Nursing Diagnosis, Care Plan, and Interventions for GI Bleeding-A Student’s Guide
Introduction
Gi bleeding refers to the sudden or slow discharge of blood from anywhere in the alimentary canal or any part of the gut wall. It involves all layers from lumen to subserosa and can be subdivided into upper gastrointestinal hemorrhage and lower gastrointestinal bleeding. In this article, let’s cover the diagnosis, nursing care plan, and treatment of GI bleeding.
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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
Causes of Gastrointestinal Hemorrhage
There are several different ways that can cause a GI bleed. These vary from the upper GI or the lower Gi. Here are some of the ways that an individual can have GI bleeding:
1. Peptic ulcer disease
A peptic ulcer is a common cause of GI bleeding. This is where the lining of the stomach has sores that result from bacteria or the use of anti-inflammatory drugs. This affects the upper GI.
2. Injuries
Injuries to the gut can also lead to GI bleeding. The most common injuries result from car accidents, such as internal organ damage, risk of surgery, and use of corrosive products (such as battery acid).
3. Worm infestations
Eating undercooked meat or food contaminated with worms can cause GI bleeding in the intestine.
4. Tumor or cancer
Those that have tumors and cancers in the gut are susceptible to GI bleeding. Tumors are malignant tumors, while cancer refers to various disorders characterized by the uncontrolled growth and spread of abnormal cells. Malignancies can be primary, where the cells originate from the affected organ, or secondary, where the organ’s cells are infected or affected by other malignancies.
5. Gastric ulcer
Those with gastric ulcers are also very likely to have gi bleeding. This is due to the use of anti-inflammatory drugs such as NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) which can cause gastrointestinal bleeding. Other causes of this include aspirin or the use of alcohol in large quantities.
6. Esophagitis
Esophagitis refers to the inflammation of the esophagus, which is a part of the alimentary canal that connects the mouth and pharynx to the stomach. It can be caused as a result of excessive use of alcohol or drugs like aspirin. This infection can cause GI bleeding.
7. Esophageal varices
This is where there is the development of abnormally enlarged veins in the esophagus. This also leads to the development of GI bleeding.
8. Mallory-Weiss tears
This is also a common cause of gi bleeding. This condition occurs when there is an enlargement or tearing of the mucosal layer of the esophagus as a result of vomiting.
9. Gastrointestinal infections
GI bleeding can also occur as a result of gastrointestinal infections. GI bleeding can be caused by bacteria that attack the gut wall and destroys it, causing GI bleeding to flow out of the gut.
10. Abdominal aortic aneurysm
An abdominal aortic aneurysm is a dilation of the artery that leads from the abdomen to the heart, most commonly caused by atherosclerosis. This can lead to gi bleeding.
11. Fletcher’s disease
This is also known as chronic intestinal pseudo-obstruction. This occurs when there is decreased activity of the ileum and colon as a result of nerve damage to the bowel wall.
12. Hemorrhoids
Those that have hemorrhoids are likely to get gi bleeding. This is as a result of rupture or dilation of the hemorrhoidal veins in the anal canal and surrounding tissue, causing gi bleeding. Hemorrhoids also cause gi bleeding when they bleed excessively, giving off bright red blood from the rectum.
13. Hematochezia
Hematochezia refers to the passage of fresh blood from the rectum, resulting in bright red blood. This can be as a result of hemorrhoids and other forms of gi bleeding. This is usually chronic. Two types of hematochezia can occur in a person:
Atonic hematochezia, which is passing blood without any outside pressure.
Chronic hematochezia, where the bleeding occurs over a long period of time.
14. Hematemesis
This refers to vomiting or spitting up blood into the mouth. This form of GI bleeding can be as a result of stomach ulcers, esophagitis, etc.
15.Gastrointestinal volvulus
This occurs when there is twisting and writhing of the gut wall through obstruction or spasms. This eventually leads to death and blood flowing out from the intestine into other areas in the abdomen.
16. Hepatic portal vein thrombosis (HPVT)
This is where blood clots in the hepatic portal vein lead to obstruction of the flow of blood to the liver and can eventually cause gi bleeding. This condition occurs with chronic alcoholism.
17. Pancreatitis
Pancreatitis refers to inflammation of the pancreas, and it occurs as a result of gallstones, alcohol, or other drugs. This can cause gi bleeding.
18. Pyloric stenosis
This is where the pylorus is narrowed greatly while blood flow to the stomach is increased. This increases pressure in the pyloric sphincter and duodenum, resulting in failure of delivery to the intestines, leading to GI bleeding.
Symptoms of GI bleeding
The signs of GI bleeding will entirely depend on where the bleeding is. The signs and symptoms of GI bleeding can be different in people. These signs and symptoms include the following:
- Vomiting of blood. The blood can either be red or brown, looking like coffee ground.
- Foul-smelling, black stools.
- Dark-colored urine with clots in it. The urine can be foul-smelling at times as well.
- Pain in the abdomen, especially in the left upper quadrant area of the abdomen.
- Severe abdominal cramps usually occur on one side or the other of the abdomen area.
- Abdominal tenderness.
- Having a feeling of fainting, also known as lightheadedness
- The individual with gi bleeding may also faint.
- There may also be chest pains.
- The individual may not urinate, or when they do, they will do it infrequently in small amounts or
- The individual who is experiencing gi bleeding can also have a rapid heartbeat as well as clammy skin, pallor, and coolness of the extremities.
Complications of GI bleeding
Having blood bleed into the intestine results to very many complications. These include;
- Chronic anemia – this is due to loss of blood from fractures in the gut. The blood loss is usually slow and over a long period of time, from several months to years. This can lead to anemia.
- Compartment syndrome occurs when the bleeding causes the gut wall or the blood vessels around it to become engorged with blood and swell. This causes pressure on nerves, muscle damage, or even necrosis which eventually leads to the death of tissues. This condition can be referred to as a surgical emergency as it is life-threatening.
- Hematoma – This is when blood collects in the tissues of the abdomen and leads to swelling of the affected area. This usually causes pressure on organs such as the intestines and stomach etc. This will eventually lead to the death of the patients if they cannot be operated on for their removal.
- Cecal volvulus – this occurs when the gut twists around itself as a result of GI bleeding. This obstructs the intestine, leading to nausea and vomiting of blood or even hematochezia. Abscess formation – an abscess forms at the site where there is GI bleeding.
Steps to Follow Before Diagnosis
In order to make a nursing diagnosis of being gi bleeding, you need to follow these steps;
1. Identify your client and their problem – This includes factors affecting wellness such as situational factors, age, and gender. Also, the physiological, psychological, as well as spiritual needs of the client need identification.
2. Identify your clients’ health-related problems – These include risk factors that increase the likelihood of gi bleeding occurrences such as surgeries where blood transfusions are needed or conditions of inflammatory bowel disease where ulcers have formed and also treatment options that the health practitioner may give.
3. Identify your clients’ actual response to health-related problems. This includes recognizing and evaluating current signs, symptoms, and lab values as well as interaction with other people and social factors such as pressures at work, example.
Having carried out the above procedures, you can now identify possible diagnoses for GI bleeding.
Nursing Diagnosis of GI bleeding
The doctor usually makes this diagnosis, but if he or she gets an infection that causes GI bleeding, it can be a complex one. The health practitioner can carry out tests
1. Blood tests – This determines the presence of infection, anemia, and blood type. This can help during a blood transfusion.
2. Imaging studies – these include ultrasound scans, etc. This is when the images of the organs in the abdomen are made, and a diagnosis can be given.
3. Nasogastric lavage is a procedure where the internal organ of the stomach that is affected by GI bleeding is flushed out with saline for examination or diagnosis.
4. Stool tests are tests carried out on the patient’s stool to determine if they have harmful organisms.
5. Endoscopy – this is where a small camera called an endoscope which has magnifying lenses, is placed into the mouth, down the esophagus, and all the way through to the stomach. This helps in the diagnosis of internal organs and also GI bleeding.
Steps to Follow for Nursing Care Plan
Here are steps for the nursing care plan:
1. Keep the patient warm and comfortable. This is done to keep up their blood pressure as well as prevent shock, which can lead to death if not treated on time.
2. Administer first aid where bleeding is coming from. This includes controlling the GI bleed or applying pressure bandages on the wound to avoid blood loss that may demand blood transfusion.
3. Provide people individual with information and education. This is to help the patient understand gi bleed treatment options as well as possible complications that may arise. This is also to let them know that they can trust the nursing care plan.
4. Maintain a safe environment where necessary. This is to ensure that no further dangers are created for the patient. This can be by requesting others not to carry food or drinks that can cause gi bleeding in the patient.
5. Assist patients to participate in decisions related to health care plans. This is done by encouraging them to ask questions so that they understand their condition. You can also help them make choices when treatment options are given and make sure they know what these entail.
6. Develop therapeutic relationships with clients where required. This is to ensure that the patients feel comfortable and are open about their condition.
7. Provide health education. This is done by providing correct knowledge of gi bleeding, what causes it, and how to prevent it from happening again.
8. Discharge teaching – This is when you provide information for clients after they have been discharged home. This is done to ensure that they understand the GI bleeding treatment options as well as possible complications that may arise.
Interventions for the Treatment of GI bleeding
The initial aim of treating GI bleeding is to stop blood loss and then provide proper care for all the complications. GI intervention methods include:
1. Treatment of infection – the doctor usually prescribes antibiotics for this, and if it is a serious one, then hospitalization may be needed.
2. Control of Pain – analgesics are given and antiemetics are because GI bleeding can cause nausea and vomiting of blood.
3. Replacement therapy- this includes platelets, plasma, and even whole blood transfusions.
4. Admission, surgery, discharge plan – this is usually carried out when the patient gets admitted to the hospital after a diagnosis has been made. This involves discharging them with proper instructions on what to do if they get GI bleeding again since it can be a recurring one.
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