Nursing care plan upper gastrointestinal esophageal bleeding

I. Pathophysiology
a. Ulceration and erosion of the mucosa of upper gastrointestinal
(GI) organs, including stomach and esophagus, which is indicated
by presence of melena, hematemesis, or blood in gastric
contents (following lavage)
b. Arises from branches of the celiac artery and superior
mesenteric artery
c. Variceal bleeding often arises from esophageal or gastric
varices from the coronary vein or short gastric veins in
portal hypertension.

II. Etiology
a. Peptic ulcers are localized erosions of the innermost mucosal
layer of the digestive tract (Krumberger, 2005).
i. Duodenal ulcer affects the upper part of the small
intestine.
ii. Gastric ulcer affects the lining of the stomach.
iii. Common causes of ulcers include infection with
Helicobacter pylori; alcohol, aspirin, and aspirincontaining
medicines; and various other medicines, such
as nonsteroidal anti-inflammatory drugs (NSAIDs), used
for arthritis.
b. Tear in the mucosa at the gastroesophageal junction
(Mallory-Weiss syndrome) can occur as a result of severe
vomiting, trauma, or seizures.
c. Hemorrhagic gastritis or stress ulcer can occur as a result of
severe physiological stress, such as trauma, burns, surgery,
or alcohol abuse (Krumberger, 2005).
d. Esophageal varices is generally associated with alcoholic or
post-hepatitis cirrhosis of the liver; approximately 30% of
such patients experience hemorrhage (Sartin, 2005).
e. Esophageal or gastric cancer
f. Hiatal hernia, hemophilia, leukemia, and disseminated
intravascular coagulation (DIC) are less common causes of
upper gastrointestinal bleeding (UGIB).

III. Statistics (Varma & Allen, 2005)
a. Morbidity: Gross bleeding into the GI tract is responsible
for about 2% of all emergency medical visits in the United
States, with approximately 300,000 hospitalizations
annually.
b. Mortality: Rate is approximately 10%.
c. Cost: Estimated at $2.5 million annually in the United
States.

Care Setting
Generally, a client with severe, active bleeding is admitted
directly to a critical care unit; however, a client may develop
GI bleeding on the medical-surgical unit or be admitted there
for evaluation or treatment of subacute bleeding.

Related Concerns
Cirrhosis of the liver
Fluid and electrolyte imbalances
Psychosocial aspects of care
Renal failure: acute
Gastrectomy/gastric resection

Nursing Priorities
1. Control hemorrhage.
2. Achieve and maintain hemodynamic stability.
3. Promote stress reduction.
4. Provide information about disease process and prognosis,
treatment needs, and potential complications.
Discharge Goals
1. Hemorrhage curtailed.
2. Hemodynamically stable.
3. Anxiety and fear reduced to manageable level.
4. Disease process and prognosis, therapeutic regimen, and
potential complications understood.
5. Plan in place to meet needs after discharge.

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