This article can be used as a tool to create a plan of care for a patient with a risk for bleeding. Risk for bleeding is commonly defined as a risk for a decrease in blood volume to an extent that health is jeopardized. Patient outcomes can be improved using risk for bleeding assessments and interventions to prevent and readily identify bleeding complications.
Many conditions can put a patient at risk for bleeding. Some genetic disorders, liver disease, and certain cancers can interfere with the ability for blood to clot, putting the patient at risk for bleeding.
Major surgery, trauma, or ulcerative gastrointestinal disorders can all be sources of blood loss. Risk for bleeding can also be associated with pregnancy and postpartum complications.
Some medications, such as NSAIDs, increase a patient’s bleeding risk as a side effect of the drug.
Identifying the patient’s individual risk factors is crucial to implementing effective risk for bleeding interventions.
Care Goals for Risk for Bleeding
Care goals for risk for bleeding are focused on prevention of bleeding and patient education. Three expected outcomes for a patient with a risk for bleeding diagnosis are the following:
- Patient does not experience bleeding as evidenced by hemoglobin and hematocrit levels within desired range, PT and INR values within desired range, and blood pressure and heart rate within normal range.
- Patient verbalizes understanding of measures to prevent bleeding
- Patient verbalizes recognition of signs of bleeding that need to be reported to a healthcare provider
Nursing Care Plans for Risk for Bleeding
Care plans for risk for bleeding should be focused on the patient’s specific risk factors and appropriate interventions. Some conditions associated with risk for bleeding are:
- DIC (Disseminated intravascular coagulopathy)
- Gastrointestinal condition
- Impaired liver function
- Inherent coagulopathy, such as hemophilia
- Postpartum and pregnancy complications
- Trauma or surgery
- Medications and treatments that can cause bleeding
Nursing Assessment for Risk for Bleeding
1. Assess the patient’s medical history for risk factors or current conditions that could put the patient at risk for bleeding.
Appropriate preventative measures can be implemented by identifying potential risks for bleeding.
2. Review the patient’s medications for drugs that can compromise hemostasis, such as anticoagulants, NSAIDs, or chemotherapy.
Drugs that compromise the body’s ability to clot increase a patient’s risk for bleeding.
3. Monitor vital signs, including blood pressure and heart rate.
Early signs of bleeding are tachycardia and hypotension.
4. Assess periodically and watch for signs of orthostatic hypotension.
Light-headedness or significant blood pressure drops when changing position can indicate reduced blood volume.
Nursing Interventions for Risk for Bleeding
1. Instruct the patient about appropriate risk-reduction interventions.
- Use a soft toothbrush and do not use dental picks.
- Avoid rectal suppositories, enemas, and thermometers.
- Avoid vaginal douches and tampons.
- Avoid straining with bowel movements.
- Avoid forceful coughing, sneezing, or blowing of the nose.
- Use caution with sharp objects.
- Use an electric razor instead of razor blades.
Using precautionary measures prevents tissue trauma and reduces the risk for bleeding.
2. Educate the patient and family about signs of bleeding that need to be reported to a healthcare provider.
Early identification and treatment of bleeding can reduce blood loss complications.
3. Administer reversal agents or blood products as ordered.
For patients on anticoagulants reversal agents may be ordered.
- Protamine sulfate is the antidote for heparin.
- Vitamin K is the antidote for warfarin.
Whole blood or blood products may be ordered to replace lost blood volume or blood components.
Antidotes will counteract anticoagulants. Blood and blood products replace clotting factors and oxygen-carrying RBCs.
4. Teach the patient to read labels for over-the-counter medications. Instruct them to avoid products that contain aspirin or NSAIDs.
These drugs reduce platelet action and inhibit clotting. They also increase the risk for gastrointestinal bleeding.
References and Sources
- Gulanick, Meg, and Judith L. Myers. Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier/Mosby, 2014.
- Herdman, T. Heather, and Shigemi Kamitsuru. Nursing Diagnoses: Definitions and Classification 2018-2020. Thieme, 2018.