BACHELOR OF SCIENCE IN NURSING

NCMB312 RLE:
Care of Clients with Problem in Oxygenation, Fluids & Electrolytes, Infectious, Inflammatory &
Immunologic Response, Cellular Aberrations (Acute & Chronic)
RLE MODULE RLE UNIT WEEK
3 13 15
Gastrointestinal Bleed

 Read course and laboratory unit objectives

 Read study guide prior to class attendance
 Read required learning resources; refer to course unit
terminologies for jargons
 Participate in weekly discussion board (Canvas)
 Answer and submit course unit tasks

At the end of this unit, the students are expected to:

General Objective
This case scenario aims to broaden the students’ knowledge regarding GI Bleeding care and it is designed to
develop and enhance the skills and attitude in the application of different nursing processes and management
of the patient with such problem.

Specific Objectives
 Discuss the anatomy and physiology of the GIT.
 Explain the pathophysiology of GI Bleeding.
 Determine the nursing priorities and nursing management requisite and executable in GI Bleeding, and
incorporate these in the creation of a pertinent nursing care plan
 Distinguish the different pharmacological actions of the drugs involved in the treatment of GI Bleeding, and
identify the nursing considerations that must be employed.
 Formulate relevant health teachings and outpatient care for a patient with GI Bleeding.

Create a conceptual map using the case scenarios as guide. Conceptual map should include pathophysiology,
medical diagnosis, signs and symptoms, and risk factors, if any. Nursing diagnosis, nursing interventions, medical
management (medication and procedures), expected outcomes.
CASE SCENARIO

CHIEF COMPLAINT: "I'm passing black stool" and lightheadedness - 3 days.

HISTORY OF PRESENT ILLNESS: Mr. Murphy is a 45 year old advertising executive who presents to the
emergency room complaining of the passage of black stools x 3 days and an associated lightheadedness. He
also relates that he cannot keep up with his usual schedule because of fatigability. Upon further questioning he
states that his stools are not only black, but are sticky and malodorous. He further complains of recent worsening
of a chronic epigastric burning which had been a problem off/on for years. He had doubled his usual dose of turns
without significant relief of the burning. He has 2-3 martinis at lunch and another cocktail before dinner. He takes
NSAIDS as needed for back pain and recently started on one aspirin per day for cardiac prophylaxis. He smokes
two packs of cigarettes per day and an occasional cigar. He was told of an ulcer in the distant past but had no
specific evaluation or treatment for same.

Mr. Murphy has been treated for hypertension for eight years but denies any known cardiac history. His weight
increased and he claims to have an excellent appetite. He has a normal bowel habit and has not had prior black
stools. He has had no abdominal surgery and denies bleeding tendencies or prior transfusion.

PHYSICAL EXAMINATION: Examination reveals an alert, oriented, overweight male. He appears anxious and
somewhat restless. Vital sips are as follows. Blood Pressure 120/80 mmHg, Heart Rate 110/min - Supine; BP
90/60 mmHg; HR thready - Standing (Patient complains of dizziness upon standing). Respiratory Rate - 20
/minute; Temperature 98F.

HE-ENT/SKIN: Facial pallor and cool, moist skin are noted. No telangiectasia of the lips or oral cavity are noted.
No spider nevi are seen. The parotid glands appear full.

CHEST: Lungs are clear to auscultation and percussion. The cardiac exam reveals regular rhythm with an S4.
No murmur is appreciated. Peripheral pulses are present but are rapid and weak.

ABDOMEN/RECTUM: The abdomen reveals a rounded abdomen. Bowel sounds are hyperactive. There is
moderate tenderness in the epigastrium. The liver is percussed to 13 cm (mal); the edge feels firm. The spleen
was not felt and no masses were appreciated; the exam was felt to be suboptimal secondary to the patient's
obesity. Rectal examination revealed black, tarry stool.
There are no dupuytren's contractions.

LABORATORY TESTS: Hemoglobin 9gm/dL, Hematocrit 27%, MCV 90. WBC13,000/mm. PT/PTT - normal.
BUN 45mg/dL, Creatinine 1.0 mg/dL. Chest x-ray - normal. X-ray of abdomen (kidney, ureter, bladder - KUB) is
unremarkable.

GROUP TASK
Each group will be given 30 minutes to discuss the concept map in synchronous session via zoom
class. Manuscript and Power Point presentation must be submitted thru Canvas upload.
PRESENTATION
1. Describe the disease process: Definition, epidemiology, signs & symptoms treatment & mgt.
2. Trace the pathophysiology of disease.
3. Make a drug study
4. Make at least two nursing care plan based on your assessment that needs to prioritize.
5. What are your discharge plan or recommendation to patient using the mnemonic METHOD:

Langhorne, M. E., Fulton, J. S., & Otto, S. E. (2011).GI Bleeding, 5th ed. St. Louis, Mo.:
Mosby/Elsevier. pp 258-274.
PhilHealth (n.d.). https://www.philhealth.gov.ph
WHO. (2020). https://www.who.int.