Nursing care for the patient with a GI bleed is an essential part of their overall treatment plan. GI bleeds can range from mild to severe and require specialized knowledge to properly manage and monitor. As a nurse, it’s important to understand the cause of the bleeding, the approaches used to treat it, and how you can provide quality care throughout your hospitalization or clinic visit.
In this blog post, we’ll discuss everything you need to know about managing patients with GI bleeds while emphasizing respect for their dignity. At the end of this article, you will have gained insight into best-practice protocols so that you too can become comfortable in providing nursing care of patients with GI bleeds.
Table of Contents
What is a GI Bleed?
A GI (Gastrointestinal) bleed is defined as any bleeding that occurs in the digestive tract. Most commonly, it’s caused by peptic ulcers, varicose veins in the esophagus, diverticulosis or diverticulitis, or a ruptured ectopic pregnancy. Other causes may include trauma to the digestive tract and tumors like gastric cancer.
Signs and symptoms of GI bleeds vary depending on the cause and location of the bleed. Common signs and symptoms include:
- Vomiting blood
- Black, tarry stools (usually associated with upper GI bleeds)
- Rectal bleeding (associated with lower GI bleeds)
- Abdominal pain
What is the Classification of GI Bleeding?
GI Bleeding is typically divided into two main types:
Upper Gastrointestinal Bleeding
When we talk about upper GI bleeds, we’re referring to bleeding in the esophagus, stomach, or duodenum. Common causes of upper GI bleeds include peptic ulcers, varicose veins in the esophagus (esophageal varices), and Mallory-Weiss tears.
Lower Gastrointestinal Bleeding
Lower GI bleeds occur in the small intestine, large intestine (colon), and rectum. Common causes of lower GI bleeds include diverticulitis, inflammatory bowel disease (Crohn’s or ulcerative colitis), and cancer.
Upper GI bleeding originates in the esophagus, stomach, or duodenum. Lower GI bleeding (also called lower gastrointestinal hemorrhage) begins after the first part of the small intestine and includes any bleeding that occurs in the rectum or anus.
Note– An upper GI bleed is much more common than a lower GI bleed, occurring in 50 to 150 cases per 100,000 adults annually. Comparatively, a lower GI bleed only happens in 20 to 30 out of every 100,000 people per year. This amounts to approximately 300,000 hospital admissions within the United States alone each year.
What are the Two Types of GI bleeding?
The two main types of GI bleeds are active and occult.
Active: Active bleeding is characterized by signs such as bright red blood in the stool or vomit, severe abdominal pain, and dizziness.
Occult: Occult bleeding is less noticeable and may not be accompanied by symptoms. It can be detected through a stool test or other tests ordered by the doctor.
Forms of Blood During GI Bleeding
The blood from your patient’s GI bleed will typically present in one of three forms:
• Melena: this is a black, tarry, foul-smelling stool. It usually indicates upper GI bleeding such as from a peptic ulcer.
• Hematochezia: this is bright red blood in the stool, which typically indicates lower GI bleeding from the colon or rectum.
• Hematemesis: this is when your patient vomits blood, which is usually an indication of upper GI bleeding.
Diagnosing a GI Bleed
The doctor will use a variety of tests to diagnose the cause of the GI bleed. These tests include:
- Abdominal x-ray
- Stool test to detect blood in the stool.
Treatment of a GI Bleed
Treatment for a GI bleed depends on the cause and severity of the bleed. Milder cases may be treated with medications to reduce the risk of further bleeding and repair any damaged tissues, while more severe cases may require surgery. Common medications used to treat GI bleed include:
- Proton pump inhibitors (PPIs),
- H2-receptor blockers,
Nursing Interventions for Gastrointestinal Bleeding:
Nursing interventions must be individualized and tailored to the patient’s specific needs. Here are some of the main nursing interventions for GI bleeds:
Nursing Diagnosis For GI Bleed
Gi bleeds nursing diagnosis involves the identification of the patient’s physical symptoms, medical history, and laboratory tests. The diagnosis is essential for developing an effective treatment plan, which may include blood transfusions, surgery, or medications to stop the bleeding. Then perform the following procedure:
Monitor Hemoglobin (HGB)
Hemoglobin (Hbg), an iron-containing compound, is the main protein in Red Blood Cells (RBCs). It helps to transport oxygen and carbon dioxide (CO2) throughout the body. Generally speaking, a hemoglobin level below 8 warrants a blood transfusion.
Check Heart Rate & Blood Pressure
When the heart’s fluid levels drop, it will beat faster whilst your pressure gets lower. If BP drops too much, blood is diverted to vital organs. In this instance, reverse Trendelenburg positioning, fluids, and physician assistance are required. Monitor the patient’s heart rhythm for any irregularities while replenishing their cardiovascular system with fluids.
Administer Blood Products
This necessitates a blood match, based on ABO compatibility and Rh factor. It is important to double-check the blood product before administering it to the patient.
Vital Signs Every
Monitor vitals regularly and administer pantoprazole (Protonix) – a proton pump inhibitor (PPI) that reduces acid in the GI lining – which can help reduce ulceration, a potential cause of gastrointestinal bleeding. If this does not stop the bleeding, surgical intervention may be necessary. Also note any anticoagulants taken by the patient (e.g. warfarin, aspirin, heparin).
12 Lead ECG
A 12 lead ECG provides insight into how low blood levels are affecting heart functioning.
Assess GI Bleeding
If present, the provider will use a gloved finger to check for feces in the rectum. The feces is then placed on a hemoccult card which will turn blue if there is blood present. Ask the patient whether they have noticed black/tarry (upper GI bleed) or bright red (lower GI bleed) stools.
Given their increased risk of falling, educate the patient on using the call light and provide assistance with any mobilization activities they may need help with. Make sure to also enhance safety measures such as bedrails and non-slip mats.
Nurses should provide information about the condition to both patients and families as appropriate. This should include teaching them how to manage their diet to prevent further GI bleeding, signs and symptoms to watch out for, and when to seek medical assistance.
Nurses can play an important role in the prevention of GI bleeds by emphasizing lifestyle modifications (such as reducing alcohol intake and smoking cessation) and monitoring patients who are at risk for complications from their underlying condition. Additionally, nurses should encourage patients to take medications as prescribed and monitor for side effects.
GI bleeds can be serious and require careful monitoring and treatment. Nursing interventions for gi bleed should be individualized and tailored to the patient’s needs. These interventions encompass diagnosis, monitoring, administering blood products, taking vital signs, assessing GI bleeding, and providing patient education. It is essential for nurses to not only focus on acute care but also emphasize preventive measures to reduce the risk of further complications.
Many organizations offer continuing education opportunities to stay up-to-date on current best practices for GI bleeds. Nurses can review evidence-based resources such as the American Gastroenterology Association guidelines to aid in patient diagnosis, treatment, and prevention. Additionally, nurses should maintain an open dialogue with their healthcare team to ensure they are providing the best possible care to their patients.
Ultimately, nursing interventions for gi bleeds can have a significant impact on patient outcomes. Nurses should strive to provide the best evidence-based care to their patients while also emphasizing preventive measures and patient education as part of comprehensive treatment plans. With proper diagnosis, monitoring, and management, healthcare professionals can work together to improve GI bleeding prognosis for patients.
Mrs. Marie Brown has been a registered nurse for over 25 years. She began her nursing career at a Level I Trauma Center in downtown Chicago, Illinois. There she worked in the Emergency Department and on the Surgical Intensive Care Unit. After several years, she moved to the Midwest and continued her nursing career in a critical care setting. For the last 10 years of her nursing career, Mrs. Brown worked as a flight nurse with an air ambulance service. During this time, she cared for patients throughout the United States.