A GI bleed is bleeding anywhere in the digestive tract, from the esophagus to the rectum. Upper bleeds often show as vomited blood or black, tarry stools, while lower bleeds often show as bright red blood from the rectum. Your priorities are protecting circulation, replacing blood loss, and watching closely for signs of shock.
Each care plan below follows the nursing process (ADPIE).
Deficient Fluid Volume
- Active blood loss from the GI tract
- Vomiting and reduced oral intake
- Hematemesis or coffee-ground emesis
- Melena or bright red blood per rectum
- Tachycardia and hypotension
- Falling hemoglobin and hematocrit
- Urine output under 30 mL/hr
- Heart rate and BP return to the client's baseline within 4 to 8 hours of treatment
- Urine output of at least 30 mL/hr
- Hemoglobin stays stable with no new signs of bleeding
- Client states which signs of bleeding to report at home
- Vital signs and orthostatic changes as ordered
- Color, amount, and frequency of emesis and stool
- Hemoglobin, hematocrit, platelets, and clotting studies
- Strict intake and output
- Level of consciousness and skin color
| INTERVENTION | RATIONALE |
|---|---|
| Start two large-bore IV lines (18 gauge or larger) | Large lines allow rapid fluids and blood products if the client becomes unstable. |
| Give IV crystalloids and blood products as ordered | Replacing volume and red cells restores perfusion and oxygen delivery. |
| Give IV proton pump inhibitors as ordered for upper GI bleeding | Lowering stomach acid helps clots form and stay in place over the bleeding site. |
| Keep the client NPO and prepare for endoscopy as ordered | An empty stomach lowers aspiration risk and allows the bleeding source to be found and treated. |
| Report a rising heart rate, falling BP, or new bleeding right away | These are early signs of ongoing blood loss and shock. |
EVALUATION
- Heart rate and BP are back to baseline
- Urine output meets the goal
- Hemoglobin is stable on repeat labs
- Client names melena and dizziness as signs to report
Risk for Shock
- Ongoing or recurrent bleeding
- Hypovolemia
- Use of anticoagulants, antiplatelets, or NSAIDs
- History of varices or liver disease
- MAP stays at 65 or higher throughout the shift
- Client stays alert and oriented
- Client is free of shock and organ damage at discharge
- MAP, heart rate, and SpO2 frequently
- Capillary refill and skin temperature
- Mental status changes such as restlessness
- Lactate as ordered
| INTERVENTION | RATIONALE |
|---|---|
| Monitor vital signs often and trend them over time | A trend shows early decline before BP drops sharply. |
| Position the client flat with legs raised if hypotensive, unless contraindicated | This helps blood return to the vital organs. |
| Hold anticoagulants and NSAIDs and clarify with the provider | These medications worsen bleeding. |
| Monitor for transfusion reactions during blood administration | Fast recognition of a reaction prevents serious harm. |
EVALUATION
- MAP stays at 65 or higher
- Client is alert and oriented
- No signs of shock are present
Practice this in Priority Care
Spot the client who is quietly bleeding and decide who you see first.
Play Priority CareQuick answers
What stool finding suggests an upper GI bleed?
Black, sticky, tarry stool called melena. The blood has been digested as it moved through the gut, which turns it dark.
What is the priority action for a client vomiting large amounts of blood?
Protect the airway and circulation. Turn the client to the side, get large-bore IV access, and notify the provider for fluids and blood.
For learning only. Individualize every care plan to your client, and follow your program, current guidelines, provider orders, and facility policy.