Critical care - Acute gastrointestinal bleeding: Nursing

Acute gastrointestinal or gi bleeding occurs when there's sudden loss of blood from the upper or lower gi tract. Upper gi bleeds occur in structures above a suspensory ligament called the ligament of trites, including the esophagus, stomach and duodenum.

On the other hand, lower gi bleeds occur in structures below this ligament including the colon rectum and anus. Gi bleeds are caused by any condition that disrupts the integrity of the gi tract.

Causes of upper gi bleeding include ulcers and varices. While causes of lower gi bleeds typically include cancer, hemorrhoids and diverticulosis.

As the nurse you'll provide patient centered care for critically ill patients with acute gi bleeding. Ok.

So, the gi tract consists of multiple layers. The mucosa is the innermost layer which helps absorb nutrients, provides protection from harmful bacteria and substances like excess stomach acid and produces mucus to lubricate food and prevent excoriation.

The submucosal layer is under the mucosa and contains connective tissue, blood vessels and nerves. Then there's the muscular layer where the muscles of the gi tract reside and the cirrhosa layer which is the outermost layer that helps reduce friction and protects the inner structures.

Now, these mucosal layers can be disrupted. Like when stomach acid auto digests the layers.

Or if a tumor within the gi tract like colon cancer directly invades the layers. Once the submucosal layer is disrupted, blood vessels can be damaged leading to bleeding.

Additionally, varices which are dilated, fragile vessels. Commonly found in the esophagus can easily rupture and bleed.

If bleeding is severe, hypovolemic shock can occur due to a reduced circulating blood volume. When this happens, the body compensates by vasoconstricting blood vessels and increasing heart rate, which can help maintain cardiac output and mean arterial pressure or map.

If left untreated acute gi bleeding can progress to multiple organ dysfunction syndrome and death. Clinical manifestations vary depending on the location of the bleeding.

Upper gi bleed can cause hematemesis which is bloody vomitus that can either be bright red or look like coffee grounds bright red blood indicates fresh blood.

Whereas coffee grounds indicate older blood that has been oxidized by stomach acid turning it a dark color blood may also move from the upper gi tract to the lower gi tract and present as Melana which is a shiny black tarry fowl smelling stool.

On the other hand, with lower gi bleeds bright red or maroon blood known as hematochezia can occur though keep in mind that acute gi bleeding can also be occult meaning not visible to the naked eye.

Hematocrit and hemoglobin can be normal early in the disease process but can decrease with continued bleeding which can manifest as fatigue and lightheadedness.

Platelets may initially increase in an attempt to stop the bleeding but may ultimately decrease as well. Now, if blood loss is severe and circulating volume decreases, signs and symptoms of hypovolemic shock can be present such as low BP and tachycardia cool and clammy skin as blood is shunted to major organs and altered level of consciousness.

If the brain doesn't receive enough oxygenated blood, lastly, acid base imbalances such as metabolic acidosis may occur when cells in hypoxic tissues switch to anaerobic metabolism.

Ok. Now, let's look at the nursing care you'll be providing for your critically ill patient with acute gi bleeding.

Your priority nursing goals are to restore and maintain intravascular volume limit bleeding and monitor for complications.

Begin by assessing your patient's airway breathing and circulation or ABC S for any emergent lifethreatening. Findings activate emergency protocols as needed.

Next. Be sure.

Your patient has two large bore IV catheters in place and initiate rapid fluid resuscitation and administer blood products.

As prescribed. You may also administer and titrate vasopressors as needed to maintain their map within the prescribed goal and provide supplemental oxygen to support oxygen delivery.

Insert, a nasogastric or NG tube as ordered to reduce aspiration risk. The NG tube can also be used to facilitate gastric lavage or the stomach is irrigated with normal saline until the return solution is clear, assess your patient's response to treatment and routinely monitor their vital signs.

Oxygen saturation, level of consciousness intake and output and laboratory test results then take steps to promote hemostasis and lowering the risk of recurrent bleeding.

If your patient's bleeding is due to peptic ulcer disease, administer the prescribed acid reducing medications. If your patient requires surgery or a procedure such as an endoscopy, collaborate with the interdisciplinary team to prepare your patient.

Be sure to regularly assess your patient's pain and anxiety levels and administer the prescribed analgesics and anxiolytics to promote comfort.

In addition, you can offer relaxation techniques, distraction or other complementary therapies to support them. Finally monitor for signs of complications like gastric perforation which can present with sudden severe abdominal pain, rigidity and rebound tenderness and peritonitis that may present with an increased white blood cell count, fever and persistent tachycardia.

Be sure to notify the healthcare provider if your patient's condition changes or worsens. All right, as a quick recap, acute gastrointestinal or gi bleeding occurs when there's sudden loss of blood from the upper or lower gi tract.

Clinical manifestations depend on the location of the bleeding and can include hematemesis Melana and hematochezia. When caring for your critically ill patient with an acute gi bleed.

Your goals of care include restoring and maintaining intravascular volume, limiting bleeding and monitoring for complications.