GI bleeds Flashcards
where should we be checking for upper GI bleeds
- esophagus, stomach, and duodenum
where do we check for lower GI bleed
- jejunum, large intestine, rectum
what are causes of upper GI bleeds
- peptic ulcer
- erosive esophagitis
- varices
- mallory-weiss syndrome
- cancers
what is peptic ulcer disease (PUD)
- eurosive GI mucosa resulting from digestive action of HCl and pepsin
chronic esophagitis (affects esophagus)
- alcohol, smoking, or GERD causing irritation of the esophageal wall
mallory-weiss tear (affects esophagus)
- severe retching and vomiting that leads to tearing of the esophageal wall
esophageal varices (affects esophagus)
- secondary to liver cirrhosis
- they are enlarged veins in the esophagus
what causes bleeds in stomach and duodenal
- medications (ASA, ibuprofen, corticosteroids), alcohol, GERD
what are behvaioral issues that can cause mallory weiss tears
- chronic alcoholism
- bulimia nervosa
- anorexia nervosa
pathological issues that can cause mallory-weiss syndrome
- GERD
- hiatal henia
- chemo
what history can we collect to source the bleeding
- PUD (history of H. pylori infection, NSIAD use, antithrombotic use)
- history of liver disease, alcohol use
what are patient histories that will impact treatment for upper GI bleeds
- anemia (heart pulmonary disease)
- fluid overload (HF)
- coagulopathies, thrombocytopenia
- meds (NSAIDS, anticoagulants, antiplatelets)
-blood transfusions
symptoms of Upper GI bleeds
- nausea, vomitting, weight loss, thrist, diarrhea, black tarry stools, decreased UO, weakness, abd pain
cardiovascular signs for upper GI bleeds
- tachy, weak pulse, ortho hypotension, slow cap refill
symptoms for severe bleedign for upper GI
- ortho lightheadedness
- confusion
- angina
- severe palpitations
- cold/clammy extremities
whats a big risk factor that can occur with severe GI bleeds
- hypovolemic shock
what laboratory tests need to be done for upper GI bleeds
- CBC (hgb)
- prothrombin time
- renal profile (increased BUN, UGIB)
- liver profile (increased AST, ALT)
- ECG
- troponins (increased)
- know blood type
- get vomit and stool sample
diagnostic tests for upper GI bleeds
- endoscopy (into mouth)
- colonoscopy (in rectum)
what should nurses do when GI bleed is being figured out or is found (7)
- monitor ABCs
- vitals/perfusion status
- keep patient NPO
- ensure IV lines 16 gauge
- oxygen >94%
- treat hypotesnion (bolus infusion crystalloids)
- blood transfusion 1:1:1 ratio of RBCs, plasma, platelets
pharmacological management of GI bleed
- histamine 2 receptor blockers (zantac)
- proton pump inhibitors (pantoprazole)
- antacids
- antibiotic therapy (treat H. pylori)
what do histamine receptors do (zantac)
- decrease HCl production
what is acute pancreatitis
- acute inflammation of the pancreas
- auto digestion causes necrosis of endocrine and exocrine cells
what are causes of acute pancreatitis
- gallbladder gallstones
- alcohol
interstitial pancreatitis
- mild inflammatory response
- most common cause is gall stone and alcohol
- quick onset and easy recovery
necrotizing pancreatitis
- life threatening muiltisystem disease
- necrosis
- infection/sepsis
- ICU and long term hospitalization
- high mortality rate
signs and symptoms of acute pancreatitis
- sudden onset
- pain radiates to back and is epigastric pain - wprse when laying down
- nausea/vomting
- decreased bowel sounds
- bruising bewteen last rib and ileac crest or umbilicus
what happens to cardiac and respiratory during acute pacreatitis
- vasodilation, hypotension
- tachycardic
- bronchoconstriction
what lab results will we see with someone who has acute pancreatitis
- hyperglycemic
- serum amylase decreases
- serum lipase elevated
- US or CT abd
- ERCP (endoscopic retrograde)
nursing care for acute pancreatitis
- rest pancreas
- pain management
- monitor for potenitial complications (AKI (volume depletion), resp distress (edema), infection)
treatment for pancreatitis
maintian NPO
- IV hydration
- NG suction
- monitor BS
- nutrition
- pain managment (no morphine!!)
what can cause acute liver failure
- primary disease process (virus, autoimmune, alcohol, drugs, hepatitis)
- chronic liver disease, cirrhosis
- MOD (shock)
labs for acute liver failure
- coagulation greater than 1.5
- altered mental state
- encaphalopathy
- illness
complications that can arise with liver failure (6)
- hepatic encephalopathy (brain)
- portal hypotension
- ensophageal varices
- ascites
- hepatorenal syndrome
- infections
how do rupture varices occur
- coughing, vomiting, straining
- bleeding will be a medical emergency
what are signs and symptoms with acute liver failure (5)
- cardio: pulmonary edema, hypotension
- GI: nausea/vomitting, diarrhea, anorexia, ascites, hypoglycemia, abdominal pain
- Hematologic: coagulation failed (bleeding)
- pulmonary: tachypnea, crackles
- integument: spider angioma, jaundice, edema
how to manage hepatic encephalopathy
- enema or laxative to have bowel movement
- helps remove urea ammonia
ascites management for liver failure
- diuretics
- sodium restriction
- paracentisis
hypoglycemia management for liver failure
- monitor signs
- administer IV dextrose
metabolic abnormalities management
- monitor and treat electrolyte imbalances
how to manage gastrointestinal hemorrhage
- vitamin K
- oral antacids
- frozen plasma, platelets
management for cerebral edema
- monitor ICP
- administer IV mannitol
- elevate head of bed
