How urgent do you consider melena to be?

[Maddy_Rose]

I understand that passing any frank blood is a very urgent concern and I would need to call the doc stat (thank goodness none of my patients have encountered that yet!). But what about melena (or coffee grounds emesis) in an otherwise stable patient? I work nights mainly, does allnurses consider that more of a...wait-until-morning-and-inform sort of concern?

Thanks for any input :)

[Stcroix, ASN, PhD, RN]

I think it would be alarming based on other criteria. Is this new to the pt, is their H&H dropping/ very low, are they symptomatic (pale, tachy, diaphoretic)? If the pt came in w a diagnosis of GI bleed and they were stable and their H&H was ok, then no, I wouldn't call. If however, if the opposite was true, then yes I would call. Also, I would look at the trend in their vitals and labs to see if this is an accelerating problem.

[KariZayBSN]

I would inform the MD during the night after checking VS and pt mental status, regardless of the admit dx. The MD/on call may still wish to draw stat labs including cross type and start blood and increase fluids which can be started your shift. Just what I would do.

[amoLucia]

You ask a tough question.

If it's new onset, most definitely I would call. Or a change in volume. I'd also closely review current meds for any issues.

If it's ongoing, does the PMP know? NEVER ASSUME s/he does. And for that again I would want to know.

For other variables I might wait - MAYBE. And that's a BIG MAYBE. But I make my own phone calls myself just before I leave.

But if my little inner voice is talking to me and asking if I should call, then I listen and call. Regardless. Better safe than sorry!

[Maddy_Rose]

Thanks for the responses. The sense I'm getting is that, in general, if a patient has new onset of either symptom (aka they're not a known GI bleed already) I need to call even during nights.

[sapphire18]

Thanks for the responses. The sense I'm getting is that, in general, if a patient has new onset of either symptom (aka they're not a known GI bleed already) I need to call even during nights.

100% yes.

[DoeRN]

Thanks for the responses. The sense I'm getting is that in general, if a patient has new onset of either symptom (aka they're not a known GI bleed already) I need to call even during nights.[/quote']

Absolutely

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[BostonFNP, APRN]

Right before I graduated my NP program my mentor told me one last piece of advice: if you are thinking about doing something (calling, ordering, etc) then do it.