preparing for a GI bleed scenario ?

Nurses General Nursing

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First off I want to apologize if im posting this in the wrong section

But I recently started (my first) nursing job and they told us there would be the opportunity for several of us to get placed into a (new grad) critical care fellowship. Those interested would have to perform a scenario and we were each assigned a topic to study up on, as that is what our scenario would be centered around.

My topic was a patient with GI bleed.

Any suggestions on things I should know/study up to best prepare myself?

I presume that assessment, interventions, and pathophysiology are going to be the main points of emphasis.

Thanks so much !

(oh and im under the impression that this scenario will be performed on one of those training manikins)

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Specializes in Emergency Room, Trauma ICU.

Have you started reading up on GI bleeds? I mean I'm sure we could all write up what you need to know, but to me that's like doing your homework for you. Why don't you start looking up reading up on it, and if you get confused or stuck on something post questions.

I don't mean for this to come off harsh or anything, but it seems like we get homework type questions a lot on here.

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Specializes in Anesthesia, ICU, PCU.

Serial (q4-6hr) CBCs, check your labs like a fiend, consent for blood transfusions in chart, type&screen&cross on record, confirmatory specimen if necessary (know the blood bank policies for drawing and verifying these), blood transfusions (review policy and procedure for this) suction for UGIBs with coffee ground emesis, close HR BP RR and SpO2 monitoring (increased HR and decreased BP as you know, especially with those BRBPRs), gastroccult/hemoccult testing, protonix gtt, IVF, Gastroenterology consults, NPO for scopes (expect go-lytely and how much people hate it)

I don't know what they expect you to do if you're just given a mannequin and asked what to do. GIBs are usually treated over a period of a few days. If the person has uncontrollable internal bleeding there's nothing the nurse will really be able to do but support oxygenation if needed, hang fluids, and call the MD for surgical intervention.

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Have you started reading up on GI bleeds? I mean I'm sure we could all write up what you need to know, but to me that's like doing your homework for you. Why don't you start looking up reading up on it, and if you get confused or stuck on something post questions.

I don't mean for this to come off harsh or anything, but it seems like we get homework type questions a lot on here.

I just got off my shift (they told me at work today), so ive only been researching it for about a half an hour now.

I apologize if it was coming off as a do my HW type question. I just noticed sometimes these boards can take a while to get a response, and know that others experiences can often be far more valuable than a textbook

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Make sure they have great access. They'll need multiple IVs and at least one should be larger bore (like 18g). Check labs (CBC is the main one, but for diagnostic purposes also think coags, bmp, tox screen, liver labs). GIBs come in different shapes and sizes so it's hard to give too much advice without knowing the scenario. Is it a patient with coffee ground emesis that has Mallory Weiss tears or is it a cirrhosis patient with a blakemore and 5 pressors bleeding out of their mouth?

So let's say you get a patient and you don't have a diagnosis yet. IVs, labs, NPO, make sure patient has a type and screen sent to the blood bank. Get a good medical history and ask about what meds they've been taking (very frequently people will have bleeding ulcers from NSAID use in my experience). Anticipate giving blood, fluids, starting Protonix and octreotide gtts, and in certain cases a dose of IV abx. Don't put in any enteral access unless you get the okay from the GI team, if their bleeding is esophageal in nature you don't wanna be poking around in there with tubes. Have suction set up and ready in the room. Patient may be nauseous, ask for antiemetics. If it's a lower GIB and the patient is incontinent, know that it is very irritating to the skin so watch for breakdown.

A very important thing to assess, as always, is airway. Your patient with an upper GIB may need to get intubated to prevent aspiration. Bloody vomit in the lungs is horrible news. The GI team may also want the patient intubated for their scope if it seems like they'll need a lot of sedation.

Phew, okay I'll stop, but I could go on for hours. Definitely research GIBs, esophageal varices, liver diseases, etc. Look up endoscopies, colonoscopies, blakemore tubes, TIPS, and tagged RBC scans :)

Good luck!

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Make sure they have great access. They'll need multiple IVs and at least one should be larger bore (like 18g). Check labs (CBC is the main one, but for diagnostic purposes also think coags, bmp, tox screen, liver labs). GIBs come in different shapes and sizes so it's hard to give too much advice without knowing the scenario. Is it a patient with coffee ground emesis that has Mallory Weiss tears or is it a cirrhosis patient with a blakemore and 5 pressors bleeding out of their mouth?

So let's say you get a patient and you don't have a diagnosis yet. IVs, labs, NPO, make sure patient has a type and screen sent to the blood bank. Get a good medical history and ask about what meds they've been taking (very frequently people will have bleeding ulcers from NSAID use in my experience). Anticipate giving blood, fluids, starting Protonix and octreotide gtts, and in certain cases a dose of IV abx. Don't put in any enteral access unless you get the okay from the GI team, if their bleeding is esophageal in nature you don't wanna be poking around in there with tubes. Have suction set up and ready in the room. Patient may be nauseous, ask for antiemetics. If it's a lower GIB and the patient is incontinent, know that it is very irritating to the skin so watch for breakdown.

A very important thing to assess, as always, is airway. Your patient with an upper GIB may need to get intubated to prevent aspiration. Bloody vomit in the lungs is horrible news. The GI team may also want the patient intubated for their scope if it seems like they'll need a lot of sedation.

Phew, okay I'll stop, but I could go on for hours. Definitely research GIBs, esophageal varices, liver diseases, etc. Look up endoscopies, colonoscopies, blakemore tubes, TIPS, and tagged RBC scans :)

Good luck!

Goldmine of info. Thanks a ton !

I literally broke out my textbooks from fundies/medsurge and the godforsaken Saunders Book from the NCLEX.

I have no problem if I dont get the spot, but it wont be because I wasnt prepared. Thank you again

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Goldmine of info. Thanks a ton !

I literally broke out my textbooks from fundies/medsurge and the godforsaken Saunders Book from the NCLEX.

I have no problem if I dont get the spot, but it wont be because I wasnt prepared. Thank you again

No problem, friend! I still look through my old text books from time to time. I hope you get it!

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Specializes in Acute Care - Adult, Med Surg, Neuro.

NPO, serial Hgb's, IVF, Protonix drips, vital sign monitoring (HR, BP, O2), type/cross, consent form, prepare to give blood. GI consult and scopes. Another thing is falls risk. With bad bleeds many patients may be dizzy and we've had some GI bleeds have episodes of syncope while getting up to the bathroom. I am always with patients and if they are dizzy we use bedside commode or bedpan.

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Specializes in Emergency, Telemetry, Transplant.

They will almost certainly draw coags. If they are on an anticoagulant and/or have abnormal coag results, what will be done?

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Specializes in Oncology; medical specialty website.

Well, I guess there's no need to actually do the research now.

OP, please make sure to do your own reading and research, even though you're gotten some replies with many interventions that should be done. When you do your own research and reading, it stays with you longer than people just giving you the answers.

Best wishes. I hope you get the spot.

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I think you question was very appropriate. Sometimes doing your own research is like trying to get a drink of water from a fire hydrant. You can get over whelmed and lost in some tangential area.

Often advice or ideas I read in Allnurses sticks with me better, is explained better, makes more sense, than what I learned from doing my own research.

Anyhow there is an excellent You Tube video on inserting a Blakemore tube. You might not be expected to know this. Other less invasive interventions might work or the bleed might not be severe. It is called Blakemore Tube Inserting by YNHHClinicals.

The gastroenterologist will be inserting the Blakemore tube (at least where I used to work) but the nurse will be doing a lot of assisting and managing of the tube after the it is in.

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Well, I guess there's no need to actually do the research now.

OP, please make sure to do your own reading and research, even though you're gotten some replies with many interventions that should be done. When you do your own research and reading, it stays with you longer than people just giving you the answers.

Best wishes. I hope you get the spot.

Oh I still am. As a new grad (without experience) I dont thoroughly understand everything that others have mentioned so its really necessary for me to look up some of these things in my textbooks.

Others have done an excellent job painting a picture, and pointing out things I truthfully never would have even crossed my mind (ie thinking about fall risk, which is such a huge issue for hospitals) as well as things like Varices which is almost like a vague memory from medsurge from me right now.

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