Lower GI Bleed: Result of bleeding from the small
intestine, large intestine, rectum, or anus. Can be
#1 Priority: Risk for
significant blood loss.
Goal: Patient will have
hemodynamic stability.
AD: Large maroon stool, 800
mL marron stool, passing
large amount of bright red
blood.
NA: Take vitals, increased
O2, increase fluids, call
physician, prepare for blood
transfusion by inserting 2nd
IV, verify informed consent,
strict I/O, keep NPO, insert
indwelling catheter. Assess
neuro. Auscultate heart,
lungs, and bowels.
E: Bleeding has stopped.
Patient is hemodynamically
stable.
Orders: IVF bolus of 500
mL normal saline. 2 units
PRBCs STAT.
Treatment: Colonoscopy
S/S: Pale, diaphoretic,
altered LOC
Labs: Hgb 7.8 g/dL, Hct
23%
ABGs: Respiratory
alkalosis
Tests: Positive Fecal
Occult
S/S: BP 110/64 > 92/58
Pale, diaphoretic, altered
LOC
H&P: History and
Physical
caused by hemorrhoids, fissures, fistulas, IBD, or
certain medications.
#2 Priority: Risk for
fluid volume deficit.
Goal: Patient will regain
fluid volume stability.
AD: BP 110/64 > 92/58.
Patient is losing large amount
of blood. Patient is pale and
diaphoretic.
NA: Increase IV fluids.
Trendelenburg position,
increased O2 with non-
rebreather mask, take vitals,
continuous pulse oximetry,
insert indwelling catheter,
strict I/O. Administer IVF
bolus.
E: Patient will regain fluid
volume stability.
Orders: IVF bolus of
500 mL normal saline. 2
units PRBCs STAT.
S/S: BP 110/64 > 92/58
Pale, diaphoretic, altered
LOC
Medical Dx & patho
H & P: KL is 62-year-old
man. He works as a
sandblaster. He has had
# 3 Priority: Risk for #4 Priority: Knowledge deficit:
anxiety. how to prevent another GI bleed.
silicosis for 12 years and take
Goal: Patient will be free Goal: Patient will verbalize risk 40 mg of prednisone daily to
from pain and anxiety. factors associated with GI bleed. manage it. He has severe
diarrhea, a large marron stool,
is agitated and pale. His vitals
AD: Active bleed. Heavy, AD: GI bleed induced from
significant blood loss. prednisone intake. are 110/64, 110, 28, 93%,
Undergoing a colonoscopy which NA: Educate patient on why
can cause anxiety. prednisone is being decreased.
98.2 F. His fecal occult test is
NA: Administer anxiety Avoid NSAID, antiplatelet, and positive. He has LR running
medication. Reassure patient. alcohol. Educate on purpose of at 125 mL/hour and 5L of
Educate patient on procedures. esomeprazole. Administer
E: Patient will be free from esomeprazole IV. Educate on S/S of O2/NC.
anxiety. GI bleed or anemia. Patient will be
reevaluated in 2 months. KL passed 800mL marron
E: Patient will verbalize
stool. Vitals are 92/58, 116,
understanding of how to prevent GI
bleed and when to seek help. 32, 93%. IVF bolus and
Meds: Midazolam for Meds: Decrease PRBCs are orders. ABG
procedural anxiety. prednisone dosage. indicate respiratory alkalosis.
Procedure: Blood Administer dose of IV
transfusion and
Hgb is 7.8 g/dL and Hct is
esomeprazole now. Take
colonoscopy r/t critical esomeprazole BID to 23%.
bleed. decrease likelihood of
another GI bleed.
Treatment: Patient will be
KL is taken to immediate
reevaluated in 2 months. colonoscopy. He is passing a
large amount of bright red
blood. He is paler,
diaphoretic, and has an
altered LOC. Bleeding is
cauterized.
Prednisone dosage is
Treatments, S/S
lowered. New omeprazole
prescription.
AD = Assessment Meds (include
Data pertinent assessment
Nursing AND info that correlates
Dx & NA = Nursing actions with meds), Labs,
R/T AND Tests, Therapies (OT,
E=Evaluation PT, RT, ST, etc.)