Nursing Diagnosis Care Plan for GI Bleed: Comprehensive Guide

Gastrointestinal (GI) bleeding refers to any hemorrhage occurring within the digestive tract, encompassing the esophagus, stomach, small intestine, large intestine (colon), rectum, and anus. It’s crucial to understand that GI bleeding is not a disease itself, but rather a symptom indicating an underlying medical condition.

GI bleeding is broadly categorized into upper and lower GI bleeds. The dividing line between these categories is the ligament of Treitz, also known as the suspensory ligament of the duodenum. Bleeding originating above this ligament is considered upper GI bleeding (UGIB), while bleeding below it is lower GI bleeding (LGIB).

Upper GI bleeding is more common than lower GI bleeding. Lower GI bleeding tends to be more prevalent in men, potentially due to a higher incidence of vascular disorders and diverticulosis in this demographic. The occurrence of GI bleeding, in general, increases with age.

Effective nursing care is paramount in managing patients with gastrointestinal bleeding. The goals of nursing interventions are to alleviate symptoms, minimize the risk of complications, and support the patient’s psychological well-being and overall prognosis. These interventions also play a critical role in preventing and managing potential risk factors associated with GI bleeding.

Nursing Assessment for GI Bleeding

The nursing process begins with a comprehensive assessment to gather crucial physical, psychosocial, emotional, and diagnostic data. This section will detail the subjective and objective data collection relevant to GI bleeding.

Review of Health History

1. History of GI Bleeding Incidents:
It is vital to inquire about both current and past episodes of GI bleeding. Gathering information about the onset, duration, frequency, and characteristics of previous bleeding incidents is crucial. This detailed history aids in symptom analysis, identification of potential triggers, and ultimately contributes to accurate diagnosis and timely treatment.

2. Comprehensive Medical History Review:
A thorough review of the patient’s medical history is essential. This includes past medical records, pre-existing conditions, and comorbidities that may be relevant to the potential causes of GI bleeding. Conditions to consider include:

• Varices (esophageal or gastric)
• Portal hypertension
• History of alcohol abuse
• Smoking history
• Peptic ulcers (gastric or duodenal)
• Helicobacter pylori (H. pylori) infection
• Diverticulitis
• Hemorrhoids
• Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
• Cancers of the stomach, esophagus, or colon

3. Medication Regimen Review:
Certain medications are known to increase the risk of GI bleeding. A detailed review of the patient’s current and recent medication regimen is necessary to identify potential contributing factors. Medications of concern include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Anticoagulants (e.g., warfarin, heparin)
• Antiplatelet drugs (e.g., aspirin, clopidogrel)
• Bismuth-containing medications (e.g., bismuth subsalicylate)
• Iron supplements

4. Assessment of General GI Bleeding Symptoms:
Beyond the overt signs of bleeding, it’s important to assess for associated symptoms that may indicate GI distress or complications. These symptoms include:

• Abdominal pain or discomfort
• Difficulty swallowing (dysphagia)
• Unexplained weight loss
• Nausea and vomiting
• Retching
• Changes in bowel habits (diarrhea, constipation)
• Abdominal bloating
• Fatigue and weakness

Physical Assessment for GI Bleeding

1. Observe and Document Signs of GI Bleeding:
A meticulous physical examination is crucial to identify objective signs of GI bleeding. Observe for the following:

• Central Nervous System (CNS): Changes in mental status, decreased level of consciousness, lightheadedness, syncope (fainting), dizziness. These can indicate reduced cerebral perfusion due to blood loss.
• Head, Eyes, Ears, Nose, and Throat (HEENT): Pallor of the conjunctiva (pale eyes), mucous membranes, and lips. This is a visual indicator of anemia.

Alt text: Pale conjunctiva of the eye, a clinical sign of anemia often associated with gastrointestinal bleeding.

• Respiratory: Decreased oxygen saturation (SpO2), shortness of breath (dyspnea). These can arise from reduced oxygen-carrying capacity of the blood.
• Cardiovascular: Chest pain, tachycardia (rapid heart rate), hypotension (low blood pressure). These are compensatory mechanisms or direct consequences of blood loss.
• Gastrointestinal: Abdominal pain, abdominal cramping, presence of anal fissures or hemorrhoids, palpable abdominal masses, hematemesis (bright red blood or coffee-ground appearance in vomitus), melena (black, tarry stools). These are direct manifestations of bleeding within the GI tract.

Alt text: Coffee-ground vomitus, a clinical sign of upper gastrointestinal bleeding where blood has been partially digested in the stomach.

Alt text: Melena, characterized by black, tarry stools, indicates bleeding in the upper gastrointestinal tract with digested blood.

• Hematologic: Signs of anemia, such as fatigue, weakness, and pallor.
• Integumentary: Skin pallor (pale skin).

2. Monitor for Signs and Symptoms of Shock:
Severe GI bleeding can lead to hypovolemic shock, a life-threatening condition. Closely monitor for the following shock symptoms:

• Severely low blood pressure (hypotension)
• Orthostatic hypotension (drop in blood pressure upon standing)
• Supine hypotension (low blood pressure while lying down)
• Resting tachycardia (elevated heart rate at rest)
• Palpitations (sensation of rapid or irregular heartbeat)
• Rapid, bounding pulses
• Oliguria (low urine output) or anuria (absent urine output)
• Decreased level of consciousness, confusion
• Syncope (fainting)

3. Abdominal Examination:
Perform a thorough abdominal examination, including:

• Inspection: Observe for abdominal distension, dilated veins, or skin discoloration.
• Auscultation: Listen for bowel sounds. Hyperactive bowel sounds may be present in GI bleeding.
• Palpation: Gently palpate for abdominal tenderness or pain. Tenderness or guarding may indicate perforation or ischemia.

4. Vital Sign Monitoring:
Continuously monitor vital signs, including heart rate, blood pressure, respiratory rate, and temperature. Changes in vital signs can be early indicators of GI bleeding complications like shock or hypovolemia. Pay close attention to trends of tachycardia, tachypnea (rapid breathing), and hypotension.

Diagnostic Procedures for GI Bleeding

1. Review Serum Laboratory Values:
Several blood tests are crucial in evaluating GI bleeding:

• Complete Blood Count (CBC): A CBC often reveals low hemoglobin (Hgb) and hematocrit (Hct) levels, indicating blood loss and anemia.
• Coagulation Profile: This assesses the blood’s clotting ability. In GI bleeding, abnormalities are common. Expect to see an increased international normalized ratio (INR), prolonged prothrombin time (PT), and activated partial thromboplastin time (aPTT).
• Lactate Levels: Elevated lactate levels can indicate tissue hypoperfusion secondary to blood loss.
• Liver Function Tests (LFTs): Abnormal liver enzyme levels may be present, especially if liver disease is a contributing factor to the bleeding. Impaired liver function can reduce the production of clotting factors, increasing bleeding risk.

2. Stool Examination:
Analyze stool samples for visible blood:

• Bright red blood in stool (hematochezia) usually indicates lower GI bleeding.
• Dark, black, tarry stools (melena) suggest upper GI bleeding or bleeding from the proximal small intestine, where blood has been digested.
• Fecal Occult Blood Test (FOBT): This bedside test detects hidden (occult) blood in the stool, even if not visibly apparent.

3. Endoscopy Procedures:
Endoscopy is a key diagnostic and therapeutic procedure:

• Upper GI Endoscopy (Esophagogastroduodenoscopy or EGD): A thin, flexible tube with a camera is inserted through the mouth to visualize the esophagus, stomach, and duodenum.
• Lower GI Endoscopy (Colonoscopy): A similar tube is inserted through the rectum to examine the colon and rectum.
• Endoscopic Interventions: During endoscopy, the source of bleeding can often be identified and treated using techniques like injection therapy, thermal coagulation, or application of hemostatic clips or bands.

4. Imaging Scans:
Various imaging modalities may be used to diagnose GI bleeding, depending on the suspected location and nature of the bleed:

• Capsule Endoscopy: A small, swallowable capsule containing a camera captures images of the small intestine.
• Flexible Sigmoidoscopy: Similar to colonoscopy but examines only the lower portion of the colon (sigmoid colon and rectum).
• Balloon-Assisted Enteroscopy: A specialized endoscope allows for deeper visualization and intervention in the small intestine, reaching areas beyond the scope of standard endoscopes.
• Angiography: This technique visualizes blood vessels. Contrast dye is injected into an artery, and X-rays are taken to identify active bleeding vessels. Angiography can also be used therapeutically for embolization (blocking bleeding vessels) or intra-arterial vasopressin infusion to constrict blood vessels.
• CT Angiography (CTA): A CT scan with contrast dye, providing detailed images of blood vessels and detecting active bleeding.
• Enteroscopy: A general term for visualizing the small bowel, often using specialized endoscopes.
• Nuclear Scintigraphy (Tagged Red Blood Cell Scan): This is a highly sensitive test for detecting active lower GI bleeding. Radioactively labeled red blood cells are injected, and a scan identifies areas of tracer accumulation, indicating bleeding.

Nursing Interventions for GI Bleeding

Effective nursing interventions are crucial for patient recovery and management of GI bleeding.

Identifying and Treating the Cause

1. Manage Active Bleeding:
While some GI bleeding resolves spontaneously, interventions are necessary for persistent or severe bleeding. Treatment strategies depend on the bleeding location and severity.

2. Address the Underlying Cause:
Identifying and correcting the root cause of the bleeding is paramount. This may range from simple measures like discontinuing certain medications (e.g., anticoagulants, NSAIDs) to more complex interventions such as surgery to address ulcers, tumors, or vascular malformations.

3. Bowel Rest (NPO Status):
Implementing “nothing per oral” (NPO) orders is often necessary to allow the GI tract to rest and minimize further irritation. This also facilitates healing and allows for diagnostic and therapeutic procedures to be performed effectively.

Supportive Care

1. Oxygen Administration:
Administer supplemental oxygen as prescribed, especially if the patient exhibits hypoxia (low oxygen saturation). Nasal cannula is typically used, but patients with ongoing hematemesis or altered mental status may require more advanced airway management, including intubation.

2. Hydration and Fluid Resuscitation:
Establish and maintain adequate intravenous (IV) access, typically with at least two large-bore peripheral IV catheters. Administer intravenous fluids, such as normal saline or lactated Ringer’s solution, to restore intravascular volume and maintain hemodynamic stability.

3. Blood Product Transfusion:
Transfusions are essential to replace lost blood components and improve oxygen-carrying capacity.

• Packed Red Blood Cell (PRBC) Transfusions: Typically indicated when hemoglobin levels fall below 7 g/dL. The target hemoglobin level may be higher in patients with cardiovascular disease or ongoing bleeding.
• Platelet Transfusion: Considered when platelet counts drop below 50,000/microL, especially in patients with active bleeding or at high risk of bleeding.

4. Reversal of Anticoagulation:
For patients taking anticoagulants like warfarin or heparin, reversal agents may be necessary to counteract the effects of these medications and stop the bleeding. Vitamin K is used to reverse warfarin, and protamine sulfate is used to reverse heparin.

5. Medication Administration:
Various medications may be administered to manage or stop GI bleeding:

• Proton Pump Inhibitors (PPIs): Used primarily in upper GI bleeding to reduce gastric acid production, which can exacerbate bleeding. PPIs may be continued or discontinued once the bleeding source is identified and managed.
• Prokinetic Agents (e.g., Erythromycin, Metoclopramide): These medications promote gastric emptying, helping to clear the stomach of blood, clots, and food, improving visualization during endoscopy.
• Somatostatin and Octreotide (Somatostatin Analogs): Vasoactive medications used to treat variceal bleeding (bleeding from enlarged veins, often in the esophagus or stomach, associated with portal hypertension). They reduce blood flow to the splanchnic circulation, decreasing variceal pressure and bleeding.
• Antibiotics: May be administered prophylactically, especially in patients with cirrhosis, to prevent bacterial translocation and subsequent infections, particularly before endoscopic procedures.

Preparation for Procedures

1. Gastric Lavage (Nasogastric Tube – NGT Lavage):
Prior to upper endoscopy, nasogastric tube lavage may be performed to remove blood and clots from the stomach, improving visualization during the procedure.

2. Sengstaken-Blakemore Tube Insertion:
In cases of massive GI bleeding due to esophageal varices unresponsive to other treatments, a Sengstaken-Blakemore tube may be considered as a temporary measure to tamponade (compress) the bleeding varices. This is typically a last resort due to potential complications.

3. Surgical Intervention:
Surgery may be necessary for patients with significant bleeding or hemodynamic instability when bleeding is unresponsive to endoscopic or medical therapies. Surgical options may include bowel resection or colectomy, depending on the bleeding source.

4. Diverticular Bleeding Management:
Colonoscopy is often used to manage bleeding from diverticulosis. Techniques include bipolar probe coagulation, epinephrine injection, or application of metal clips to stop the bleeding.

5. Thermal Therapy:
Lower GI bleeds from angiodysplasia (abnormal blood vessels in the GI mucosa) can be treated with thermal therapy, such as electrocoagulation or argon plasma coagulation, during endoscopy.

6. Prevention of Complications:
Untreated or poorly managed GI bleeding can lead to serious complications:

• Respiratory distress
• Myocardial infarction (heart attack)
• Infection or sepsis
• Shock
• Death

Patient Education for Preventing Recurrence

1. Limit NSAID Use:
Educate patients about the risks of long-term NSAID and aspirin use, which can cause mucosal damage and bleeding. Advise them to avoid or limit these medications as instructed by their healthcare provider.

2. Smoking Cessation:
Smoking increases the risk of peptic ulcers and impairs healing, increasing the risk of GI bleeding. Emphasize the importance of quitting smoking.

3. Reduce Alcohol Intake:
Excessive alcohol consumption irritates the GI tract and can damage the liver, impairing clotting function and increasing GI bleeding risk. Advise patients to reduce or abstain from alcohol intake.

4. Management of Underlying Conditions:
Educate patients about managing conditions like H. pylori infection, diverticulitis, Crohn’s disease, and ulcerative colitis to reduce the risk of GI bleeding. Stress the importance of medication adherence and follow-up care.

Nursing Care Plans for GI Bleeding

Nursing care plans guide the prioritization of assessments and interventions for patients with GI bleeding, addressing both short-term and long-term care goals. Here are examples of nursing care plans for common nursing diagnoses associated with GI bleeding:

Nursing Care Plan: Acute Pain

Nursing Diagnosis: Acute Pain related to gastrointestinal perforation or ischemia, secondary to decreased blood flow and oxygen supply to the GI system.

As evidenced by:

• Changes in blood pressure, pulse, and respiratory rate
• Guarding behavior of the affected abdominal area
• Restlessness and agitation
• Patient report of abdominal pain
• Patient report of heartburn

Expected Outcomes:

• Patient will verbalize relief or control of pain within an acceptable level.
• Patient will appear relaxed and be able to rest or sleep adequately.

Nursing Assessments:

1. Pain Assessment: Assess pain characteristics: location, quality (e.g., sharp, dull, burning), severity (using a pain scale), aggravating and relieving factors. Determine if pain is constant or intermittent.
2. Verbal and Nonverbal Pain Cues: Observe for both verbal reports of pain and nonverbal indicators such as facial grimacing, body posture, and reluctance to move. Discrepancies between verbal and nonverbal cues can provide insights into pain severity and the need for further management.
3. Coping Mechanisms: Assess the patient’s usual coping mechanisms for pain and stress. Identify effective and ineffective strategies to tailor pain management interventions.

Nursing Interventions:

1. Pharmacologic Pain Management: Administer prescribed analgesic medications as ordered. Acetaminophen is often preferred over NSAIDs due to its lower risk of GI irritation and bleeding. Antacids (without aspirin) and proton pump inhibitors may alleviate heartburn.
2. Evaluate Pain Management Effectiveness: Reassess pain levels within one hour after medication administration to evaluate the effectiveness of pharmacologic interventions. Use pain scales and observe for both verbal and nonverbal cues.
3. Comfort Measures and Non-Pharmacologic Pain Management: Provide comfort measures such as repositioning, back rubs, and pillow support. Implement non-pharmacologic pain relief techniques like relaxation exercises, guided imagery, and diversional activities to distract from pain and promote relaxation.
4. Promote Rest and Sleep: Plan rest periods and create a quiet, comfortable environment conducive to sleep. Minimize interruptions and cluster nursing tasks to promote uninterrupted rest.

Nursing Care Plan: Deficient Fluid Volume

Nursing Diagnosis: Deficient Fluid Volume related to GI hemorrhage, hematochezia, hematemesis, abdominal cancer, bleeding ulcers, or abdominal/rectal fistulas, resulting in decreased blood volume.

As evidenced by:

• Hematochezia (bright red blood in stool)
• Hematemesis (vomiting blood)
• Melena (black, tarry stools)
• Abdominal pain
• Resting tachycardia
• Orthostatic hypotension
• Weakness and fatigue
• Nausea and/or vomiting
• Decreased skin turgor (though less reliable in older adults)

Expected Outcomes:

• Patient will maintain adequate fluid volume, as evidenced by stable vital signs, balanced fluid intake and output, and appropriate capillary refill.
• Patient will demonstrate effective fluid volume balance, as evidenced by stable hemoglobin and hematocrit levels within acceptable limits.

Nursing Assessments:

1. Nutritional Status: Assess the patient’s nutritional history, including recent oral intake, weight changes, presence of nausea or vomiting, and any factors affecting fluid intake.
2. Fluid Intake and Output (I&O) Monitoring: Meticulously monitor and document all fluid intake (oral, intravenous) and output (urine, emesis, liquid stools, wound drainage). Track trends and report significant imbalances.
3. Laboratory Results: Closely monitor hemoglobin and hematocrit levels as indicators of blood loss. Note trends and report significant decreases.

Nursing Interventions:

1. Collaborate with Healthcare Provider: Work closely with the physician to identify and treat the underlying cause of fluid volume deficit and bleeding. Addressing the source of GI bleeding is essential to resolve fluid imbalances.
2. Fluid Replacement: Provide adequate oral fluids when tolerated. Administer intravenous fluids as prescribed to restore fluid volume. Avoid overly hyperosmolar or high-protein enteral formulas, which can exacerbate fluid shifts.
3. Medication Review and Administration: Review the patient’s medication list for drugs that may contribute to fluid and electrolyte imbalances or GI bleeding. Administer prescribed medications, such as proton pump inhibitors, to manage GI bleeding and reduce acid production.
4. Blood Product Administration: Administer blood products (packed red blood cells) as prescribed to replace blood loss and improve oxygen-carrying capacity. Ensure proper type and cross-matching before transfusion.

Nursing Care Plan: Imbalanced Nutrition: Less Than Body Requirements

Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to disease processes affecting the GI tract, nausea and vomiting, food aversion, loss of appetite, NPO status, and nutrient malabsorption secondary to GI bleeding.

As evidenced by:

• Abdominal pain and cramping
• Abdominal distension
• Body weight below ideal range for age and gender
• Hyperactive bowel sounds
• Lethargy and fatigue
• Pale mucous membranes
• Vomiting

Expected Outcomes:

• Patient will not experience further alterations in albumin, iron levels, or electrolyte balance.
• Patient will maintain body weight within acceptable parameters or demonstrate progress toward weight maintenance goals.

Nursing Assessments:

1. Eating Patterns and Dietary History: Assess the patient’s typical eating patterns, dietary intake, food preferences, and any recent changes in appetite or food tolerance.
2. Medication Use: Review current and past medication use, including corticosteroids and NSAIDs, which can contribute to GI irritation, ulceration, and nutrient malabsorption.
3. Laboratory Studies and Electrolyte Levels: Monitor laboratory values, including electrolytes, albumin, prealbumin, iron studies, and complete blood count, to identify nutritional deficits and electrolyte imbalances associated with GI bleeding.

Nursing Interventions:

1. Fluid and Electrolyte Replacement: Administer fluid and electrolyte replacement as prescribed to correct imbalances resulting from blood loss and gastrointestinal symptoms.
2. Minimize NPO Duration: Minimize the duration of NPO status as clinically appropriate. For patients at low risk of re-bleeding, consider early enteral nutrition to support nutritional needs and GI mucosal healing.
3. Small, Frequent Feedings: Provide small, frequent meals as tolerated to reduce nausea and vomiting, prevent early satiety, and promote gradual reintroduction of food.
4. Avoid Gastric Irritants: Advise patients to avoid gastric irritants such as caffeine, alcohol, carbonated beverages, and spicy foods, which can exacerbate GI symptoms and potentially increase the risk of re-bleeding.
5. Dietitian Referral: Refer the patient to a registered dietitian for comprehensive nutritional assessment, individualized dietary counseling, and meal planning. Dietary recommendations should emphasize iron-rich foods, whole grains, fruits, vegetables, and balanced macronutrient intake, while limiting salt, added sugars, and unhealthy fats.

Nursing Care Plan: Ineffective Tissue Perfusion

Nursing Diagnosis: Ineffective Tissue Perfusion related to upper or lower GI bleeding, gastrointestinal perforation, ischemia, peptic ulcer disease, esophageal tears or inflammation, diverticulosis/diverticulitis, inflammatory bowel disease, colonic polyps, or cancers of the colon, stomach, or esophagus, resulting in reduced oxygen delivery to tissues.

As evidenced by:

• Hematochezia
• Hematemesis
• Melena
• Abdominal pain
• Resting tachycardia
• Orthostatic hypotension
• Supine hypotension
• Nausea and/or vomiting

Expected Outcomes:

• Patient will demonstrate effective tissue perfusion, as evidenced by hemoglobin and hematocrit levels within normal limits for the patient.
• Patient will verbalize understanding of GI bleeding, the treatment plan, and when to seek medical attention.

Nursing Assessments:

1. Vital Signs Assessment: Closely monitor vital signs, particularly blood pressure and heart rate. Persistent hypotension can indicate abdominal organ hypoperfusion.
2. Assess for Bleeding: Continuously assess for signs of active bleeding, including hematemesis, melena, hematochezia, and occult blood in stool. Note any factors that may compromise GI perfusion, such as blood loss, hypotension, or septic shock.
3. History of Bleeding or Coagulation Disorders: Obtain a thorough history of previous bleeding episodes, coagulation disorders, cancer, or other risk factors for GI bleeding. This helps identify patients at higher risk and guides preventative measures.

Nursing Interventions:

1. Interdisciplinary Collaboration: Collaborate with the healthcare team (physician, surgeon, dietitian, pharmacist) to develop and implement a comprehensive plan of care to improve tissue perfusion and organ function.
2. Fluid, Blood, and Electrolyte Administration: Administer intravenous fluids, blood products, and electrolytes as prescribed to restore intravascular volume, improve oxygen-carrying capacity, and maintain hemodynamic stability. Fluid resuscitation is crucial to enhance tissue perfusion.
3. Medication Administration: Administer prescribed medications, such as antiemetics, anticholinergics, proton pump inhibitors, antihistamines, and antibiotics, as indicated to reduce fluid losses, neutralize gastric acid, and prevent further GI mucosal irritation.
4. Prepare for Endoscopy or Surgery: Prepare the patient for diagnostic and therapeutic procedures, such as endoscopy or surgery, as indicated to identify and control the source of bleeding and improve tissue perfusion.

Nursing Care Plan: Risk for Decreased Cardiac Output

Nursing Diagnosis: Risk for Decreased Cardiac Output related to disease processes causing GI bleeding, blood loss leading to hypovolemia, altered afterload, heart rate, rhythm, or stroke volume.

As evidenced by:
Risk diagnoses are not evidenced by existing signs and symptoms; interventions are aimed at prevention.

Expected Outcomes:

• Patient will maintain vital signs within normal limits for the patient, demonstrating adequate urine output and tissue perfusion.
• Patient will maintain a stable cardiac rhythm without signs and symptoms of decreased cardiac output.

Nursing Assessments:

1. Heart Rate and Rhythm Assessment: Monitor heart rate and rhythm regularly. Tachycardia is a common compensatory response to hypovolemia and decreased cardiac output.
2. Complete Blood Count (CBC) Monitoring: Monitor hemoglobin and hematocrit levels, recognizing that initial values may not immediately reflect the extent of blood loss. However, trends over time are crucial for guiding treatment.
3. Blood Urea Nitrogen (BUN) Level: Monitor BUN levels, as they may increase significantly in GI bleeding due to protein breakdown by gastrointestinal bacteria in the presence of hemorrhage.

Nursing Interventions:

1. Urine Output Monitoring: Closely monitor urine output as a key indicator of renal perfusion and overall organ perfusion. Consider inserting an indwelling urinary catheter for accurate monitoring, especially in unstable patients. Decreasing urine output can signal decreased cardiac output.
2. Hemodynamic Monitoring: Implement hemodynamic monitoring as indicated to assess circulatory status, blood pressure trends, and response to fluid resuscitation.
3. Supplemental Oxygenation: Administer supplemental oxygen as needed to correct or prevent hypoxemia and improve oxygen delivery to tissues.
4. Intravenous Fluid Administration: Administer intravenous fluids as prescribed to restore intravascular volume and improve cardiac preload. Isotonic crystalloid solutions like lactated Ringer’s solution are often used.
5. Blood Transfusion Preparation and Administration: Prepare for and administer blood transfusions (whole blood, packed red blood cells, or fresh frozen plasma) as ordered to replace blood loss and improve oxygen-carrying capacity, preventing decreased cardiac output.
6. Surgical Intervention Preparation: Prepare the patient for potential surgical interventions, such as endoscopy or surgery, to control bleeding and prevent further circulatory compromise if medical management is insufficient.
7. Drug Therapy Administration: Administer prescribed medications to reduce bleeding, decrease gastric acid secretion, and neutralize stomach acid. These measures aim to stabilize clots, reduce further bleeding, and improve cardiac output.

References

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