Saint John Colleges

Calamba, City
COLLEGE OF NURSING
CASE ABSTRACT

UPPER GASTROINTESTINAL BLEEING
Gastrointestinal (GI) bleeding refers to any bleeding that starts in the gastrointestinal tract, which extends from the mouth to the anus.
The amount of bleeding can range from nearly undetectable to acute, massive, and life threatening.
Bleeding may come from any site along the GI tract, but is often divided into:
!!er gastrointestinal bleeding: !!er GI bleeding originates in the first !art of the GI tract"the eso!hagus, stomach, or duodenum (first !art
of the intestine). Bleeding can come from ingestion of caustic !oisons or stomach cancer. #ost often, u!!er GI bleeding is caused by one of
the following:
$e!tic ulcers
Gastritis
%so!hageal varices
#allory"&eiss tears
'ower GI bleeding: The lower GI tract is located between the u!!er !art of the small intestine and the anus. The lower GI tract includes the
small and large bowels.
Gast!ointestinal Blee"ing Sym#toms
(cute gastrointestinal bleeding first will a!!ear as vomiting of blood, bloody bowel movements, or blac), tarry stools. Blood may loo) li)e *coffee
grounds.* +ym!toms associated with blood loss can include the following:
,atigue
&ea)ness
+hortness of breath
(bdominal !ain
$ale a!!earance
-omiting of blood usually originates from an u!!er GI source. Bright red or maroon stool can be from either a lower GI source or from bris)
bleeding at an u!!er GI source.
'ong"term GI bleeding may go unnoticed or may cause fatigue, anemia, blac) stools, or a !ositive test for microsco!ic blood.
LEARNING OBJECTI$ES%
.. To ac/uire more information about the condition of the !atient and the disease.
0. To have )nowledge to the client medication and be familiar to that medication.
1. To manage or to create a nursing care !lan in !atient dealing with !!er Gastrointestinal Bleeding.
RE$IE& OF ANTO'( AN P)(SIOLOG(%
Anatomy an" Physiology o* igesti+e system
The human digestive system is a com!lex series of organs and glands that !rocesses food. In order to use the food we eat, our body has to
brea) the food down into smaller molecules that it can !rocess2 it also has to excrete waste.
#ost of the digestive organs (li)e the stomach and intestines) are tube"li)e and contain the food as it ma)es its way through the body. The
digestive system is essentially a long, twisting tube that runs from the mouth to the anus, !lus a few other organs (li)e the liver and !ancreas) that
!roduce or store digestive chemicals.
T3% 4IG%+TI-% +5+T%# $678%++:
The start of the !rocess " the mouth: The digestive !rocess begins in the mouth. ,ood is !artly bro)en down by the !rocess of chewing and by
the chemical action of salivary en9ymes (these en9ymes are !roduced by the salivary glands and brea) down starches into smaller molecules).
7n the way to the stomach: the eso!hagus " (fter being chewed and swallowed, the food enters the eso!hagus. The eso!hagus is a long tube
that runs from the mouth to the stomach. It uses rhythmic, wave"li)e muscle movements (called !eristalsis) to force food from the throat into
the stomach. This muscle movement gives us the ability to eat or drin) even when we:re u!side"down.
In the stomach " The stomach is a large, sac)"li)e organ that churns the food and bathes it in a very strong acid (gastric acid). ,ood in the
stomach that is !artly digested and mixed with stomach acids is called chyme.
In the small intestine " (fter being in the stomach, food enters the duodenum, the first !art of the small intestine. It then enters the ;e;unum
and then the ileum (the final !art of the small intestine). In the small intestine, bile (!roduced in the liver and stored in the gall bladder),
!ancreatic en9ymes, and other digestive en9ymes !roduced by the inner wall of the small intestine hel! in the brea)down of food.
In the large intestine " (fter !assing through the small intestine, food !asses into the large intestine. In the large intestine, some of the water
and electrolytes (chemicals li)e sodium) are removed from the food. #any microbes (bacteria li)e Bacteroides, 'actobacillus acido!hilus,
%scherichia coli, and <lebsiella) in the large intestine hel! in the digestion !rocess. The first !art of the large intestine is called the cecum (the
a!!endix is connected to the cecum). ,ood then travels u!ward in the ascending colon. The food travels across the abdomen in the transverse
colon, goes bac) down the other side of the body in the descending colon, and then through the sigmoid colon.
The end of the !rocess " +olid waste is then stored in the rectum until it is excreted via the anus
8hronic Inflammation
Gastric gland stimulation
Increased gastric secretion
3eart burn
#ovement of stomach
acid to eso!hagus
=ausea > -omiting
with blood.
Brea)down of e!ithelial
barriers
4istruction of mucosal cell
%rosion through wall of the
stomach
Bleeding and abdominal !ain
$assage of blood in the GIT
#elena
%tiology
3"!yloric
$reci!itaing factors
"+tress
"(lcohol Inta)e
"+mo)ing
$redis!osing factors
"(ge
"Gender
"Gastritis
%so!hageal varices
"3istory of (bdomen surgery
"
PAT)OP)(SIOLOG( OF UPPER GASTROINTESTINAL BLEEING,
PART I - PATIENT ASSESS'ENT ATA BASE
)EALT) )ISTOR(
)EALT) PERCEPTION-)EALT) 'ANAGE'ENT PATTERN
I, )EALT) PERCEPTION-)EALT) 'ANAGE'ENT PATTERN
A, P!esent )ealth Stat.s
. day $T(, !atient had . e!isode of !assage of blac) stool2 no consult done, no medication.
,ew hours $T(, still . e!isode of !assage of blac) stool, accom!anied with vomiting of fresh blood hence consult and admit.
B, Past )ealth )isto!y
(ccording to !atient 1 years ago he had an o!eration on 'aguna $rovincial 3os!ital +ta. 8ru9, 'aguna. 3e undergo to the
o!eration of (nastomosis of Intestines.

Patient% Bargola,6oberto
Age% 1. years old
Se/% #ale
Nationality% ,ili!ino
Ci+il Stat.s% +ingle
Religion% 6oman 8atholic
A""!ess% Tagum!ay, Bae 'aguna
A"mission ate an" Time% #ay 0?,0@.@ A .:0@ !m
Atten"ing Physi0ian% 4r. 'agoc
iagnosis% GIB2 tBc (nemia
Chie* Com#laint% -omiting of blood and !assage of blac) stool.
B,1, Alle!gies
Ingestants "=one In;ectants C =one Inhalants " =one 8ontactants " =one
B,2, )abits
The !atient stated that he was alcohol drin)er and he smo)e.
B,3, Family )ealth )isto!y 4Genog!am5
" (ccording to the !atient, they have a history of 3$= to his father side and he stated that his father died on stro)e. (nd from
his grandmother side he stated that they have a history 4iabetes.

II NUTRITION-'ETABOLIC PATTERN
A
" The !atient was advised for the 4iet as Tolerated exce!t 4ar) colored food because this may interfere to the laboratory
test to be done to him.
III ELI'INATION PATTERN
A, Bo6el
(ccording to the !atient he had regular bowel movement, with e!isode !assage of blac) stool.
B, Bla""e!
(ccording to the !atient he urinate D"Ex daily
I$ ACTI$IT(-E7ERCISE PATTERNS
Sel*-0a!e Ability
II F ,eeding IIF Toileting IIF 4ressing
IIF Bathing IIF Bed #obility IIF Grooming
Legen",unctional 'evel 8ode
7",ull self"care
I"6e/uires use of e/ui!ment or device
II"6e/uires assistance or su!ervision from another !erson
III"6e/uires assistance or su!ervision from another !erson and e/ui!ment or device
I-"Is de!endent and does not !artici!ate
$ SLEEP-REST PATTERN
"The !atientGs usual slee!ing time is between E !m to H !m. 3is rising time is ? am.
$I COGNITI$E-PERCEPTION PATTERN
(. 3earing C no !roblem
B. -ision " no !roblem
8. +ensory !erce!tion " no !roblem
PART II - P)(SICAL E7A'INATION
GENERAL SUR$E(
I, $ITAL SIGNS
A( 1
Tem!erature 1D.?I 8
$ulseB8ardiac rate D? b!m
6es!iratory rate .E c!m
Blood !ressure .@@BJ@ mm3g
II INTEGU'ENT
(. +)in: !ale in color, smooth, no abnormalities
B.=ails: !ale nail bed with !oor ca!illary refill
8.3air : %venly distributed, blac) in color, no abnormalities
III )EENT
)ea" +i9e: normoce!haly +ha!e: round, symmetrical
Eyes 8olor"sclera ((necteric), con;unctiva (!ale) $u!il 6es!onse"$%66'(
Ea!s +ymmetry"symmetrical 4ischargeBgrowth"none
Nose #ucosal 8ondition"moist 4ischargeBGrowth: none
'o.th8Th!oat8#ha!yn/8teeth 40olo!8lesions8smoothness8#!esen0e o* 0a+ity5 " red dry li!s, no lesions, no swelling
,a0e symmetrical
I$ NEC98L('P) NOES
(. G!o6th% none
B. Lo0ation% none
$ PUL'ONAR( (breath sound)
=ormal sound(bronchial sounds u!on auscultation)
$I CARIO$ASCULAR
6ate: D? b!m
$II PERIP)ERAL8$ASCULAR
Pe!i#he!al P.lses
Grade K Tem!oral Legen"% $eri!heral $ulse +cale
Grade K 8arotid @ " absent
Grade K Bronchial . C mar)edly diminished
Grade K 6adial 0 C moderately diminished
Grade K ,emoral 1 C slightly diminished
Grade K !o!liteal K C normal
Grade K $osterior Tibialis
Grade K 4orsalis $edis
$III ABO'EN
a, gene!al 0onto.! " symmetrical
b, tenderness on the e!igastric region with midline scar due to !revious o!eration.
I7 'USCULO-S9ELETAL8E7TRI'ITIES
a5 STRENGT)% wea) muscle strength
b5 RO'% limited
7 NEUROLOGIC
a. 'ental stat.s4LOC5a00o!"ing to glas0o6 0oma s0ale% .?"alert
GCS
L%ye o!en C K
L -erbal res!onse C ?
L #otor 6es!onse C D
b. P.#ils
1 (mm)
c. ee# ten"on !e*le/es
0 C =ormal
PART III - LABORATOR(8IAGNOSTIC STUIES
Name% Bargola, 6oberto ate: #ay 0J,0@.@
&a!"% #ale ward Physi0ian% 4r. 'agoc
Se/% #ale
)E'ATOLOG(
B. '(B76(T765 %M(#I=I%+ 6%+'T =76#(' -('%+ I=T%6$6%T(TI7=
3%#7G'7BI=
J1
( #('% C .1@".E@ gBdl)
( ,%#('%N.0@".D@ gBdl) 4ecrease due to internal
bleeding.
3%#(T786IT @.00 ( #('% C @.K@"@.?K gBdl)
( ,%#('% C @.1J"@.KJ gBdl ) 4ecrease due to internal
bleeding.
T7T(' &B8 .0.K ?".@x.@ HB' Increase due to !resence of
infection and inflammation.
4ifferent count
=%T67$3I'+ @.DJ @.?."@.DJ
%7+I=7$3I'+ @.@."@.@K
'5#$3785T%+ @.11 @.0."@.1?
B(+7$3I'+ @.@@"@.@.
$latelet count .?@"K?@x.@"HB'
Blood ty!e (O
Name% Bargola, 6oberto ate: #ay 0J,0@.@
&a!"% #ale ward Physi0ian% 4r. 'agoc
Se/% #ale
BLOO C)E'ISTR(
T%+T 6%+'T =76#(' -('% I=T6%$6%T(TI7=
,B+ =.- J@"..0@ mgBdl
837'%+T%67' =.- #"..H"0E. mgB'
,"..?"0E? mgB'
86%(TI=I=% @.? =.- @.?"..J mgBdl =ormal
B= .J =.- E"0? mgBdl =ormal
6I8 (8I4 =.- #"1.D"J.J r mgB'
,"0.?"D.E r mgB'
T6IG'58%6I4%+ =.- 1D".D? mgB'
+G7T =.- .@"K IB'
+G$T =.- @"KJ IB'
PART I$ : NURSING CARE PLAN
8ues =ursing 4x $lanning Intervention 6ationale %valuation
+ub;ective
P<ulay itim !a din
ang dumi )o at
nagsusu)a, a)o ng
dugo Qas verbali9ed
by the !atient.
7b;ective
8onscious and
8oherent.
(O) hematemesis
(O) melena
&ea) and !ale
loo)ing.
$ale con;unctiva
and s)in noted
8 abdominal
midline scar
%levated
hematocrit and
hemoglobin.
,luid -olume
4eficit related
to internal
bleeding as
evidenced by
hematemesis
melena.
(fter nursing
interventions, the
!atient will
verbali9e
understanding of
causative factors
and !ur!ose of
individual
thera!eutic
interventions and
medications.
-B+ ta)en and
recorded.
(dvise the !atient
to avoid dar)
colored food.
#onitor active
fluid loss from
bleeding, and
vomiting2 maintain
accurate in!ut and
out!ut.
#onitor
elevated
hemoglobin and
elevated blood urea
nitrogen (B=)
suggest fluid
deficit.
(dminister
blood !roducts as
!rescribed.
To )now
the baseline
data
To !revent
to enterfere
the result of
color of the
stool.
To chec)
the amount of
fluid loss.
'ow level of
hmt and hgb
inter!ret the
amount blood
loss..
To re!lace the
blood loss.
These may be
re/uired for
active GI
bleeding.
(fter nursing
interventions
the !atient
verbali9es
understanding
of causative
factors and
!ur!ose of
thera!eutic
interventions.
'EICATIONS
GENERIC NA'E INICATION ACTION
CONTRAINICA
TION
PRECAUTION8
A$ERSE
REACTION
NURSING
CONSIERATION
#%T78'7$6(#I4%
B6(=4 =(#%
8o!ra, %mex, #axeran,
#axolon, 6eglan.
47+(G%
(dult .@mg 1xBday
!edia: .?"0@yrs ?".@mg
1xBday
?".Kyrs: 0.?"?mg 1xBday
1"Kyrs: 1mg 0"1xBday
."0yrs: .mg 0"1xBday
nder . yr: .mg 0xBday
Gastrointestina
l motility,
nausea,
vomiting of
central and
!eri!heral
origin assoc.
with surgery
CLASSIFICA
TIONS%
G(T67I=T%+
TI=('
(G%=T2$67
<I=%TI8
(G%=T (GI
+timulant5,
4o!amine
antagonist that
acts by
increasing
rece!tor
sensitivity and
res!onse of
u!!er GIT
tissues to
acetylcholine
GI hemorrhage,
e!ile!tics,
hy!ersensitivity,
lactation, !ts. &ith
breast cancer
$6%8(TI7=:
(ctivities
re/uiring mental
alertness, elderly,
lactation
(4-%6+% 6M=
6estlessness,
drowsiness,
fatigue, insomnia,
headache,
di99iness, nausea
Rgive 1@ mins before
meals and at bed time
R assess mental status
during treatment
Rtell !t. To avoid driving
> other ha9ardous
activities for at least 0 hrs
Radvice !t. to avoid
alcohol and other 8=+
de!ressant that enhance
sedating !ro!erties of this
drug
GENERIC NA'E ACTIONS USES CONTRAINICATIONS NURSING
RESPONSIBILITIES
7#%$6(S7'%
B6(=4 =(#%:
'osec
8'(++I,I8(TI7=:
Gastrointestinal (gent
6oute and 4osage:
(dult: $7 0@ mg onceBday
for K"E wee).
(n antisecretory
com!ound that is a gastric
acid !um! inhibitor.
+u!!resses gastric acid
secretion by inhibiting the
3O, <O (T!hase en9yme
system in !arietal cells.
4uodenal and gastric ulcer.
Gastroeso!hageal reflux
disease including severe
erosive eso!hagitis (K"E
w) treatment). 'ong term
treatment of !athologic
hy!ersecretory conditions
such as Sollinger" %llison
syndrome, multi!le
endocrine adenomas and
systemic mastocytosis. In
combination with
clarithromycin to treat
duodenal ulcers associated
with 3"!ylori.
'ong term use for
gastroeso!hageal reflux
disease( G64) duodenal
ulcers, !roton !um!
inhibitors, hy!ersensitivity
children T0 years2 use of
7T8 formulation in
children T.Ey or GI
bleeding, !regnancy
(category 8)2 use of
Segirid in metabolic
al)alosis2 hy!ocalcemia,
vomiting, GI bleeding.
8hec) for doctorGs order
0. $erform (=+T !rior to
admission
1. +hould not be given if
!ositive s)in test
K. +low I- !ush
?. Inform the !atient about
the
!ossible side effect of the
drug
D. (dvise !atient to re!ort
any
discomfort on the I-
insertion
site
J. $rovide safet
GENERIC NA'E ACTIONS SIE EFFECTS CONTRAINICATIONS NURSING
RESPONSIBILITIES
87"(#7MI8'(-
B6(=4 =(#%:
(moxicillin"
clavulanate
8'(++I,I8(TI7=:
antibiotic
6oute and 4osage:
sual adult dose: 1J?mg C
D0?mg orally or ..0g iv
three times a day
8ombination antibiotic
containing amoxicillin
trihydrate, a U"lactam
antibiotic, with
!otassium clavulanate, a
U"lactamase inhibitor.
This combination results
in an antibiotic with an
increased s!ectrum of
action and restored
efficacy against
amoxicillin"resistant
bacteria that !roduce U"
lactamase.
.
(mongst the !ossible side"
effects of this medication
are diarrhea, vomiting,
thrush, and a few other
conditions. These do not
usually re/uire medical
attention. 3owever, if the
!atient ex!eriences an
allergic reaction to the
medication, ;aundice,
fever, or severe diarrhea, it
is necessary to contact a
doctor immediately. (s
with all antimicrobial
agents,
!seudomembranous colitis
has been associated with
the use of amoxicillin"
clavulanate. (moxicillin is
a member of the !enicillin
family of antibiotics, and
therefore should not be
ta)en by !atients allergic
to !enicillin.
8o"amoxiclav is
contraindicated in !atients
with a history of allergic
reactions to any !enicillin.
It is also contraindicated in
!atients with a !revious
history of amoxicillin"
!otassium clavulanate"
associated cholestatic
;aundiceB he!atic
dysfunction.
L7btains !atientGs
history of allergy
Lassess !atient for sings
and
sym!toms of infection
wound characteristics,
s!utum, urine stool, fever
and &B8 count
Lassess for allergic
reactions during treatment
rash, uritcaria, !ruritus,
chills, fever, ;oint !ains
L#onitor for signs of
ne!hrotoxocity: urine
casts,
oliguria, !roteinuria,
increased B=, and
creatinine
Lassess bowel !atterns2
bloody diarrhea,
cram!ing, !ossible
!seudomembranous
colitis
GENERIC NA'E ACTIONS USES INICATIONS NURSING
RESPONSIBILITIES
T6(=%M(#I8 (8I4
B6(=4 =(#%:
anexamic a0i"
8y)lo)a!ron, 'ysteda
8'(++I,I8(TI7=:
antifibrinolytic agent
6oute and 4osage:
+olution Intravenous
?@@mg /D.
Tranexamic acid
com!etitively inhibits
activation of !lasminogen
(via binding to the )ringle
domain), thereby reducing
conversion of !lasminogen
to !lasmin (fibrinolysin),
an en9yme that degrades
fibrin clots, fibrinogen, and
other !lasma !roteins,
including the !rocoagulant
factors - and -III.
Tranexamic acid also
directly inhibits !lasmin
activity, but higher doses
are re/uired than are
needed to reduce !lasmin
formation.
Tranexamic acid in;ection
is used to control or
!revent excessive or heavy
bleeding during dental
!rocedures in !atients with
hemo!hilia. tranexamic
acid is for short"term use
only, usually 0 to E days.
,or use in !atients with
hemo!hilia for short term
use (two to eight days) to
reduce or !revent
hemorrhage and reduce the
need for re!lacement
thera!y during and
following tooth extraction.
L8hec) for doctorGs order
L. $erform (=+T !rior to
admission
L +hould not be given if
!ositive s)in test
L +low I- !ush
L Inform the !atient about
the
!ossible side effect of the
drug
L (dvise !atient to re!ort
any
discomfort on the I-
insertion
site
L$rovide safety
St, John Colleges
Calamba City
COLLEGE OF NURSING
CASE STU( OF PATIENT &IT)
UPPER GASTROINTESTINAL BLEEING 4UGIB5
SUB'ITTE B(%
#(65 (== G. G(68I(
B+="III
SUB'ITTE TO%
#rs. (urea Tyella -illalu9 , 6=
ATE: #(5 0@.@