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UPPER GASTROINTESTINAL/ESOPHAGEAL BLEEDING Bleeding duodenal ulcer is the most frequent cause of massive upper gastrointestinal (GI) hemorrhage, but bleeding may also occur because of gastric ulcers, gastritis, and esophageal varices. Severe vomiting can precipitate gastric bleeding as a result of a tear in the mucosa at the gastroesophageal junction (Mallory-Weiss syndrome). Stress ulcers are often associated with severe burns, major trauma/surgery, or severe systemic disease. Esophagitis, esophageal/gastric carcinoma, hiatal hernia, hemophilia, leukemia, and disseminated intravascular coagulation (DIC) are less common causes of upper GI bleeding. Note: Eighty percent to 90% of ulcer patients are now found to have Helicobactor pylori as an underlying cause. Because this organism is easily treated with anti-infectives, complications such as perforation and GI bleeding have dropped dramatically. CARE SETTING Generally, a patient with severe, active bleeding is admitted directly to the critical care unit (CCU); however, a patient may develop GI bleeding on the medical-surgical unit or be admitted there for evaluation/treatment of subacute bleeding. RELATED CONCERNS Cirrhosis of the liver Fluid and electrolyte imbalances, see Nursing Care Plan CD-ROM Psychosocial aspects of care Renal failure: acute Subtotal gastrectomy/gastric resection, see Nursing Care Plan CD-ROM Patient Assessment Database ACTIVITY/REST May report: Weakness, fatigue May exhibit: Tachycardia, tachypnea/hyperventilation (response to activity) CIRCULATION May report: Palpitations Dizziness with position change May exhibit: Hypotension (including postural) Tachycardia, dysrhythmias (hypovolemia/hypoxemia) Weak/thready peripheral pulse Capillary refill slow/delayed (vasoconstriction) Skin color: pallor, cyanosis (depending on the amount of blood loss) Skin/mucous membrane moisture: Diaphoresis (reflecting shock state, acute pain, psychological response) EGO INTEGRITY May report: Acute or chronic stress factors (financial, relationships, job-related) Feelings of helplessness May exhibit: Signs of anxiety, e.g., restlessness, pallor, diaphoresis, narrowed focus, trembling, quivering voice ELIMINATION May report: Change in usual bowel patterns/characteristics of stool May exhibit: Abdominal tenderness, distension Bowel sounds often hyperactive during bleeding, hypoactive after bleeding subsides Character of stool: Diarrhea; dark bloody, tarry, or occasionally bright red stools; frothy, foul-smelling (steatorrhea); constipation may occur (changes in diet, antacid use) Urine output may be decreased, concentrated
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FOOD/FLUID May report: Anorexia, nausea, vomiting (protracted vomiting suggests pyloric outlet obstruction associated with duodenal ulcer) Problems with swallowing; belching, hiccups Heartburn, indigestion, burping with sour taste Bloating/distension, flatulence Food intolerances, e.g., spicy food, chocolate; special diet for preexisting ulcer disease Weight loss May exhibit:
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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