Discuss what is happening on a cellular level with the disease process. Be careful to realize that patients have co-morbidities and you may need to discuss the other diseases impact on the pathophysiology and care of the patient. Three (3) resources after 2008 are required along with APA format.
GASTROINTESTINAL TRACT BLEEDING
Patient Profile
Maria, a 48 year-old woman was transferred from emergency department (ED) to transitional care unit (TCU) with a diagnosis of probable gastrointestinal (GI) tract bleeding and abdominal pain. Patient c/o nausea and vomiting blood x2 weeks.
Subjective Data:
-Has a history of alcohol abuse
-Has a history of poorly controlled peptic ulcer disease due to non-compliance with treatment
-Is overweight, but recently lost 10 pounds
-Work as an admission coordinator at local junior college
-Live with her spouse, who was recently diagnosis with prostate cancer
-Recently experienced the death of a her mother from cardiac arrest
 Physical Examination:
            B/P = 77/41 HR 49 RR 16 T (tympanic) 37.9 (100.2) O2 Sats 98% RA
            Lungs clear to auscultation, S-3 heart sound to auscultation
            Diaphoretic, short of breath, anxious
 Laboratory Studies
    NA 157          Serum K (potassium (3.0)
       Hgb 7.6         HCT: 22.8        PLTs 138
    RBC 3.32        WBC 11.6
Critical Thinking Questions:
1. Briefly explain the pathophysiology of the development of GI tract bleeding. What is the etiology associated with acute GI tract bleeding?
2. Identify common causes of GI tract bleeding and list predisposing factors specific to Maria.
3. Discriminate between the characteristics of upper and lower GI tract bleeding.
4. What complications did Maria experience?
5. Which factors determine whether blood products will be administered to a patient with GI tract bleeding?
6. Maria Hgb and Hct values dropped. Discuss the drop in Hgb and Hct values in relation to Maria blood loss.
7. If Maria continues to have active bleeding from the GI tract despite conservative management, what other medical procedures might be implement and why?
Sample Solution
Pathophysiology of Gastrointestinal (GI) Tract Bleeding
GI tract bleeding can occur anywhere in the digestive tract, from the esophagus to the rectum. The most common causes of GI tract bleeding are peptic ulcers, esophageal varices, and diverticulosis.
Peptic ulcers are sores that develop in the lining of the stomach or duodenum (the first part of the small intestine). They are caused by a combination of factors, including acid and pepsin (a digestive enzyme) produced by the stomach.
Esophageal varices are enlarged veins in the esophagus. They are caused by portal hypertension, which is high blood pressure in the portal vein. The portal vein carries blood from the digestive organs to the liver.
Full Answer Section
Diverticulosis is a condition in which pouches develop in the wall of the colon. These pouches can become inflamed and bleed, leading to diverticulitis.
Other causes of GI tract bleeding include:
- Cancer of the digestive tract
- Inflammatory bowel disease (IBD), such as Crohn's disease and ulcerative colitis
- Mallory-Weiss tear, which is a tear in the lining of the esophagus caused by vomiting
- Hemorrhoids, which are swollen veins in the rectum
- Anal fissures, which are small tears in the lining of the anus
Predisposing Factors Specific to Maria
Maria has a number of predisposing factors for GI tract bleeding, including:
- Alcohol abuse: Alcohol can irritate the lining of the stomach and duodenum, increasing the risk of peptic ulcers.
- Poorly controlled peptic ulcer disease: Peptic ulcers that are not properly treated can become larger and deeper, increasing the risk of bleeding.
- Overweight: Excess weight can increase the pressure on the stomach and duodenum, making them more likely to bleed.
- Recent weight loss: Rapid weight loss can lead to electrolyte imbalances, which can increase the risk of bleeding.
Characteristics of Upper and Lower GI Tract Bleeding
Upper GI tract bleeding occurs anywhere in the digestive tract above the ligament of Treitz, which is a band of tissue that separates the duodenum from the jejunum. Lower GI tract bleeding occurs anywhere in the digestive tract below the ligament of Treitz.
Upper GI tract bleeding is typically characterized by:
- Hematemesis (vomiting blood)
- Melena (black, tarry stools)
- Hematochezia (bright red stools)
Lower GI tract bleeding is typically characterized by:
- Hematochezia (bright red stools)
- Rectal bleeding
- Maroon-colored stools
Management of GI Tract Bleeding
The management of GI tract bleeding depends on the cause and severity of the bleeding. In some cases, the bleeding may stop on its own. In other cases, medical or surgical intervention may be necessary.
Medical interventions may include:
- Intravenous fluids to replace blood loss
- Blood transfusions
- Endoscopic hemostasis, which is a procedure to stop bleeding with a thin, flexible tube with a camera and light attached (endoscope)
- Medications to reduce the production of acid in the stomach
Surgical interventions may include:
- Surgery to remove the affected area of the digestive tract
- Surgery to bypass the affected area of the digestive tract
Nursing Care of Patients with GI Tract Bleeding
Nurses play a vital role in the care of patients with GI tract bleeding. Nurses assess patients for signs and symptoms of bleeding, monitor vital signs, and administer fluids and medications as prescribed by the physician. Nurses also provide education and support to patients and their families.
Specific nursing interventions for patients with GI tract bleeding may include:
- Monitoring vital signs and assessing for signs and symptoms of bleeding
- Administering intravenous fluids and medications as prescribed
- Providing education and support to patients and their families
- Monitoring stool output and color
- Preventing complications, such as shock and infection
Conclusion
GI tract bleeding is a serious condition that can be life-threatening. Prompt diagnosis and treatment are essential. Nurses play a vital role in the care of patients with GI tract bleeding by monitoring their condition, administering fluids and medications, and providing education and support.