GI Bleeding Disorders

GI Bleeding Disorders – Comprehensive Nursing Notes

GI Bleeding Disorders

Comprehensive Nursing Education Notes

Osmosis-Style Medical Notes for Nursing Students
GI Tract Bleeding Sites Illustration

Figure 1: Anatomical overview of common GI bleeding sites

1. Overview & Definition

Gastrointestinal (GI) bleeding represents a critical medical emergency characterized by bleeding from any portion of the digestive tract, extending from the mouth to the anus. This condition affects approximately 300,000 hospital admissions annually in the United States, with mortality rates ranging from 2-10% depending on the underlying cause and patient comorbidities.

Clinical Pearl

GI bleeding accounts for over 300,000 hospitalizations yearly, making it one of the most common gastroenterology emergencies. Early recognition and intervention are crucial for optimal patient outcomes.

Key Statistics

  • 300,000+ annual hospitalizations
  • 2-10% mortality rate
  • Higher incidence in elderly patients
  • $2.5 billion annual healthcare cost

Nursing Priorities

  • Hemodynamic stabilization
  • Source identification
  • Blood loss monitoring
  • Complication prevention

2. Pathophysiology

Understanding the Bleeding Process

GI bleeding occurs when the integrity of the mucosal, submucosal, or vascular structures within the digestive tract is compromised, leading to blood loss into the GI lumen.

Mucosal Injury

Erosion or ulceration of protective mucosal barriers leading to exposed blood vessels

Vascular Rupture

Direct injury to blood vessels from increased pressure, trauma, or vessel wall weakness

Hemostatic Failure

Inadequate clotting mechanisms or anticoagulant effects preventing natural bleeding cessation

Memory Aid: “BLEEDING” Pathophysiology

  • Blood vessel injury
  • Loss of mucosal integrity
  • Erosion of protective barriers
  • Elevated gastric acid
  • Deficient clotting factors
  • Increased portal pressure
  • NSAID-induced damage
  • Gastric varices rupture

Physiological Response to Blood Loss

Blood Loss
Compensatory
↑HR, ↑Contractility
Vasoconstriction
Hormonal
↑ADH, ↑Aldosterone
↑Catecholamines
Hemostatic
Platelet aggregation
Clotting cascade

3. Classification & Types

GI bleeding is primarily classified based on anatomical location relative to the ligament of Treitz, which serves as the dividing line between upper and lower GI tract bleeding.

Upper GI Bleeding (UGIB)

Bleeding proximal to the ligament of Treitz

Common Causes:

  • Peptic Ulcer Disease (45%) – H. pylori, NSAIDs
  • Esophageal Varices (15%) – Portal hypertension
  • Mallory-Weiss Tear (5%) – Forceful vomiting
  • Boerhaave Syndrome – Full-thickness rupture
  • Erosive Esophagitis – GERD, medications

Clinical Presentations:

Hematemesis
Vomiting blood
Coffee Ground
Digested blood
Melena
Black, tarry stools
Hematochezia
If massive bleeding

Lower GI Bleeding (LGIB)

Bleeding distal to the ligament of Treitz

Common Causes:

  • Diverticulosis (40%) – Most common in elderly
  • Angiodysplasia (20%) – Vascular malformations
  • Colorectal Cancer (10%) – Malignant lesions
  • Inflammatory Bowel Disease – UC, Crohn’s
  • Hemorrhoids – Internal/external

Clinical Presentations:

Hematochezia
Bright red blood
Maroon Stools
Right-sided bleeding
Occult Bleeding
Chronic, hidden
Melena
If right-sided, slow

Memory Aid: “UPPER” vs “LOWER” Causes

UPPER GI – “MOVE”:
  • Mallory-Weiss tear
  • Oesophageal varices
  • Vascular lesions
  • Erosions & ulcers
LOWER GI – “DITCH”:
  • Diverticulosis
  • IBD (Inflammatory Bowel Disease)
  • Tumors/Cancer
  • Colonic angiodysplasia
  • Hemorrhoids

4. Clinical Assessment

Comprehensive nursing assessment is crucial for early detection, risk stratification, and appropriate intervention planning. The assessment must be systematic, thorough, and frequently repeated.

Critical Assessment Priority

Always assess hemodynamic stability FIRST – airway, breathing, circulation. A patient can exsanguinate rapidly with massive GI bleeding.

Primary Assessment (ABCDE Approach)

A – Airway

  • • Patent airway
  • • Risk of aspiration
  • • Hematemesis present?

B – Breathing

  • • Respiratory rate
  • • Oxygen saturation
  • • Signs of distress

C – Circulation

  • • Heart rate/rhythm
  • • Blood pressure
  • • Capillary refill

D – Disability

  • • Neurological status
  • • Glasgow Coma Scale
  • • Confusion/altered LOC

E – Exposure

  • • Temperature
  • • Skin assessment
  • • Other injuries

Hemodynamic Assessment

Class I (Mild)

  • • Blood loss: <15%
  • • HR: <100 bpm
  • • BP: Normal
  • • No orthostatic changes
  • • Normal mental status

Class II (Moderate)

  • • Blood loss: 15-30%
  • • HR: 100-120 bpm
  • • BP: Orthostatic changes
  • • Mild anxiety
  • • Delayed capillary refill

Class III-IV (Severe)

  • • Blood loss: >30%
  • • HR: >120 bpm
  • • BP: Hypotensive
  • • Altered mental status
  • • Oliguria

Focused History

Key Questions to Ask:

  • • When did bleeding start?
  • • Character of blood/stool?
  • • Associated symptoms?
  • • Previous GI bleeding episodes?
  • • Current medications?
  • • Alcohol use history?
  • • Recent trauma or procedures?

Red Flag Symptoms:

  • • Massive hematemesis
  • • Severe abdominal pain
  • • Syncope or near-syncope
  • • Severe weakness/fatigue
  • • Chest pain/dyspnea
  • • Altered mental status
  • • Signs of shock

Memory Aid: “SHOCK” Assessment

  • Skin – pale, cool, clammy
  • Heart rate – tachycardia
  • Orthostatic vital signs
  • Capillary refill – delayed >2 seconds
  • Kidney function – oliguria

5. Diagnostic Testing

Diagnostic evaluation of GI bleeding involves a systematic approach combining laboratory studies, imaging, and endoscopic procedures to identify the source, severity, and underlying cause of bleeding.

Laboratory Studies

Immediate Labs (STAT)

  • Complete Blood Count (CBC)
    • Hemoglobin/Hematocrit (may be normal initially)
    • Platelet count
    • White blood cell count
  • Basic Metabolic Panel (BMP)
    • BUN/Creatinine ratio >20:1 suggests UGIB
    • Electrolyte imbalances
  • Coagulation Studies
    • PT/INR, aPTT
    • Assess bleeding risk

Additional Studies

  • Type & Crossmatch
    • 2-4 units PRBCs for active bleeding
    • Type & screen if stable
  • Liver Function Tests
    • AST, ALT, Bilirubin
    • Albumin, Total Protein
  • Special Studies
    • H. pylori testing
    • Lactate (tissue perfusion)

Clinical Pearl: BUN/Creatinine Ratio

A BUN/Creatinine ratio >20:1 suggests upper GI bleeding due to protein digestion and absorption of blood in the small intestine. This is a valuable early diagnostic clue!

Endoscopic Procedures

Upper Endoscopy (EGD)

Indications:

  • • Hematemesis or coffee-ground emesis
  • • Melena
  • • Suspected UGIB
  • • High-risk patients

Timing:

  • • Emergent: <12 hours for high-risk
  • • Early: <24 hours for stable patients

Colonoscopy

Indications:

  • • Hematochezia
  • • Suspected LGIB
  • • After negative EGD
  • • Chronic bleeding

Preparation:

  • • Bowel preparation required
  • • May be delayed if unstable

Imaging Studies

CT Angiography

  • • Active bleeding >0.3 mL/min
  • • Non-invasive
  • • Guides intervention
  • • Shows extravasation

Tagged RBC Scan

  • • Detects bleeding >0.1 mL/min
  • • Intermittent bleeding
  • • Localizes general area
  • • Nuclear medicine study

Angiography

  • • Therapeutic intervention
  • • Embolization possible
  • • Active bleeding >0.5 mL/min
  • • Invasive procedure

Memory Aid: “TESTS” for GI Bleeding

  • Type & Crossmatch blood
  • Endoscopy (EGD/Colonoscopy)
  • Stool studies (occult blood)
  • Tissue perfusion (lactate)
  • Scans (CT, tagged RBC)

6. Nursing Interventions

Nursing interventions for GI bleeding focus on hemodynamic stabilization, monitoring for complications, supporting diagnostic procedures, and providing comprehensive patient care throughout the treatment continuum.

Priority Nursing Actions

Time is critical! Establish IV access, monitor vital signs continuously, and prepare for potential emergent interventions while maintaining calm, professional demeanor.

Immediate Interventions

Hemodynamic Stabilization

  • IV Access: Two large-bore IVs (18G or larger)
  • Fluid Resuscitation: Normal saline or LR as ordered
  • Vital Signs: Q15 minutes initially, continuous monitoring
  • Oxygen: As needed to maintain SpO2 >95%
  • Positioning: Trendelenburg if hypotensive

Monitoring & Assessment

  • Neurologic Status: LOC, confusion, agitation
  • Orthostatic Vitals: If stable enough
  • Urine Output: Foley catheter, goal >0.5 mL/kg/hr
  • Skin Assessment: Color, temperature, capillary refill
  • Bowel Sounds: Presence and character

Ongoing Nursing Care

Gastrointestinal Care

  • • NPO initially
  • • NG tube if indicated
  • • Monitor gastric output
  • • Document stool characteristics
  • • Test stools for occult blood
  • • Measure abdominal girth

Safety Measures

  • • Fall precautions
  • • Bed in low position
  • • Call light within reach
  • • Assist with ambulation
  • • Monitor for syncope
  • • Side rails up PRN

Psychosocial Support

  • • Provide reassurance
  • • Explain procedures
  • • Family communication
  • • Address anxiety
  • • Cultural considerations
  • • Spiritual support PRN

Blood Product Administration

Transfusion Guidelines

Packed Red Blood Cells (PRBCs)
  • • Target Hgb 7-9 g/dL (restrictive strategy)
  • • Higher targets for cardiac patients
  • • Pre-transfusion vital signs
  • • Two-nurse verification
  • • Monitor for reactions
Other Products
  • FFP: INR >1.5, active bleeding
  • Platelets: Count <50,000 with bleeding
  • Cryoprecipitate: Fibrinogen <100 mg/dL
  • Factor VIIa: Refractory bleeding

Procedural Support

Endoscopy Preparation

Pre-Procedure
• Consent obtained
• NPO status
• IV access
• Vitals stable
During
• Monitor vitals
• Assist physician
• Position patient
• Suction PRN
Post-Procedure
• Recovery position
• Monitor for complications
• Assess gag reflex
Discharge
• Stable vitals
• No bleeding
• Instructions given

Memory Aid: “STABILIZE” Nursing Actions

  • Start large-bore IVs
  • Take vital signs frequently
  • Assess neurologic status
  • Blood products as ordered
  • Intake and output monitoring
  • Lab values trending
  • Immobilize if unstable
  • Zero oral intake initially
  • Endoscopy preparation

7. Pharmacological Management

Pharmacological interventions play a crucial role in managing GI bleeding by reducing gastric acid production, promoting hemostasis, and treating underlying conditions. Understanding these medications and their nursing implications is essential for safe patient care.

Proton Pump Inhibitors (PPIs)

Common PPIs

  • Omeprazole (Prilosec): 40-80 mg IV/PO daily
  • Pantoprazole (Protonix): 40-80 mg IV daily
  • Esomeprazole (Nexium): 40 mg IV daily
  • Lansoprazole (Prevacid): 30 mg PO daily

Mechanism of Action

Irreversibly binds to H+/K+-ATPase pump, blocking gastric acid secretion for 24-72 hours

Nursing Considerations

  • • Administer before meals if PO
  • • IV push over 2-5 minutes
  • • Monitor for drug interactions
  • • Long-term use: B12, Mg monitoring
  • • Assess for C. diff risk
  • • Monitor bone density with long-term use

Side Effects

  • • Headache, diarrhea, nausea
  • • Increased infection risk
  • • Hypomagnesemia (long-term)

Vasoactive Medications

Octreotide (Sandostatin)

Indication: Esophageal/gastric varices bleeding

Dosing: 50 mcg IV bolus, then 50 mcg/hr infusion

Mechanism: Reduces portal pressure and splanchnic blood flow

Nursing:

  • • Monitor blood glucose (can cause hypoglycemia)
  • • Assess for bradycardia
  • • Give via central line preferred
  • • Monitor for gallbladder complications

Vasopressin (Pitressin)

Indication: Variceal bleeding (less commonly used)

Dosing: 0.3-0.4 units/min IV infusion

Mechanism: Causes splanchnic vasoconstriction

Nursing:

  • • Monitor for cardiac arrhythmias
  • • Assess for chest pain/MI
  • • Check electrolytes (hyponatremia)
  • • Often given with nitroglycerin

Hemostatic Agents

Vitamin K

  • Dose: 10 mg IV/SQ
  • Use: Warfarin reversal
  • Onset: 6-12 hours
  • Monitor: PT/INR

Prothrombin Complex

  • Dose: Weight-based
  • Use: Rapid reversal
  • Onset: Minutes
  • Risk: Thrombosis

Tranexamic Acid

  • Dose: 1g IV q8h
  • Use: Antifibrinolytic
  • Caution: Seizure risk
  • Monitor: Neuro status

H2 Receptor Antagonists

Common H2 Blockers

  • Ranitidine: Withdrawn from market
  • Famotidine (Pepcid): 20-40 mg IV/PO BID
  • Cimetidine (Tagamet): 300 mg IV q6h

Note: Less effective than PPIs for acute bleeding

Nursing Considerations

  • • Dose reduction in renal impairment
  • • Monitor for drug interactions (especially cimetidine)
  • • Less potent acid suppression than PPIs
  • • May be used as step-down therapy

Medications to Avoid or Use Cautiously

High-Risk Medications

Absolutely Avoid:

  • • NSAIDs (ibuprofen, naproxen)
  • • Aspirin (unless cardioprotective dose needed)
  • • Bisphosphonates
  • • Iron supplements (can cause GI irritation)

Use with Extreme Caution:

  • • Anticoagulants (warfarin, heparin)
  • • Antiplatelet agents (clopidogrel)
  • • Corticosteroids
  • • SSRIs (bleeding risk)

Memory Aid: “ACID STOP” Medication Management

  • Avoid NSAIDs and aspirin
  • Check anticoagulation status
  • IV PPI first-line therapy
  • Dose adjust for renal function
  • Splanchnic flow reduction (octreotide)
  • Tranexamic acid for severe bleeding
  • Octreotide for variceal bleeding
  • Prothrombotic agents PRN

8. Complications

GI bleeding can lead to numerous serious complications that require prompt recognition and intervention. Understanding these potential complications enables nurses to provide proactive monitoring and early intervention to improve patient outcomes.

Life-Threatening Complications

Hypovolemic shock, exsanguination, and aspiration pneumonia represent the most immediate threats to patient survival and require aggressive intervention.

Immediate Complications

Hypovolemic Shock

Pathophysiology: Rapid blood loss → decreased preload → reduced cardiac output

Signs & Symptoms:

  • • Tachycardia >100 bpm
  • • Hypotension <90 mmHg systolic
  • • Cool, clammy skin
  • • Altered mental status
  • • Oliguria <0.5 mL/kg/hr
  • • Weak, thready pulse

Nursing Interventions:

  • • Aggressive fluid resuscitation
  • • Blood product administration
  • • Continuous hemodynamic monitoring
  • • Prepare for ICU transfer

Aspiration Pneumonia

Risk Factors: Hematemesis, altered LOC, supine positioning

Prevention:

  • • Position patient on side if vomiting
  • • Suction airway PRN
  • • Keep HOB elevated when stable
  • • Monitor respiratory status closely

Signs of Aspiration:

  • • Coughing, choking during vomiting
  • • Decreased oxygen saturation
  • • Adventitious lung sounds
  • • Fever, leukocytosis

Rebleeding

Risk Factors

  • • Large ulcer size (>2 cm)
  • • Active bleeding at endoscopy
  • • Visible vessel or adherent clot
  • • Hemodynamic instability
  • • Advanced age
  • • Comorbidities (cirrhosis, CKD)
  • • Continued anticoagulation

Prevention Strategies

  • • High-dose PPI therapy
  • • Avoid NSAIDs and anticoagulants
  • • Endoscopic therapy as indicated
  • • Serial monitoring of Hgb/Hct
  • • Blood pressure control
  • • Treat underlying conditions

Organ System Complications

Cardiac Complications

  • Myocardial Infarction: Demand ischemia from anemia
  • Arrhythmias: Electrolyte imbalances
  • Heart Failure: Volume overload from resuscitation
  • Monitoring: Continuous telemetry, serial ECGs, troponins

Renal Complications

  • Acute Kidney Injury: Hypoperfusion, contrast exposure
  • Prerenal Azotemia: Volume depletion
  • Monitoring: Urine output, BUN/Cr, electrolytes
  • Prevention: Adequate perfusion, avoid nephrotoxins

Neurologic Complications

  • Cerebral Hypoxia: Severe anemia, hypotension
  • Stroke: Hypoperfusion, hypercoagulable state
  • Delirium: ICU stay, medications, illness
  • Assessment: Frequent neuro checks, cognition screening

Long-term Complications

Chronic Iron Deficiency Anemia

  • • Fatigue, weakness, dyspnea on exertion
  • • Restless leg syndrome, pica
  • • Reduced exercise tolerance
  • • Treatment: Iron replacement, dietary counseling

Transfusion-Related Complications

  • • Iron overload (multiple transfusions)
  • • Alloimmunization
  • • Transfusion-transmitted infections
  • • Transfusion-associated circulatory overload

Psychological Impact

  • • Anxiety about recurrent bleeding
  • • Depression from chronic illness
  • • Fear of medical procedures
  • • Impact on quality of life

Economic Burden

  • • Recurrent hospitalizations
  • • Loss of work productivity
  • • Long-term medication costs
  • • Follow-up care requirements

Clinical Pearl: Early Recognition

The key to preventing serious complications is early recognition of clinical deterioration. Trends in vital signs, laboratory values, and patient appearance are more important than single abnormal values.

Memory Aid: “COMPLICATIONS” Monitoring

  • Cardiac status (MI risk)
  • Oxygen saturation (aspiration)
  • Mental status changes
  • Pulmonary edema risk
  • Liver function (in cirrhosis)
  • Infection risk
  • Coagulation abnormalities
  • Acute kidney injury
  • Thromboembolism risk
  • Iron deficiency anemia
  • Organ hypoperfusion
  • Neurologic changes
  • Shock development

9. Patient Education

Comprehensive patient education is essential for preventing recurrent GI bleeding, promoting medication adherence, and ensuring patients recognize warning signs that require immediate medical attention. Education should be tailored to the patient’s underlying condition and risk factors.

Education Principle

Use teach-back method to ensure understanding. Ask patients to repeat key information in their own words, and provide written materials in appropriate language and literacy level.

Warning Signs to Report Immediately

🚨 CALL 911 or GO TO ER IMMEDIATELY IF YOU EXPERIENCE: 🚨

Bleeding Signs:
  • • Vomiting blood or coffee-ground material
  • • Black, tarry, or bloody stools
  • • Large amount of bright red blood in stool
  • • Sudden increase in bleeding
Serious Symptoms:
  • • Dizziness, fainting, or feeling faint
  • • Severe weakness or confusion
  • • Rapid heartbeat or chest pain
  • • Difficulty breathing

Medication Management

PPI Therapy Education

  • Timing: Take 30-60 minutes before first meal of the day
  • Consistency: Take at the same time daily, even if you feel better
  • Duration: Continue for prescribed length (often 8-12 weeks)
  • Don’t Stop: Without consulting your healthcare provider
  • Swallow Whole: Don’t crush or chew delayed-release capsules

Medications to Avoid

  • NSAIDs: Ibuprofen, naproxen, aspirin (unless prescribed)
  • Blood Thinners: Only as prescribed by your doctor
  • Herbal Supplements: Ginkgo, garlic, ginseng (increase bleeding risk)
  • Check First: Ask pharmacist about over-the-counter medications
  • Keep List: Carry list of all medications and allergies

Lifestyle Modifications

Dietary Guidelines

  • • Eat smaller, more frequent meals
  • • Avoid spicy, acidic foods if they cause symptoms
  • • Limit caffeine and carbonated beverages
  • • Stay well-hydrated
  • • Iron-rich foods if anemic
  • • Avoid very hot foods/drinks

Alcohol & Smoking

  • Alcohol: Avoid or strictly limit
  • • Increases stomach acid production
  • • Interferes with healing
  • Smoking: Quit completely
  • • Delays ulcer healing
  • • Increases bleeding risk

Stress Management

  • • Practice relaxation techniques
  • • Regular exercise as tolerated
  • • Adequate sleep (7-8 hours)
  • • Stress reduction activities
  • • Consider counseling if needed
  • • Support groups available

Follow-up Care

Scheduled Appointments

  • • Keep all follow-up appointments
  • • Primary care provider within 1-2 weeks
  • • Gastroenterologist as scheduled
  • • Blood work to monitor hemoglobin
  • • Repeat endoscopy if recommended
  • • Bring medication list to all appointments

Monitoring at Home

  • • Monitor stool color and consistency daily
  • • Watch for signs of anemia (fatigue, weakness)
  • • Track symptoms in a diary
  • • Monitor weight if instructed
  • • Check blood pressure if hypertensive
  • • Report any concerns promptly

Special Populations

Elderly Patients

  • • Higher risk for complications
  • • May need assistance with medications
  • • Fall risk due to anemia/weakness
  • • Ensure caregiver understands instructions
  • • Consider medication organization systems
  • • Home safety evaluation may be needed

Patients with Cirrhosis

  • • Strict alcohol avoidance essential
  • • Monitor for signs of liver decompensation
  • • Regular screening endoscopy needed
  • • Dietary restrictions (sodium, protein)
  • • Medication compliance crucial
  • • Vaccination updates (hepatitis A/B, pneumonia)

Memory Aid: “EDUCATE” Patient Teaching

  • Emergency signs to report
  • Drug interactions to avoid
  • Understand medication timing
  • Compliance with follow-up
  • Alcohol and smoking cessation
  • Teach-back method verification
  • Encourage questions and concerns

10. Summary & Review

GI bleeding disorders represent a critical area of nursing practice requiring comprehensive knowledge, skilled assessment, and rapid intervention. This summary consolidates key concepts for clinical application and examination preparation.

Key Takeaways

Assessment Priorities

  • • Hemodynamic stability assessment first (ABCDE)
  • • Location of bleeding determines presentation
  • • Upper GI: hematemesis, melena, coffee-ground emesis
  • • Lower GI: hematochezia, maroon stools
  • • BUN/Creatinine ratio >20:1 suggests upper GI source
  • • Orthostatic vitals indicate significant volume loss

Nursing Interventions

  • • Two large-bore IVs for fluid resuscitation
  • • Frequent vital sign monitoring
  • • NPO initially, monitor I&O
  • • Blood product administration as ordered
  • • Fall precautions due to weakness/anemia
  • • Endoscopy preparation and support

Clinical Decision-Making Framework

1. ASSESS
• Hemodynamic status
• Bleeding severity
• Source location
2. STABILIZE
• IV access
• Fluid resuscitation
• Blood products
3. INVESTIGATE
• Laboratory studies
• Endoscopy
• Imaging PRN
4. MANAGE
• Treat underlying cause
• Prevent complications
• Patient education

Common Causes by Location

Upper GI Bleeding (45% of cases)

  • 1. Peptic Ulcer Disease (45%) – H. pylori, NSAIDs
  • 2. Esophageal Varices (15%) – Portal hypertension
  • 3. Mallory-Weiss Tear (5%) – Forceful vomiting
  • 4. Erosive Esophagitis – GERD, medications
  • 5. Boerhaave Syndrome – Full thickness rupture

Lower GI Bleeding (55% of cases)

  • 1. Diverticulosis (40%) – Most common in elderly
  • 2. Angiodysplasia (20%) – Vascular malformations
  • 3. Colorectal Cancer (10%) – Malignant lesions
  • 4. Inflammatory Bowel Disease – UC, Crohn’s
  • 5. Hemorrhoids – Internal/external

Medication Pearls

First-Line Therapy

  • PPIs: Pantoprazole 40-80 mg IV daily
  • • Most effective acid suppression
  • • Promotes ulcer healing
  • • Continue 6-8 weeks minimum

Variceal Bleeding

  • Octreotide: 50 mcg bolus + infusion
  • • Reduces portal pressure
  • • Monitor blood glucose
  • • Give with endoscopic therapy

Avoid/Caution

  • NSAIDs: Absolutely contraindicated
  • Anticoagulants: Hold if bleeding
  • Aspirin: Only if cardioprotective
  • Iron: May cause GI irritation

Critical Complications to Monitor

Immediate (Hours)

  • Hypovolemic shock – Most dangerous
  • Aspiration pneumonia – Hematemesis risk
  • Cardiac ischemia – Demand from anemia
  • Rebleeding – 20% within 72 hours

Later (Days-Weeks)

  • Iron deficiency anemia – Chronic bleeding
  • Acute kidney injury – Hypoperfusion
  • Transfusion complications – Multiple units
  • Thromboembolism – Immobilization

Patient Education Essentials

Red Flag Symptoms

  • • Vomiting blood or coffee-ground material
  • • Black, tarry stools (melena)
  • • Bright red blood in stool
  • • Dizziness, fainting, weakness
  • • Chest pain, shortness of breath

Lifestyle Modifications

  • • Take PPIs as prescribed (before meals)
  • • Avoid NSAIDs completely
  • • No alcohol or smoking
  • • Keep follow-up appointments
  • • Carry medication list

Master Mnemonic: “GI BLEEDING CARE”

  • Get IV access (large bore x2)
  • Immediately assess hemodynamics
  • Blood products as ordered
  • Lab studies (CBC, coags, type & cross)
  • Endoscopy preparation
  • Educate patient on warning signs
  • Document stool characteristics
  • Input/output monitoring
  • NPO initially
  • Give PPIs as prescribed
  • Complications monitoring
  • Avoid NSAIDs
  • Rebleeding surveillance
  • Early mobilization when stable

🎯 Nursing Excellence in GI Bleeding Care

Excellence in nursing care for GI bleeding patients combines rapid assessment skills, evidence-based interventions, vigilant monitoring, and compassionate patient education.

Remember: Your prompt recognition and skilled intervention can be life-saving for patients with GI bleeding. Stay vigilant, stay informed, and never hesitate to escalate concerns!

© 2025 Comprehensive Nursing Education Notes – GI Bleeding Disorders

Evidence-based content for nursing excellence

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