Risk for bleeding nsg dx help...

Turd Ferguson · Feb 1, 2011

"Is it because she's pulling out her PEG tube, or was there an underlying cause to her GI bleed that I clearly missed, and because of that I can't move forward with this dx?? Please help..."

What was the cause of the patient's GI bleed? That seems like something you should have found out in report or reading the chart.

Sapphirestarr · Feb 1, 2011

"Is it because she's pulling out her PEG tube, or was there an underlying cause to her GI bleed that I clearly missed, and because of that I can't move forward with this dx?? Please help..."
What was the cause of the patient's GI bleed? That seems like something you should have found out in report or reading the chart.

They didn't know the cause of the bleed when I was on the unit. The pt was relatively new, transferred from the psych dept.

luv2b_a_nurs · Feb 1, 2011

Well since she's a GI bleed pt, that is why priority dx is risk for bleeding until the bleed is resolved. Following the ABC's that is why bleeding is the priority. However, I do not know if "risk for bleeding" is a NANDA nursing DX. My care plan book lists risk for deficient fluid volume, acute pain, and imbalanced nutrition as some of the Dx for gi bleeds.

Turd Ferguson · Feb 1, 2011

I don't see "risk for bleeding" in my NANDA book either... but a few that come to mind:

Risk for deficient fluid volume r/t bleeding and NPO status

Risk for infection r/t her pulling at peg tube (did she open her skin at all?)

Ineffective tissue perfusion r/t hypovolemia or decreased Hgb (depending on her labs)

And anytime you have a confused patient you're going to consider the obvious such as fall risk, adult failure to thrive, imbalanced nutrition, self care deficit, impaired tissue integrity (depending on mobility/toileting/sensation), etc...

Sapphirestarr · Feb 1, 2011

Yeah, I didn't know that risk for bleeding was a nursing dx, but it's one of the brand new ones for 09-11. My prof told me to look at her comorbidities and how they relate to the bleeding. They are: COPD, HTN, DM and schizophrenia. I'm going to see what I can do with this, but thanks for your replies. :)

Sapphirestarr · Feb 1, 2011

I don't see "risk for bleeding" in my NANDA book either... but a few that come to mind:
Risk for deficient fluid volume r/t bleeding and NPO status
Risk for infection r/t her pulling at peg tube (did she open her skin at all?)
Ineffective tissue perfusion r/t hypovolemia or decreased Hgb (depending on her labs)
And anytime you have a confused patient you're going to consider the obvious such as fall risk, adult failure to thrive, imbalanced nutrition, self care deficit, impaired tissue integrity (depending on mobility/toileting/sensation), etc...

Yeah, my other 2 dx are risk for infection r/t compromised host defenses (DM, PEG, foley, multiple wounds (according to the primary nurse they might have been self inflicted, but she's not sure) and risk for injury. I gave my prof risk for deficient fluid volume, imbalanced nutrition and impaired tissue perfusion and she insisted on risk for bleed. I had to go out and buy a new nursing handbook because I knew nothing about it as a nursing diagnosis and in the handbook it doesn't give me much to go off. So now I feel like it was a waste.