Gastrointestinal (GI) Bleed Nursing Diagnosis & Care Plan

Any bleeding that takes place in the gastrointestinal tract is referred to as gastrointestinal (GI) bleeding. The esophagus, stomach, small and large intestine (colon), rectum, and anus are all parts of the GI tract. GI bleeding is not an illness in and of itself, but rather a sign of an underlying condition.

Upper and lower origins of bleeding are the two main divisions of GI bleeding. The ligament of Treitz sometimes referred to as the suspensory ligament of the duodenum, is the anatomical marker that delineates the upper and lower bleeding.

Upper GI bleeding (UGIB) occurs more frequently than lower GI bleeding (LGIB). Men are more likely than women to have vascular disorders and diverticulosis, which makes LGIB more prevalent in men. With age, the incidence rises.

The Nursing Process

It is important to treat hematochezia, hematemesis, or melena promptly. This usually requires admittance to an acute care hospital with consultation from a gastroenterologist and a surgeon. It is vital to determine the source and cause of bleeding and intervene.

Effective nursing care is essential for patients with gastrointestinal bleeding to alleviate symptoms, lower the risk of complications, and promote patient psychological well-being and prognoses. Nursing interventions are also implemented to prevent and mitigate potential risk factors.

Ineffective Tissue Perfusion Care Plan

Ineffective tissue perfusion associated with gastrointestinal bleeding can be caused by any bleeding from the mouth to the anus depending on the location. The loss of blood can decrease oxygenation and perfusion to the tissues.

Nursing Diagnosis: Ineffective Tissue Perfusion

As evidenced by:

Expected outcomes:

  • Patient will be able to demonstrate effective tissue perfusion as evidenced by hemoglobin and hematocrit within normal limits
  • Patient will be able to verbalize an understanding of gastrointestinal bleeding, the treatment plan, and when to contact a healthcare provider.

Ineffective Tissue Perfusion Assessment

1. Assess vital signs.
Recognize persistent hypotension, which may lead to abdominal organ hypoperfusion. The nurse can monitor the vital signs of the patient, especially alterations in the blood pressure and pulse rate which may indicate the presence of bleeding.

2. Assess for the presence of bleeding.
Take note of any circumstances that may impair the gastrointestinal system’s perfusion and circulation (e.g., major trauma with blood loss and hypotension, septic shock). Bowel ischemia and gastrointestinal (GI) hypoperfusion can be caused by blood loss, hypovolemic or hypotensive shock, or both.

3. Assess the client’s history of bleeding or coagulation disorders.
Determine the client’s history of cancer, coagulation abnormalities, or previous GI bleeding to determine the client’s risk of bleeding issues. The nurse can interview the client and review the health history to determine the risk factors and bleeding history of the client.

Ineffective Tissue Perfusion Interventions

1. Collaborate with the interdisciplinary team in creating the plan of care.
Collaboration of an interdisciplinary team improves communication and continuity of care. It also allows the development of an appropriate and suitable treatment plan that will improve systemic perfusion and organ function of the client.

2. Administer fluids, blood, and electrolytes as prescribed.
The goal of fluid resuscitation is to improve tissue perfusion and stabilize hemodynamics. To make up for blood and fluid loss and to keep GI circulation and cellular function intact, IV fluids, blood products, and electrolytes are often required.

3. Administer prescribed medications.
Give prescribed prophylactic medications, such as antiemetics, anticholinergics, proton pump inhibitors, antihistamines, and antibiotics. These will lessen fluid loss and neutralize stomach acid hopefully preventing further irritation of the GI mucosa.

4. Prepare for endoscopy or surgery.
An endoscopy procedure may be necessary to determine the location and cause of GI bleeding. Surgery may be necessary if bleeding is severe and tests can’t visualize the source.

Acute Pain Care Plan

Acute pain associated with gastrointestinal bleeding can be caused by gastrointestinal perforation or ischemia. This is due to a decrease in blood flow and oxygen in the gastrointestinal system.

Nursing Diagnosis: Acute Pain

  • Gastrointestinal perforation
  • Gastrointestinal ischemia

As evidenced by:

  • Changes in BP, pulse, and respiratory rate
  • Guarding position of the affected area
  • Restlessness
  • Report of abdominal pain
  • Report of heartburn

Expected outcomes:

  • Patient will be able to verbalize relief or control of pain.
  • Patient will be able to appear relaxed and able to sleep or rest appropriately.

Acute Pain Assessment

1. Assess the client’s pain characteristics.
The assessment of pain includes the location, characteristics, severity, palliative, and precipitating factors of the pain. The nurse can assess by asking the patient to rate their pain with the use of pain assessment tools applicable to the patient and determine whether the pain is constant, aching, stabbing, or burning. It’s important to also assess the exact location of abdominal pain.

2. Examine the patient’s pain indicators, both verbal and nonverbal cues.
The disparity between verbal and nonverbal signs may disclose clues about the severity of pain, the need for additional management, and the intervention’s effectiveness.

3. Assess coping mechanisms of the patient.
Coping mechanisms assist the patient in enduring, minimizing, and managing stressful circumstances. The nurse can ask and observe for coping mechanisms that the patient uses.

Acute Pain Interventions

1. Administer pharmacologic pain management as ordered.
Because it doesn’t induce side effects like stomach pain and bleeding, acetaminophen is typically seen as being safer than other nonopioid pain medicines. Antacids without aspirin and proton pump inhibitors may alleviate heartburn.

2. Evaluate the effectiveness of pharmacologic pain management.
Because pain perception and alleviation are subjective, it is best to evaluate pain management within an hour after administration of medication. If the client is unable to communicate, the nurse should assess the patient’s physiological and nonverbal pain cues.

3. Provide comfort measures and non-pharmacologic pain management.
The nurse can provide comfort measures such as frequent positioning, back rubs, and pillow support. The nurse can also provide non-pharmacologic pain management interventions such as relaxation techniques, guided imagery, and appropriate diversional activities to promote distraction and decrease pain.

4. Plan rest periods and create a conducive environment for sleeping and resting.
Rest increases coping abilities by reducing fatigue and conserving energy. Reduce interruptions and group tasks to allow for a quiet, restful environment.

Deficient Fluid Volume Care Plan

Deficient fluid volume associated with gastrointestinal bleeding can be caused by decreased blood volume due to blood loss. This may lead to a decrease in blood flow and ineffective tissue perfusion in the gastrointestinal system.

Nursing Diagnosis: Deficient Fluid Volume

  • GI hemorrhage
  • Hematochezia
  • Hematemesis
  • Abdominal cancer
  • Bleeding ulcers
  • Abdominal or rectal fistulas

As evidenced by:

  • Hematochezia
  • Hematemesis
  • Melena
  • Abdominal pain
  • Resting tachycardia
  • Orthostatic hypotension
  • Weakness
  • Nausea and/or vomiting
  • Decreased skin turgor

Expected outcomes:

  • Patient will be able to maintain adequate fluid volume as evidenced by stable vital signs, balanced intake and output, and capillary refill <3 seconds.
  • Patient will be able to demonstrate efficient fluid volume as evidenced by stable hemoglobin and hematocrit.

Deficient Fluid Volume Assessment

1. Assess nutritional status.
The nurse must take into account the current consumption, weight fluctuations, oral intake issues, supplement use, tube feedings, and other variables (e.g., nausea and vomiting) that may have an adverse impact on fluid intake.

2. Monitor intake and output.
To track and record trends, the nurse must maintain precise intake and output (I&O) documentation. This includes measurements of all intake (oral and IV) as well as losses through vomiting, urine, and bloody stools.

3. Evaluate lab results.
Closely monitoring hemoglobin and hematocrit is essential with GI bleeding. Hemoglobin is the oxygen-carrying component of blood while hematocrit reflects blood volume. Low levels of Hgb and Hct signal blood loss.

Deficient Fluid Volume Interventions

1. Assist the healthcare provider in treating underlying issues.
Collaboration with the healthcare provider is necessary to determine the root cause of decreased fluid volume and bleeding. Stopping the source of gastrointestinal bleeding will also control the fluid volume deficiency.

2. Provide a sufficient amount of free water with meals and a nutritionally balanced diet or enteral feedings.
Avoid using formulas that are too hyperosmolar or heavy in protein. Proper nutrition reduces the risk of anemia and enhances general health. Along with oxygenation, organs require nutrients like antioxidants, vitamins, and minerals to function.

3. Review and Administer prescribed medications.
Examine the client’s prescription, over-the-counter (OTC), herbal, and nutritional supplements to find any substances that might affect fluid and electrolyte balance or may be a cause of GI bleeding. Proton-pump inhibitors may be prescribed to curb stomach acid production.

4. Administer blood products.
PRBCs are a common intervention for GI bleeding. The nurse can ensure the patient is type and cross-matched to prepare for blood transfusions.

References and Sources

  1. DiGregorio, A. M., & Alvey, H. (2020, August 24). Gastrointestinal bleeding – StatPearls – NCBI bookshelf. National Center for Biotechnology Information.
  2. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, interventions, and rationales (15th ed.). F A Davis Company.
  3. Hinkle, J. L., & Cheever, K. H. (2018). Management of Patients with Gastric and Duodenal Disorders. In Brunner and Suddarth’s textbook of medical-surgical nursing (14th ed., pp. 3426-3452). Wolters Kluwer India Pvt.
  4. Overview of gastrointestinal bleeding – Gastrointestinal disorders – MSD manual professional edition. (n.d.). MSD Manual Professional Edition.
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Kathleen Salvador is a registered nurse and a nurse educator holding a Master’s degree. She has more than 10 years of clinical and teaching experience and worked as a licensed Nursing Specialist in JCI-accredited hospitals in the Middle East. Her nursing career has brought her through a variety of specializations, including medical-surgical, emergency, outpatient, oncology, and long-term care.