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NURS 3512 - Class 1-6 > Week 5 - Upper GI Bleed > Flashcards

Week 5 - Upper GI Bleed Flashcards

1
Q

where can an upper GI bleed occur (3)

A
  • esophagus
  • stomach
  • duodenum
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2
Q

what can cause upper GI bleeds (2)

A
  • drugs

- systemic diseases

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3
Q

what kind of drugs can cause upper Gi bleeding (3)

A
  • NSAIDs
  • salicylates
  • corticosteroids
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4
Q

what are some causes of an esophageal upper GI bleed (3)

A
  • esophageal varices
  • esophagitis
  • mallory-weiss tear (often d/t chronic vomitting)
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5
Q

what are some causes of stomach & duodenum upper GI bleeds (5)

A
  • gastric cancer
  • hemorrhagic gastritis
  • peptic ulcer disease
  • polyps
  • stress ulcer
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6
Q

what are some systemic diseases that can cause upper GI bleeds (3)

A
  • blood dyscrasias
  • renal failure
  • liver failure
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7
Q

what are signs of an upper GI bleed (3)

A
  • emesis –> coffee ground or hematemesis
  • melena
  • abdominal pain
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8
Q

what can an upper GI bleed lead to

A
  • shock (esp. if dont replace fluids quickly)
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9
Q

what is hematemesis

A
  • vomitting of bright red blood
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10
Q

what does hematemesis indicate

A
  • the blood has not come in contact with the stomach’s acid secretions
    = bleed above stomach
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11
Q

what is coffee ground emesis

A
  • vomiting of dark brown, granular material that resembles coffee grounds
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12
Q

what does coffee ground emesis indicate

A
  • the blood has been in contact with the stomach and has changed by contact with gastric secretions
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13
Q

what is melena

A
  • black, tarry stools
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14
Q

what does melena indicate

A
  • slow bleeding from an upper GI source

- the longer the passage of blood thru the intestines = more darker as result of degradation of hgb

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15
Q

what can be used to diagnose an upper GI bleed (2)

A
  • endoscopic procedures to identify sources of bleeding thru direct visualization
  • angiography if endoscopy cant be done

barium studies not super helpful in indentifying bleeding sites during acute phase

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16
Q

what is important to note when completing emergency assessment and management of upper GI bleed (3)

A
  • most stop spontaneously
  • cause must be identified and treatment initiated immediately
  • complete history imp to discover cause, but defer til after emergency care is implemented
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17
Q

what interventions are used to stabilize a pt with an upper GI bleed (12)

A
  • treat like and look for S&S of hypovolemia shock
  • calm approach
  • frequent VS (BP, pulse) q 15-30 min
  • O2 & resp assessment
  • establish 2 Ivs
  • IV fluids & monitor for fluid overload
  • monitor I&O, urine output
  • monitor stool & emesis
  • lab work (electrolytes may be imbalanced)
  • monitor peripheral perfusion & cap refill
  • abdomen assessment: rigidity (peritonitis or perforation)
  • monitor hct & hgb q 4-6h
18
Q

what are 3 different categories of collaborative care for an upper GI bleed

A
  • endoscopic therapy (primary treatment procedure)
  • surgical
  • drug
19
Q

what is the goal of endoscopic hemostasis

A
  • identify and stop the bleeding
20
Q

what are 3 different endoscopic methods used for upper GI bleeds

A
  • sclerosing needles
  • endoclips
  • electrocoagulation probes
21
Q

describe what and how sclerosing needles work

A
  • sclerosing needles passed thru endoscope

- then meds (ex. epi) or glue are injected to stop the bleeding

22
Q

describe how endoclips work

A
  • endoclips passed thru endoscope

- then used to clamp off the bleeding area

23
Q

describe how electrocoagulation probes work

A
  • heat of the probe coagulates the tissue directly on the bleeding site
24
Q

when is surgical intervention indicated

A
  • if bleeding continues regardless of therapy provided

- and the site of bleeding has been identified

25
Q

in the acute phase, drugs are used to…

A
  • decreasing bleeding
  • decrease HCl secretion
  • neutralize HCl
26
Q

drugs to decrease bleeding are administered how?

A
  • endoscopically
27
Q

list some meds used for treatment of upper GI bleed (5)

A
  • octreotide (sandostatin)
  • vasopressin
  • antacids
  • PPIs
  • H2 receptor blockers
28
Q

what does vasopressin do

A
  • produces vasoconstriction
29
Q

what is important to monitor/consider w vasopressin

A
  • constricts other vessels
    = risk of decreased myocardial contractility, decreased coronary blood flow, can cause myocardial, peripheral, visceral ischemia
30
Q

why is it helpful to reduce acid secretion in treatment of an upper GI bleed

A
  • the acidic enviro can alter platelet function & interfer w clot stabilization
31
Q

what do H2R blockers do

A
  • inhibit action of histamine at H2 receptors on parietal cells & decrease acid secretion
32
Q

what is are 2 examples of a type of H2R blockers

A
  • ranitifine (zantac)

- famotidine (pepsid)

33
Q

what are PPIs

A
  • proton pump inhibitors

- inhibit cellular pump which is imp for acid secretion

34
Q

what is an example of a type of PPI

A
  • omeprazole (Losec)
35
Q

what do anatacids do

A
  • neutralize HCl & increase pH of gastric contents
36
Q

what is an example of an antacid

A
  • aluminum hydroxide (amphogel)
37
Q

what is octreotide (sandostatin)

A
  • somatostatin anolgue

- reduces blood flow and acid secretion

38
Q

list imp pt teaching to a pt with /after an upper GI bleed (4)

A
  • note: pt who has had one bleeding episode is likely to have another*
  • avoid gastric irritants
  • decrease stress-inducing situations
  • caution w OTC meds (may contain ASA, etc.)
  • if pt on ulcerogenic drugs, educate of potential adverse effects these have on GI mucosa
39
Q

what are some examples of gastric irritants to avoid in a pt with upper GI bleed (2)

A
  • smoking

- alcohol

40
Q

what type of meds should you use caution in administering to a pt with upper GI bleed? why>

A
  • sedatives

- restlessness is a warning sign of shock, so these meds can mask that

NURS 3512 - Class 1-6 (47 decks)

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