Saint John Colleges Calamba, City COLLEGE OF NURSING CASE ABSTRACT UPPER GASTROINTESTINAL BLEEDING 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: Upper gastrointestinal bleeding: Upper GI bleeding originates in the first part of the GI tract-the esophagus, stomach, or duodenum (first part of the intestine). Bleeding can come from ingestion of caustic poisons or stomach cancer. Most often, upper GI bleeding is caused by one of the following: Peptic ulcers Gastritis Esophageal varices Mallory-Weiss tears Lower GI bleeding: The lower GI tract is located between the upper part of the small intestine and the anus. The lower GI tract includes the small and large bowels.
Transcript
Saint John CollegesCalamba, City
COLLEGE OF NURSING
CASE ABSTRACT UPPER GASTROINTESTINAL BLEEDING
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:
Upper gastrointestinal bleeding: Upper GI bleeding originates in the first part of the GI tract-the esophagus, stomach, or duodenum (first part of the intestine). Bleeding can come from ingestion of caustic poisons or stomach cancer. Most often, upper GI bleeding is caused by one of the following:
Lower GI bleeding: The lower GI tract is located between the upper part of the small intestine and the anus. The lower GI tract includes the small and large bowels.
Gastrointestinal Bleeding Symptoms
Acute gastrointestinal bleeding first will appear as vomiting of blood, bloody bowel movements, or black, tarry stools. Blood may look like "coffee grounds." Symptoms associated with blood loss can include the following:
Vomiting of blood usually originates from an upper GI source. Bright red or maroon stool can be from either a lower GI source or from brisk bleeding at an upper GI source.
Long-term GI bleeding may go unnoticed or may cause fatigue, anemia, black stools, or a positive test for microscopic blood.
LEARNING OBJECTIVES:
1. To acquire more information about the condition of the patient and the disease.
2. To have knowledge to the client medication and be familiar to that medication.
3. To manage or to create a nursing care plan in patient dealing with Upper Gastrointestinal Bleeding.
The human digestive system is a complex series of organs and glands that processes food. In order to use the food we eat, our body has to break the food down into smaller molecules that it can process; it also has to excrete waste.
Most of the digestive organs (like the stomach and intestines) are tube-like and contain the food as it makes its way through the body. The digestive system is essentially a long, twisting tube that runs from the mouth to the anus, plus a few other organs (like the liver and pancreas) that produce or store digestive chemicals.
THE DIGESTIVE SYSTEM PROCESS:
The start of the process - the mouth: The digestive process begins in the mouth. Food is partly broken down by the process of chewing and by the chemical action of salivary enzymes (these enzymes are produced by the salivary glands and break down starches into smaller molecules).
On the way to the stomach: the esophagus - After being chewed and swallowed, the food enters the esophagus. The esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic, wave-like muscle movements (called peristalsis) to force food from the throat into the stomach. This muscle movement gives us the ability to eat or drink even when we're upside-down.
In the stomach - The stomach is a large, sack-like organ that churns the food and bathes it in a very strong acid (gastric acid). Food in the stomach that is partly digested and mixed with stomach acids is called chyme.
In the small intestine - After being in the stomach, food enters the duodenum, the first part of the small intestine. It then enters the jejunum and then the ileum (the final part of the small intestine). In the small intestine, bile (produced in the liver and stored in the gall bladder), pancreatic enzymes, and other digestive enzymes produced by the inner wall of the small intestine help in the breakdown of food.
In the large intestine - After passing through the small intestine, food passes into the large intestine. In the large intestine, some of the water and electrolytes (chemicals like sodium) are removed from the food. Many microbes (bacteria like Bacteroides, Lactobacillus acidophilus, Escherichia coli, and Klebsiella) in the large intestine help in the digestion process. The first part of the large intestine is called the cecum (the appendix is connected to the cecum). Food then travels upward in the ascending colon. The food travels across the abdomen in the transverse colon, goes back down the other side of the body in the descending colon, and then through the sigmoid colon.
The end of the process - Solid waste is then stored in the rectum until it is excreted via the anus
1 day PTA, patient had 1 episode of passage of black stool; no consult done, no medication.Few hours PTA, still 1 episode of passage of black stool, accompanied with vomiting of fresh blood hence consult and admit.
B. Past Health History
According to patient 3 years ago he had an operation on Laguna Provincial Hospital Sta. Cruz, Laguna. He undergo to the operation of Anastomosis of Intestines.
Patient: Bargola,Roberto
Age: 31 years old
Sex: Male
Nationality: Filipino
Civil Status: Single
Religion: Roman Catholic
Address: Tagumpay, Bae Laguna
Admission Date and Time: May 25,2010 @ 1:20 pm
Attending Physician: Dr. Lagoc
Diagnosis: UGIB; t/c Anemia
Chief Complaint: Vomiting of blood and passage of black stool.
The patient stated that he was alcohol drinker and he smoke.
B.3. Family Health History (Genogram)
- According to the patient, they have a history of HPN to his father side and he stated that his father died on stroke. And from his grandmother side he stated that they have a history Diabetes.
II NUTRITION-METABOLIC PATTERNA
- The patient was advised for the Diet as Tolerated except Dark colored food because this may interfere to the laboratory test to be done to him.
III ELIMINATION PATTERN
A. BowelAccording to the patient he had regular bowel movement, with episode passage of black stool.
B. BladderAccording to the patient he urinate 6-8x daily
IV ACTIVITY-EXERCISE PATTERNS
Self-care Ability
II = Feeding II= Toileting II= Dressing II= Bathing II= Bed Mobility II= Grooming
LegendFunctional Level CodeO-Full self-careI-Requires use of equipment or deviceII-Requires assistance or supervision from another personIII-Requires assistance or supervision from another person and equipment or deviceIV-Is dependent and does not participate
V SLEEP-REST PATTERN
-The patient’s usual sleeping time is between 8 pm to 9 pm. His rising time is 5 am.
VI COGNITIVE-PERCEPTION PATTERN
A. Hearing – no problemB. Vision - no problemC. Sensory perception - no problem
PART II - PHYSICAL EXAMINATION
GENERAL SURVEY
I. VITAL SIGNS DAY 1
Temperature 36.5° C Pulse/Cardiac rate 65 bpm Respiratory rate 18 cpmBlood pressure 100/70 mmHg
II INTEGUMENT
A. Skin: pale in color, smooth, no abnormalitiesB.Nails: pale nail bed with poor capillary refillC.Hair : Evenly distributed, black in color, no abnormalities
III HEENT
Head Size: normocephaly Shape: round, symmetrical
Eyes Color-sclera (Anecteric), conjunctiva (pale) Pupil Response-PERRLAEars Symmetry-symmetrical Discharge/growth-noneNose Mucosal Condition-moist Discharge/Growth: noneMouth/Throat/pharynx/teeth (color/lesions/smoothness/presence of cavity) - red dry lips, no lesions, no swellingFace symmetrical
ang dumi ko at nagsusuka, ako ng dugo ”as verbalized by the patient.
Objective Conscious and
Coherent. (+) hematemesis (+) melena Weak and pale
looking. Pale conjunctiva
and skin noted C abdominal
midline scar Elevated
hematocrit and hemoglobin.
Fluid Volume Deficit related to internal bleeding as evidenced by hematemesis melena.
After nursing interventions, the patient will verbalize understanding of causative factors and purpose of individual therapeutic interventions and medications.
V/S taken and recorded.
Advise the patient to avoid dark colored food.
Monitor active fluid loss from bleeding, and vomiting; maintain accurate input and output.
>give 30 mins before meals and at bed time> assess mental status during treatment>tell pt. To avoid driving & other hazardous activities for at least 2 hrs>advice pt. to avoid alcohol and other CNS depressant that enhance sedating properties of this drug
GENERIC NAME ACTIONS USES CONTRAINDICATIONS NURSING RESPONSIBILITIES
OMEPRAZOLE
BRAND NAME:Losec
CLASSIFICATION:Gastrointestinal Agent
Route and Dosage:
Adult: PO 20 mg once/day for 4-8 week.
An antisecretory compound that is a gastric acid pump inhibitor. Suppresses gastric acid secretion by inhibiting the H+, K+ ATphase enzyme system in parietal cells.
Duodenal and gastric ulcer. Gastroesophageal reflux disease including severe erosive esophagitis (4-8 wk treatment). Long term treatment of pathologic hypersecretory conditions such as Zollinger- Ellison syndrome, multiple endocrine adenomas and systemic mastocytosis. In combination with clarithromycin to treat duodenal ulcers associated with H-pylori.
Long term use for gastroesophageal reflux disease( GURD) duodenal ulcers, proton pump inhibitors, hypersensitivity children <2 years; use of OTC formulation in children <18y or GI bleeding, pregnancy (category C); use of Zegirid in metabolic alkalosis; hypocalcemia, vomiting, GI bleeding.
Check for doctor’s order2. Perform ANST prior toadmission3. Should not be given ifpositive skin test4. Slow IV push5. Inform the patient about thepossible side effect of the drug6. Advise patient to report anydiscomfort on the IV insertionsite
7. Provide safet
GENERIC NAME ACTIONS SIDE EFFECTS CONTRAINDICATIONS NURSING RESPONSIBILITIES
CO-AMOXICLAV
BRAND NAME:Amoxicillin- clavulanate
CLASSIFICATION:antibioticRoute and Dosage:
Usual adult dose: 375mg – 625mg orally or 1.2g iv three times a day
Combination antibiotic containing amoxicillin trihydrate, a β-lactam antibiotic, with potassium clavulanate, a β-lactamase inhibitor. This combination results in an antibiotic with an increased spectrum of action and restored efficacy against amoxicillin-resistant bacteria that produce β-lactamase..
Amongst the possible side-effects of this medication are diarrhea, vomiting, thrush, and a few other conditions. These do not usually require medical attention. However, if the patient experiences an allergic reaction to the medication, jaundice, fever, or severe diarrhea, it is necessary to contact a doctor immediately. As with all antimicrobial agents, pseudomembranous colitis has been associated with the use of amoxicillin-clavulanate. Amoxicillin is a member of the penicillin family of antibiotics, and therefore should not be taken by patients allergic to penicillin.
Co-amoxiclav is contraindicated in patients with a history of allergic reactions to any penicillin. It is also contraindicated in patients with a previous history of amoxicillin-potassium clavulanate-associated cholestatic jaundice/ hepatic dysfunction.
*Obtains patient’s history of allergy *assess patient for sings and symptoms of infection wound characteristics, sputum, urine stool, fever and WBC count *assess for allergic reactions during treatment rash, uritcaria, pruritus, chills, fever, joint pains *Monitor for signs of nephrotoxocity: urine casts, oliguria, proteinuria, increased BUN, and creatinine *assess bowel patterns; bloody diarrhea, cramping, possiblepseudomembranouscolitis
GENERIC NAME ACTIONS USES INDICATIONS NURSING RESPONSIBILITIES
TRANEXAMIC ACID
BRAND NAME:anexamic acidCyklokapron, Lysteda
CLASSIFICATION:antifibrinolytic agent
Route and Dosage:
Solution Intravenous500mg q6.
Tranexamic acid competitively inhibits activation of plasminogen (via binding to the kringle domain), thereby reducing conversion of plasminogen to plasmin (fibrinolysin), an enzyme that degrades fibrin clots, fibrinogen, and other plasma proteins, including the procoagulant factors V and VIII. Tranexamic acid also directly inhibits plasmin activity, but higher doses are required than are needed to reduce plasmin formation.
Tranexamic acid injection is used to control or prevent excessive or heavy bleeding during dental procedures in patients with hemophilia. tranexamic acid is for short-term use only, usually 2 to 8 days.
For use in patients with hemophilia for short term use (two to eight days) to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction.
*Check for doctor’s order*. Perform ANST prior toadmission* Should not be given ifpositive skin test* Slow IV push* Inform the patient about thepossible side effect of the drug* Advise patient to report anydiscomfort on the IV insertionsite
*Provide safety
St. John CollegesCalamba City
COLLEGE OF NURSING
CASE STUDY OF PATIENT WITH UPPER GASTROINTESTINAL BLEEDING (UGIB)
