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GI Bleeding Nursing Care Plan and Interventions
GI bleeding nursing care starts with the airway, two large-bore IVs and NPO status, then fluids and blood as ordered while trending hemoglobin, BP and heart rate. Watch for hypovolemia, describe the blood you see (bright red, coffee-ground, melena) and prepare the client for endoscopy.
GI bleeding nursing care plan
| Nursing problem | Goal | Key interventions |
|---|---|---|
| Deficient fluid volume (blood loss) | BP and HR stable, urine output adequate, hemoglobin steady. | |
| Risk for aspiration (vomiting blood) | Airway protected; no aspiration. | |
| Risk for rebleeding | Bleeding source treated; stable trend after endoscopy. | |
| Health maintenance: needs teaching | Knows which drugs to avoid and the signs of a new bleed. |
Problem wording is plain-language nursing diagnosis style. Your program may require NANDA-I labels and your own assessment data.
What it is
GI bleeding: upper vs lower
Upper: esophagus, stomach or duodenum (above the ligament of Treitz). Lower: below that point, usually the colon or rectum. 1
Bleeding can be overt (you see it) or occult (found only by testing the stool).
Common causes
Upper: peptic ulcer (most common), esophageal varices, a tear after retching (Mallory-Weiss). Lower: diverticulosis, hemorrhoids, cancer. 1
Risk rises with NSAIDs, aspirin, anticoagulants, clopidogrel, SSRIs and liver disease.
Assessment: what you will see
Hematemesis vs coffee-ground emesis
Red vomited blood means active upper GI bleeding. Coffee-ground vomit means bleeding that slowed or stopped, darkened by stomach acid. 1
Coffee-ground emesis is still blood. Report it and assess for volume loss.
Melena: black, tarry stool
Usually an upper GI source. It takes about 100 to 200 mL of blood, and it can last for days after the bleeding stops. 1
Iron or bismuth also turns stool black, but without blood. Test the stool for occult blood.
Hematochezia: blood from the rectum
Bright red blood from the rectum usually means a lower GI source. A brisk upper bleed can cause it too when blood moves fast. 1
Blood only on toilet paper: hemorrhoids or a fissure. Blood mixed into stool: a higher source.
Labs: read the trend
Hemoglobin and hematocrit can look normal at first, then fall. BUN may rise. Also check platelets, PT and PTT, and a type and crossmatch. 2,1
A normal first hemoglobin does not rule out a big bleed. Repeat it as ordered and compare.
Complications and red flags
Hypovolemia from blood loss
Early restlessness or anxiety, HR over 100, cool clammy skin, low urine output, flat neck veins. BP falls late. 3,4,1
Heart disease: blood loss can trigger angina or an MI. Liver disease: it can trigger encephalopathy.
Priority: what the nurse does first
Priorities: airway, access, NPO
Protect the airway: aspirated blood is a major danger in upper GI bleeds. Two large-bore IVs (14 to 16 gauge). Keep the client NPO. 1,2
Vomiting blood with a falling level of consciousness: intubation may be needed before endoscopy.
Nursing interventions and treatment
Volume: fluids, then blood
Rapid isotonic crystalloid (normal saline or lactated Ringer's) as ordered, then packed red blood cells for ongoing loss. 1,5,2
Lost blood: replace with blood. Confirm transfusion consent first.
Meds for GI bleeding
IV PPI (such as pantoprazole) for a suspected or confirmed ulcer bleed. IV octreotide for variceal bleeding. Meds go IV while NPO. 1,2
Variceal bleed in cirrhosis: octreotide plus a preventive IV antibiotic, then banding.
Endoscopy finds and fixes
Upper endoscopy for upper bleeds, colonoscopy for lower. Bleeding ulcers can be clipped or cauterized; varices can be banded. 1
Most lower GI bleeds and many upper bleeds stop on their own, but some come back.
Evaluation: is care working?
Evaluate: stable or still bleeding?
Stable: urine at least 30 mL per hour, HR 60 to 100, MAP 65 or higher, steady hemoglobin, normal level of consciousness. 3,1
Heart rate still climbing despite fluids, or fresh red vomit: suspect the bleeding has not stopped.
Client teaching
Teaching after a GI bleed
Avoid NSAIDs and alcohol unless the provider approves. Take PPIs and H. pylori treatment as ordered. Ask before stopping a blood thinner. 1,6
Report black or bloody stools, vomiting blood, dizziness or fainting right away.
NCLEX traps
No orthostatic vitals in a severe bleed
Standing a client with severe bleeding can cause fainting, and the readings are unreliable. Use HR, BP, mental status and urine output. 1
A small bleed may show only a heart rate just over 100, or no signs at all.
Keep studying gi bleeding in NurseLingo Pro
Everything for gi bleeding in one place. A free account gets 5 free opens of any condition; Pro opens all 277.
Test yourself: free med-surg practice questions with answers and rationales.
Frequently asked questions
What are the priority nursing diagnoses for gi bleeding?
Common nursing problems for gi bleeding include deficient fluid volume (blood loss); risk for aspiration (vomiting blood); risk for rebleeding; health maintenance: needs teaching. Choose the ones your assessment supports and rank airway, breathing and circulation problems first.
What does the nurse do first for gi bleeding?
Protect the airway: aspirated blood is a major danger in upper GI bleeds. Two large-bore IVs (14 to 16 gauge). Keep the client NPO.
What is upper gastrointestinal bleeding?
Bleeding from the esophagus, stomach or duodenum, above the ligament of Treitz. Signs include vomiting bright red blood or coffee-ground material and black, tarry stools (melena). Common causes include peptic ulcers and esophageal varices.
More gi & liver
Related cheat sheets
Sources
- merckmanuals.com
- OpenStax Medical-Surgical Nursing, 35.5
- OpenStax Medical-Surgical Nursing, 23.2
- OpenStax Medical-Surgical Nursing, 10.2
- OpenStax Pharmacology for Nurses, 22.3
- OpenStax Medical-Surgical Nursing, 19.4
For study only, not medical advice. Follow your program, your facility's policies and the provider's orders.