UPPER

GASTROINTESTIN
AL BLEEDING
CASE PRESENTATION
BSN 3-1
 GROUP MEMBERS
Padiernos, Astrid Jody
Pangilinan, Riz-Ann
Parocha, Lanrose
Romero, Roman Tristan Glenn
Tumibay, Noreen Lianne
Vitales, Jasmin Mae
 GENERAL OBJECTIVE
After the case presentation, the patient, patient’s family members,
health professionals, and nursing students will be able to acquire
knowledge about the patient’s condition, familiarize themselves with
the clinical manifestations, etiology, and upper gastrointestinal bleeding
complications. Additionally, the nursing students will develop effective
treatment plans and nursing interventions for patients having this kind
of disease.
 SPECIFIC OBJECTIVES
At the end of the presentation, the nursing students must be able to
:
1. Present a thorough general assessment which includes physical
examination and family history taking.
2. Illustrate the pathophysiology and physiologic response of the
body.
 SPECIFIC OBJECTIVES
3. Recognize common causes and underlying disease processes
of upper gastrointestinal bleeding.
4. Understand and discuss upper gastrointestinal bleeding
management, including the medical and pharmacological
approach and the possible side effects of the drugs.
 SPECIFIC OBJECTIVES

5. Develop an appropriate nursing diagnosis and

nursing care plans based on the identified problems.
6. Apply appropriate nursing interventions necessary
for the patient’s condition.
 OVERVIEW OF THE EXISTING
HEALTH PROBLEMS
 Upper GI bleeding (UGIB) is defined as bleeding derived
from a source proximal to the ligament of Treitz.
 OVERVIEW OF THE EXISTING
HEALTH PROBLEMS

The most common causes of UGIB are:

 Peptic Ulcer
 Esophagitis
 Gastritis
 OVERVIEW OF THE EXISTING
HEALTH PROBLEMS
Epidemiology
 Upper gastrointestinal bleeding (UGIB), especially peptic ulcer
bleeding, remains one of the most important causes of
hospitalization and mortality worldwide (Sung et al., 2011).
 Every year, approximately 100,000 people in the United States go to
the hospital for upper GI bleeding, and in-hospital mortality remains
high (13%), and rebleeding is common (15%).
 OVERVIEW OF THE EXISTING
HEALTH PROBLEMS
Epidemiology
 In the United Kingdom, UGIB accounts for 70,000
hospital admissions each year.
 In a nationwide study from Spain, UGIB was six times
more common than lower GI bleeding
 Mortality rates: 6%-10% overall.
 OVERVIEW OF THE EXISTING
HEALTH PROBLEMS

Who is more likely to have GI bleeding?

 UGIB is twice as common in men as in women and

increases in prevalence with age (>60 y). However,

the death rate is similar in both sexes.

 DEFINITION OF CASE

UPPER GASTROINTESTINAL BLEEDING

(UGIB)
 The upper gastrointestinal bleeding (UGIB) is
defined as bleeding within the intraluminal
gastrointestinal tract from any location between the
upper esophagus to the duodenum at the ligament of
Treitz.
 It is one of the important medical emergencies
worldwide.
 UGIB can be acute, occult, or obscure. 
 DEFINITION OF CASE

Signs and Symptoms of UGIB:

 bright red blood in vomit (hematemesis)
 DEFINITION OF CASE

Signs and Symptoms of UGIB:

 black or tarry stool (melena)
 DEFINITION OF CASE

Signs and Symptoms of UGIB:

 vomit that looks like coffee grounds
 DEFINITION OF CASE

Signs and Symptoms of UGIB:

 dark or bright red blood mixed with stool
 DEFINITION OF CASE

Signs and Symptoms of UGIB:

 cramps in the abdomen
 DEFINITION OF CASE

Signs and Symptoms of UGIB:

 cramps in the abdomen
 dizziness or faintness
 DEFINITION OF CASE

Signs and Symptoms of UGIB:

 cramps in the abdomen
 dizziness or faintness
 feeling tired
 DEFINITION OF CASE

Signs and Symptoms of UGIB:

 cramps in the abdomen
 dizziness or faintness
 feeling tired
 paleness
 DEFINITION OF CASE

Signs and Symptoms of UGIB:

 cramps in the abdomen
 dizziness or faintness
 feeling tired
 paleness
 shortness of breath
 DEFINITION OF CASE

Signs and Symptoms of UGIB:

 cramps in the abdomen
 dizziness or faintness
 feeling tired
 paleness
 shortness of breath
 weakness
 DEFINITION OF CASE
Causes can include:
I. Peptic ulcer - most common cause of upper GI bleeding.
 DEFINITION OF CASE
Causes can include:

II. Tears in the lining of the

tube that connects your
throat to your stomach
(esophagus)
- Known as Mallory-Weiss
tears, they can cause a lot of
bleeding.
 DEFINITION OF CASE

Causes can include:

III. Abnormal, enlarged veins

in the esophagus (esophageal
varices)
 DEFINITION OF CASE

Causes can include:

IV. Esophagitis
 DEFINITION OF CASE

Causes can include:

V. Angiodysplasia
 DEFINITION OF CASE

Causes can include:

V. Angiodysplasia
VI. Colitis
 DEFINITION OF CASE

Causes can include:

V. Angiodysplasia
VI. Colitis
VII. Gastritis
 DEFINITION OF CASE

Complications:
A gastrointestinal bleed can cause:
 Shock
 Anemia
 Death
 PATIENT’S DATA
BIOGRAPHY DATA:
Patient: Pt. X
Sex: Male
Age: 37 years old
Address: Sta Rosa, Nueva Ecija
Civil Status: Single
Nationality: Filipino
Religion: Roman Catholic
 PATIENT’S DATA

ADMITTING HISTORY:
Admission Date: March 22, 2021
Time: 1:20 PM
Diagnosis: Upper Gastrointestinal
Bleeding (UGIB); t/c Anemia
CHIEF COMPLAINT:
Patient experienced vomiting of blood and
had a passage of black stool
 PATIENT’S DATA

HISTORY OF PAST ILLNESS:

I. Past Health History:
Patient had undergone operation of Anastomosis of
Intestines.
Patient was also a alcohol drinker and smoker.

II. Family Health History:

History of HPN on father side and father died due
to stroke
 PATIENT’S DATA

STATUS OF PRESENT ILLNESS:

Patient had passage of black stool, no
medication was given. After few hours of
PTA, patient still had 1 episode of
passage of black stool accompanied with
vomiting of fresh blood hence consult
and admit.
 PATIENT’S DATA

NEUROLOGIC ASSESSMENT:
LOC: GCS 15
Pupils: 3(mm)
Deep tendon reflexes: normal

PHYSICAL EXAMINATION:
Vital Signs (Day 1):
Temp: 36.5 C
PR: 65 bpm
RR: 18 cpm
BP: 100/70 mmHg
 PHYSICAL ASSESSMENT
BODY PARTS NORMAL FINDINGS ACTUAL FINDINGS ANALYSIS/RESULT
Skull Rounded, smooth skull Head Size: normocephalic Normal findings.
contour, absence of nodules Shape: round,
and masses. Normal head symmetrical
circumference for 8-month-
old is 44.5 cm.

Scalp Absence of dandruff, no Not examined. No findings.

mass and nodules, no
redness and inflammation.

Hair Evenly distributed hair, thick Evenly distributed, black Normal findings
hair, no signs of infection, in color, (-) abnormalities
and no presence of dandruff,
silky and resilient hair.
 PHYSICAL ASSESSMENT
Face Has symmetric facial features and
movements.
Eyes Eyebrows and eyelashes are
evenly distributing. The eyelids
have no discharge and no
discoloration of pupils. Pupils are
black in color, round, equal in size
normally 3-7 mm in diameter,
reactive to light and
accommodation; conjunctiva pink
in color, the sclera is white in color.
Symmetrical / no facial Normal findings.
asymmetry
Anicteric sclera Pale conjunctiva is a sign that
Pupil response: PERRLA the patient is dehydrated
(Pupils are equal, round, related to blood loss when
and reactive to light vomiting
and accommodation)
Pale conjunctiva

Ears Color same as facial skin, Symmetrical discharge Normal findings.

symmetrical, auricle aligned with
outer cantus of eyes about 10
degree from vertical, not tender;
pinna recoils after it is folded and
able to hear sounds in both ears.
 PHYSICAL ASSESSMENT
Nose and Symmetric and straight no Moist discharge Normal findings.
Paranasal discharge or flaring, uniform in
sinuses color same as facial skin. No
tenderness and no lesions.
Mouth Lips pink in color, soft, moist, no lesions, no swelling One of the first signs of a
smooth texture, able to purse Dry lips mild dehydration is a dry lips.
lips; the teeth are smooth,
white, firm texture to the
gums. Tongue is in central
position, pink in color and
moist.
Neck Muscle equal in size head (-) growth Normal findings.
centered; head movement is
coordinated and in smooth
movement. No enlarge lymph
node.
 PHYSICAL ASSESSMENT
Chest Quiet, rhythmic respiration, Normal; bronchial sounds Bronchial sounds may be
normal breathing rate, no upon auscultation due to because he was a
difficulty seen when breathing. smoker and alcohol
No retractions when breathing. drinker.
Symmetrical.
Heart Peripheral pulses all present and 65 bpm pulse rate. Normal findings.
strong, heart rate regular and 100/70 mmHg
strong, no tenderness, heart
sounds clear and strong, (-)
murmur. Normal BP for infant is
80 to 100/55 to 65 mm Hg.
Normal pulse rate is 80 to 160
beats per minute

Abdomen Uniform in color, no evidence of Tenderness on the Normal findings.

enlarged liver or spleen. Audible epigastric region with
bowel sounds, absence of midline scar due to
arterial bruits, absence of friction previous operation
ribs. No tenderness.
 PHYSICAL ASSESSMENT
Extremities Convex curvature, angle of
nail plate 160 degrees,
smooth texture. When
performing blanch test for
capillary refill it is prompt
return to usual color (2-3
secs). Normal gait. No
restriction of movement
(+) muscle weakness. Weakness of the muscle
Limited ROM and limited restriction of
movement is a signs of
Anemia which occurs
when a person’s
hemoglobin levels are low,
often due to an iron
deficiency.
 PHYSICAL ASSESSMENT

Skin Uniformed in color except in Smooth, (-) Due to dehydration

the areas exposed to the abnormalities,
sun, no edema present and pale color
no other lesions.

Genital Area No lesion, rash, redness, or Not examined. No findings.

abnormal pigmentation. No
bleeding and discharges. No
mass and no signs of
infection.
 ANATOMY & PHYSIOLOGY

GASTROINTESTINAL TRACT

• Gastrointestinal tract, also

called digestive tract or alimentary
canal, pathway by which food enters the
body and solid wastes are expelled.
 ANATOMY & PHYSIOLOGY
Upper Gastrointestinal Tract
• It digests your food and prepares it for
processing and utilizing nutrients
throughout the body.
• As you chew your food, saliva begins
to break down the food – starting the
digestive process. Once food is
swallowed, it travels down the
esophagus and into the stomach for
full digestion.
ESOPHAGUS

STOMACH

DUODENUM
 ANATOMY & PHYSIOLOGY
Lower Gastrointestinal Tract
• The contents of the small intestine
empty into the large intestine, which
is also called the colon. While food
travels through the colon, the water
and salts are absorbed.
• Once the nutrients are removed from
the food, the remaining materials
become stool – which moves into the
rectum to be expelled from the body
as waste.
LARGE SMALL
INTESTINE INTESTINE

ANUS
pathophysiology
 H. Pylori (gram
NSAIDs Stress induced
negative bacteria)

Toxin
release Ischemic
COX-1 Toxicity to
inhibition Gastric
Inflammatory epithelial In ICU
response cells setting
Decreased
prostaglandins
Inhibition
of H+
detection
in gastric H+
antrum production,
gastric
H+ over- mucous
secretion production

Mucosal Injurious
Gastroprotective Factors
Substances
 Gastroprotective Factors: Mucosal Injurious
• Mucous Substances
• Blood Flow • Acid
• Epithelial Cells • Toxins
Erosion of Mucosa
• Prostaglandins

PEPTIC ULCER
(Erosion into blood
vessels)

UPPER GASTROINTESTINAL BLEEDING

Bleeding into Bleeding into
stomach esophagus

Blood passes Blood gets oxidized

through GI tract, by HCl but moves
becomes oxidized back into esophagus
by HCl & digestion
 UPPER GASTROINTESTINAL BLEEDING

Bleeding into Bleeding into

stomach esophagus

Blood passes Blood gets oxidized HEMATEMESIS

through GI tract, by HCl but moves (Vomiting of
blood)
becomes oxidized back into esophagus
by HCl & digestion

COFFEE-
MELENA GROUND
(black, tarry, EMESIS
foul-smelling
stool)
 H. pylori
Decreased in
Increased acid
Alcohol and production of Reduced
Smoking
secretion with
Bicarbonate Blood Flow
back diffusion Buffer
NSAIDs

Direct damage Disruption of

GASTRITIS to Epithelium Mucus Layer
 GASTRITIS

MELENA
EPIGASTRIC NAUSEA & HEMATEMESIS (black, tarry,
PAIN VOMITING (Vomiting of blood) foul-smelling
stool)
 SIGNS AND SYMPTOMS

● black or tarry stool
 SIGNS AND SYMPTOMS

● black or tarry stool
● Vomitus of bright red blood
 SIGNS AND SYMPTOMS

● black or tarry stool
● Vomitus of bright red blood
● Paleness
● Weakness
 LABORATORY STUDY

Examination Result Normal Values

HEMOGLOBIN 73 g/dl ( MALE – 130-180 g/dl)
 

HEMATOCRIT 0.22 g/dl ( MALE – 0.40-0.54 g/dl

 

TOTAL WBC 12.4 5-10x10 9/L

Blood type A+  
 DIAGNOSTIC EXAMINATIONS

Gastric Lavage
DIAGNOSTIC EXAMINATIONS

Gastric Lavage
Endoscopy
DIAGNOSTIC EXAMINATIONS

Gastric Lavage
Endoscopy

Abdominal CT Scan
VIII. MEDICAL MANAGEMENT

● Blood transfusions
● Upper endoscopy
● Administer antibiotics as prescribed
NURSING CARE
PLAN
X. NURSING CARE PLAN
X. NURSING CARE PLAN
X. NURSING CARE PLAN
DRUG STUDY
 XI. DRUG STUDY
Generic Name Name of Action/Contraindications/Si Nursing
Medication
Dosage
de effects Implications/Nursing
(Brand Name) Responsibilities
Metoclopramide Copra, Emex, 10mg-3x a day Action: -Assess for extrapyramidal
Maxeran, symptoms and tardive
Anti cholinergic, Anti emetic
dyskinesia(more likely in older
maxolon,
Contraindications: patients)
Reglan
Patient with gastrointestinal -Assess for gastrointestinal
obstruction, perforation, or complaints such as nausea,
haemorrhage, phaechromycytoma, vomiting and constipation
breastfeeding
-For oral administration, better
Side Effects: absorption allow 30 min to one
hour before eating
Extrapyrimidal effects,
Hyperprolactinemia, Tardive -Instruct the patient to avoid
dyskinesia, drowsiness, alcohol or other CNS
restlessness, diarrhea depressants

Depression, neuroleptic malignant -An overdose could cause

syndrome, drowsiness and muscle
spasms. The doctor should be
Rashes and pruritus notified
 XI. DRUG STUDY
Generic Name of Dosage Action/Contraindications/Si Nursing Implications/Nursing
Medication de effects Responsibilities
Name (Brand Name)
PO-20mg OD x Action: -Assess for possible contraindications and
Omeprazole Prilosec caution hx of allergy to a proton pump inhibitor
4-8 weeks
Gastrointestinal Agent,
-Inspect the skin lesion, rash, pruritus and
Dual therapy: Proton pump inhibitor dryness to identify possible adverse effects.
Prilosec 40mg +
Clarithromycin Contraindications: -monitor the patients response to the
500mg dosage(relief of GI symptoms caused by
Patients that manifest hyperacidity, healing of erosive Gi lesions
+Amoxicillin
100mg
hypersensitivity reactions
-Monitor improvements in GI symptoms
,anaphylaxis, angioedema, (gastritis, heartburn, and so forth) to help
bronchospasm, acute determine if drug therapy is successful.
intestinal nephritis and -Monitor any chest pain and attempt to
urticaria determine if pain is drug induced or caused by
cardiovascular dysfunction
Side Effects:
-Assess dizziness that might affect gait,
Includes stomach pain, balance, and other functional activities. Report
diarrhea(watery or bloody), balance problems and functional limitations to
seizure(convulsions), little or the physician, and caution the patient and
family/caregivers to guard against falls and
no urine, hematuria, rapid trauma.
wt.gain, dizziness, muscle
-Monitor the effectiveness of the teaching plan.
cramps and headache
 
 XI. DRUG STUDY
Generic Name of Dosage Action/Contraindications/Sid Nursing Implications/Nursing
Medication e effects Responsibilities
Name (Brand Name)
PO-375mg-625 mg Action: - Assess for Hx of allergies to penicillins,
Co-Amoxiclav Amoxicillin- cephalosporins, or other allergens; renal
or thru IV-1.2g TID Antibiotic
clavulanate disorders; lactation
Capsules: 250 mg, Contraindications: -Obtain Physical: Culture infected area; skin
500 mg (3) color, lesion; R, adventitious sounds; bowel
Patients that has a hx of a serious
sounds, Refer for CBC, LFTs, renal function
Tablets: 500 mg, hypersensitivity reaction (e.g.,
tests, serum electrolytes, Hct, urinalysis
875 mg (3) anaphylaxis or Stevens-Johnson
syndrome) to AMOXIL or to other -Teach the patient to take this drug around-
Powder for Oral beta-lactams the-clock.
Suspension: 125 (e.g., penicillins or cephalosporins) -remind the patient to take the full course of
mg/5 mL, 200 mg/5 therapy; do not stop because you feel better.
mL, Side Effects:
-Educate the patient that this antibiotic is
  Includes diarrhea, rash, nausea and specific for this problem and should not be
vomiting, Abdominal or stomach used to self-treat other infections.
cramps or tenderness, tarry stools,
bleeding gums, blood in the urine, -Explain to the patient that he/she may
chest pain, chills, difficulty with experience these side effects: Nausea,
breathing, difficulty with swallowing, vomiting, GI upset (eat frequent small meals);
Dizziness, fast heartbeat, feeling of diarrhea; sore mouth (frequent mouth care
may help).
discomfort, fever, general body
swelling -Tell the patient to report unusual bleeding or
bruising, sore throat, fever, rash, hives, severe
 
diarrhea, difficulty breathing.
 XI. DRUG STUDY
Generic Name of Action/Contraindications/ Nursing Implications/Nursing
Medication
Dosage
Side effects Responsibilities
Name (Brand Name)
Anexamic acid, IV-500 mg Q6 Action: - Monitor blood pressure, pulse, and respiratory status
Tranexamic as indicated by severity of bleeding.
cyklokapron, For CABG:IV-10 to
Acid lysteda
Antifibronolytic agent
15mg/kg over -Monitor for overt bleeding every 15–30 min.
Contraindications:
20mins. -Monitor neurologic status (pupils, level of
Patients that experience increased
For Hyphema:PO- consciousness, motor activity) in patients with
risk of blood clotting, fluid
25mg/kg Q8hd for 5- accumulation in the brain, a heart subarachnoid hemorrhage.
7 days attack, acute blood clot in a blood -Assess for thromboembolic complications.(especially
vessel supplying the lungs, heart in patients with history). Notify physician of positive
valve disease, a stroke and Homans’ sign, leg pain hemorrhage, edema,
obstruction by blood vessel by a
hemoptysis, dyspnea, or chest pain.
blood clot.
-Monitor platelet count and clotting factors prior to and
Side Effects:
periodically throughout therapy in patients with
Includes headache, tiredness, systemic fibrinolysis.
sinus pain, back pain, stomach
pain ,bone, joint, or muscle pain, -Stabilize IV catheter to minimize thrombophlebitis.
hives, rash, itching, difficulty Monitor site closely
breathing or swallowing, swelling of -Instruct patient to notify the nurse immediately if
the face, throat, tongue, lips, eyes, bleeding recurs or if thromboembolic symptoms
hands, feet, ankles, or lower legs,
develop.
hoarseness, changes in vision,
including color vision, chest pain, -Caution patient to make position changes slowly to
shortness of breath avoid orthostatic hypotension.
 
 DISCHARGE PLANNING

1.Activities:
Rest as directed.
Ask when you can return to your
usual activities, such as work.
 DISCHARGE PLANNING

2.Diet: A special diet can help treat GI conditions and prevent

problems such as GI bleeding.
 Eat small meals more often while your digestive system heals.
 Avoid or limit caffeine and spicy foods as well as foods that
cause heartburn, nausea, or diarrhea.
 Consulting with a dietician in planning meals that are
appropriate can help.
 DISCHARGE PLANNING

3.Prevention:
• Medicines
Take all medicines for these conditions as directed.
Ask your healthcare provider if it is safe for you to take
NSAIDs.

• Do not drink alcohol

Alcohol can cause ulcers and esophageal varices. Over time
the blood vessels become weak and may bleed
 DISCHARGE PLANNING

3.Prevention:
• Do not smoke
Nicotine and other chemicals in cigarettes and cigars
can increase your risk for ulcers.

• Asepsis
If you have had surgery, to care for your surgical
wound, wash your hands before changing the dressing
and after disposing of the dressing.
 DISCHARGE PLANNING
4.Follow-up care is a key part of your treatment and safety:
 Be sure to make and go to all appointments.
 They should have prompt follow-up identified for
monitoring of their hemoglobin and referral to
gastroenterology for endoscopy or colonoscopy as
appropriate.
 REFERENCES
 Varma, M. (2018, November 19). Upper Gastrointestinal Bleeding Imaging.
Emedicine.Medscape. https://emedicine.medscape.com/article/417980-overview
 

 Gastrointestinal (GI) Bleeding. (n.d.). National Institute of Diabetes and Digestive and Kidney

Diseases. Retrieved March 25, 2021, from https://www.niddk.nih.gov/health-

information/digestive-diseases/gastrointestinal-bleeding/definition-facts
 Ahmed, A., Stanley, A.J. Acute Upper Gastrointestinal Bleeding in the Elderly. Drugs Aging 29, 933–940 (2012).
https://doi.org/10.1007/s40266-012-0020-5
 
 Gastrointestinal Bleeding. (n.d.). Drugs.Com. Retrieved March 28, 2021, from
https://www.drugs.com/cg/gastrointestinal-bleeding-discharge-care.html#:~:text=A%20special
%20diet%20can%20help,heartburn%2C%20nausea%2C%20or%20diarrhea

 
 REFERENCES
 
 Healthwise Staff. (2019, June 26). Upper Gastrointestinal Bleeding: Care
Instructions. MyHealth.Alberta.Ca.
https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=
zp4085
 
 Britannica, T. Editors of Encyclopaedia (2019, April 10). Gastrointestinal tract.
Encyclopedia Britannica. https://www.britannica.com/science/gastrointestinal-tract
 

 Diagnosis of GI Bleeding. (n.d.). National Institute of Diabetes and Digestive and

Kidney Diseases. Retrieved March 25, 2021, from

https://www.niddk.nih.gov/health-information/digestive-diseases/gastrointestinal-blee

ding/diagnosis
 REFERENCES
 
 

 Wayne, G. (2020, September 7). Fluid Volume Deficit (Dehydration) Nursing Care

Plan. Nurselabs. https://nurseslabs.com/deficient-fluid-volume/

 De Leon, G. (n.d.). NCP Activity Intolerance Related To Decreased in Oxygen Supply.

Scribd. Retrieved March 28, 2021, from

https://www.scribd.com/doc/61445304/Ncp-Activity-Intolerance-Related-to-Decreased-i

n-Oxygen-Supply

 Omeprazole (Rx, OTC). (n.d.). Medscape. Retrieved March 25, 2021, from

https://reference.medscape.com/drug/prilosec-omeprazole-341997
 END OF
PRESENTATION
THANK YOU!