicated in pregnancy

explain and inform
NPO
administer enema on previous evening

films shot at end of expiration while holding breath for five seconds;

Question 10

Causes of upper GI bleed,

Answer 10

Ulcers
Varices
Esophageal tears
Growths
Gastritis
Gerd
Hiatal hernia;

Question 11

Causes of lower GI bleed,

Answer 11

Disease: UC DT IBS Chrohn’s Celiac
Tumors/polyps
Trauma to abd
Hemorrhoids
Anal fissures;

Question 12

Importance of Prostaglandins,

Answer 12

Regulate mucous secretion and stomach acid

protect lining

ensure blood flow to mucosa

increase and decrease motility

influence glucose and glycogen metabolism in liver

reduce absorption and induce secretion of electrolytes in jejunum and ileum;

Question 13

What medications interrupt prostaglandin synthesis,

Answer 13

NSAIDs and COX-2 inhibitors

Aspirin, Toradol, Naproxen, etc.;

Question 14

Systems to assess for GI bleed,

Answer 14

Vascular: assessing for normal temp - color - perfusion

GI: pain - med use - diet - blood in stool or vomit;

Question 15

Why fluid status important,

Answer 15

Bleeds;

Question 16

Cardiac assessments?,

Answer 16

Tachy
weak pulses;

Question 17

Med assessment importance,

Answer 17

Blood clotting issues
Ulcer issues
Liver damage issues;

Question 18

Oral mebranes assessment importance,

Answer 18

dryness due to fluid volume deficit
color change from anemia
petechiae from thrombocytopenia;

Question 19

Hemoglobin range,

Answer 19

12-17.5;

Question 20

Hematocrit range,

Answer 20

36-54;

Question 21

Platelet range,

Answer 21

150k-450k;

Question 22

BUN range,

Answer 22

5-20;

Question 23

Creatinine range,

Answer 23

0.6-1.2;

Question 24

ALT range,

Answer 24

0-45;

Question 25

AST range,

Answer 25

0-35;

Question 26

INR range,

Answer 26

<1.2;

Question 27

Blood in stool range,

Answer 27

<2-3mg/g of stool;

Question 28

Proton pump inhibitors,

Answer 28

bind proton pumps SE: N/D/HA pain gas constip B12 - bone - magnesium deficiencies;

Question 29

H2 blockers,

Answer 29

Famotidine Ranitidine Cimetidine Compete for histamine inhibit acid production SE D/HA constip fatigue pain dry mouth LIVER DMG B12 defic;

Question 30

Cytoprotective agents,

Answer 30

Sucralfate Misoprostol Reduce inflam Increase mucous and blood flow SE HOTN N/V Calcium defic;

Question 31

Antacids,

Answer 31

Aluminum Magnesium Calcium Neutralize acid Increase pH SE Decr absorp of meds constip N/V/D gas acid rebound anemia;

Question 32

Somatostatin Analogue Octreotide,

Answer 32

Sandostatin Bind to somatostatin recept Suppress GI peptides Decr GI blood flow SE D/N/V/Cstp gas pain dysrhythmias Dry Dizzy Mscl cramps weight gain Incr/Decr glucose;

Question 33

Isotonic Fluids,

Answer 33

NS 0.9% LR D5W Fluid resuscitation and replace electrolytes SE Fluid overload Incr BP Hyperglycemia;

Question 34

Priority Nursing Interventions for GI,

Answer 34

Find and correct cause Manage bleed Admin 02 Reverse anticoag NPO Hydrate Admin meds Prep for procedures;

Question 35

ABO Types,

Answer 35

A+ A- AB+ AB- B+ B- O+ O-;

Question 36

Which is the universal donor and which is the universal receiver,

Answer 36

AB+ = universal receiver has no antibodies from any blood type antigen O- = universal donor has no antigens;

Question 37

Antigens vs Antibodies,

Answer 37

Antigens are foreign substances that trigger immune system Antibodies, or immunoglobulins, recognize, bind to, and neutralize antigens;

Question 38

Rh Factor,

Answer 38

Rhesus factor is an antigen protein found on the surface of red blood cells;

Question 39

Nursing responsibilities for blood product administration,

Answer 39

~ Verify orders ~ Confirm consent ~ Pretransfusion meds 30 mins prior get products ~ Verify with another nurse (order- consent - ~ 2 pt IDs - med record # - blood type and group - expiration date - inspect blood for abnorm) ~ Baseline vitals ~ Begin slow for 15 min and observe closely ~ Recheck vitals and incr rate ~ Ensure infused w/in 4 hours ~ Observe pt Q15;

Question 40

Types of reactions during blood admin,

Answer 40

Hemolytic transfusion reaction Allergic: anaphylaxis Circulatory overload