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Jose Reyes Memorial Medical Center Rizal Ave.

, Manila

A Case Study On

Upper Gastrointestinal bleeding, secondary to bleeding peptic ulcer disease

Presented by: Micah Jonah B. Elicaño

Hematochezia (red blood per rectum) usually indicates bleeding distal to the ligament of Treitz. Upper gastrointestinal bleeding (UGIB) is a significant and potentially life-threatening worldwide problem. Occasionally. mortality and morbidity have remained constant. rapid bleeding from an upper GI source may result in hematochezia. Although more than 75% of cases of bleeding cease with supportive measures. which has an overall mortality rate of 10%. More than 350.INTRODUCTION Upper gastrointestinal (GI) bleeding occurs when the inner lining (mucosa) of the esophagus. Coffee-ground emesis results from precipitation of blood clots in the vomitus. Upper gastrointestinal bleeding (UGIB) is defined as hemorrhage that emanates proximal to the ligament of Treitz. and interventional radiologists. Typically patients present with bleeding from a peptic ulcer and about 80% of such ulcers stop bleeding. Peptic ulcer is the most common cause. and effective treatment depends on identification of the source of the bleeding and expeditious administration of therapy. life-threatening bleeding. it is dark red. a significant percentage of patients require further intervention. It is important to identify patients with a low probability of re-bleeding from patients with a high probability of re-bleeding. The color of the vomitus depends on its contact time with the hydrochloric acid of the stomach. Increasing age and co-morbidity increase mortality. or when the blood vessels themselves rupture. Despite advances in diagnosis and treatment. Bleeding from the upper gastrointestinal tract (GIT) is about 4 times as common as bleeding from the lower GIT. A variety of conditions can cause GI bleeding. Varices are dilated blood vessels found most frequently in the esophagus and stomach. If vomiting occurs early after the onset of bleeding. Upper GI bleeding can be divided into two broad categories: variceal bleeding and nonvariceal bleeding. Ulcers are most likely to occur in the stomach and duodenum and less . it appears red. exposing the underlying blood vessels. UGIB often causes hematemesis (vomiting of blood) or melena (passage of stools rendered black and tarry by the presence of altered blood). surgeons. which often involves the combined efforts of gastroenterologists. It is a common and potentially life-threatening condition. An ulcer bleeds when the blood vessels at the base of the ulcer are disrupted. with delayed vomiting. brown. stomach. Upper GI bleeding can range in severity from clinically inapparent (insignificant) to large-volume. or black. or proximal small intestine (duodenum) is injured.000 hospital admissions are attributable to UGIB. Non-variceal upper gastrointestinal bleeding can be caused by a variety of conditions. Clinically.

OBJECTIVES General objectives: This case study focuses on the advancement of my skills in managing and administering the extensive range of my intervention to my client with Upper Gastrointestinal Bleeding (UGIB). 3. I choose this case because I want to learn why gastrointestinal bleeding occurs. And as a health care provider I need to know more about the disease in order for me to establish rapport to my patient and how to deal with it.frequently in the esophagus. . Ulcers are caused most commonly by an infection with the bacterium Helicobacter pylori or use of nonsteroidal anti-inflammatory drugs. To formulate and apply necessary nursing care plans utilizing the nursing process. 5. 4. Indeed. To enhance my knowledge about GI bleeding. To define what is Upper Gastrointestinal Bleeding (UGIB). This study will further help me to expand my knowledge about the said disease. To trace the pathophysiology of UGIB. 2. To enumerate the different signs and systems of UGIB. To established good rapport to the client and to get the physical assessment. Specific objectives: 1.

She has no allergies in foods and medication. Upon assessment. medical consultation was done at Medical City hospital found decrease hemoglobin and admitted there for four days transfused with 5 units of PRBC. Pulse rate= 101 bpm.7C.D. consultation at Jose Reyes Memorial Medical Center had made. One week prior to admission the client consulted at bulacan hospital. Adraneda Melena and Abdominal pain Upper Gastro Intestinel Bleeding problem secondary to Bleeding Peptic Ulcer Disease HISTORY OF PRESENT ILLNESS Two weeks prior to admission the client experienced melena 1-2 episode per day amounting approximately 20-30cc per stool.D.M. But she is a smoker and can consume 1/2 packs of cigarette a day. Thus.D. 2013 Dr. Respiratory rate= 23 cpm . BP= 120/80 mmHg. Temp.. Thus. 77 yrs old July 5. The client experiences persistent vomiting and passage of black tarry stool for 2 weeks.M. no document available still prsistence of melena. 1936 Quezon Province Roman Catholic Filipino July 3. PAST HEALTH HISTORY Clinet D. She also stated that before she drinks alcohol occasionally.M. = 37. She is hypertensive and not diabetic. Colonoscopy and endoscopy found to be normal however. She never undergoes any procedure.Biographic Data Name: Age: Birthdate: Birthplace: Religion: Nationality: Admission Date: Attending Physician: Chief Complaint: Admitting Diagnosis: Client D. has no previous hospitalization. the following data was obtained from Client D.

She usually drinks 5-6 glasses of water per day. During his hospital stay. “ unti lang ang nauubos kong pagkain mga wala pa sa kalahati”. and sometimes talk with friends and family. She said she frequently drinks coffee. He sometimes spends his time doing his usual household chores as his exercise.PERCEPTION/ HEALTH MANAGEMENT PATTERN The patient is almost generally the same as how every Filipino seeks health assistance. he has a black-tary color of stool. He said he had difficulty in sleeping because of the pain he felt in his abdomen. NUTRITIONAL/ METABOLIC PATTERN The patient eats three times a day but wasnt able to finished the served meal given to her. He said that every time he defecates. He urinates an average of 850 cc per shift (8 hours) with yellowish colored urine. when he is at home.HEALTH. he had difficulty in defecating and when he push to do so. SLEEP. his stool has a blood. During his hospitalization he defecates three to four times a day. ELIMINATION PATTERN According to the patient. During his confinement his leisure time is talking to his daughter. She is pale to look at. He said he drinks alcohol everytime he wants especially when some of his friends invite him after farming.REST PATTERN The patient sleeps for an average of 8 hours per day before his confinement. she would not approach health workers not unless it is life threatening. Without any problem regarding her health. . he usually sleeps for 5-6 hours and takes nap in the morning and afternoon. She said that she usually eat foods with soup like sinigang and nilaga so that she can easily swallow the food. She stated. The patient consumed whole share of food with fair appetite. Patient complaints pain a year ago but tolerated it. ACTIVITY/ EXERCISE PATTERN He spent most of his time doing things on the farm.

The eldest is married and the two are helping him in farm. COGNITIVE/ PERCEPTUAL PATTERN Patient X is conscious. his wife wants to stay with him as well as his children but they can’t because they need to work to earn money for his hospitalization. well oriented to time.SELF-PERCEPTION/ SELF-CONCEPT PATTERN “pobre gihapon. but it affects to his family since they had a big problem financially. VALUE/ BELIEF PATTERN Patient X is a Roman Catholic. Misamis Oriental and as for his hospitalization expenses. ROLE/RELATIONSHIP PATTERN Patient X is married. place and person and is in a calm emotional state. He always goes to church every Sunday with his family. a farmer and has 3 children. His vital support group is his family and significant others. He exhibited appropriate behavior and response when communicating and has not experienced any dizziness or tingling sensation. COPING/ STRESS-TOLERANCE PATTERN “kapoy mag puyo ug hospital labi na ug wla kay kwarta ika bayad” as verbalized. The patient lives with his family in Salay. pero malipayon. his family especially his son find ways just to pay the bill. He thinks that God is vital to everyone and he trusts in God on whichever turn his . His family feels worried about the situation. Problima sa ibayad” as verbalized. The patient verbalized that being hospitalized was not a change for him.

. He says that hospitalization truly interferes. as he can’t go to church because of his illness.condition will be.