I.

INTRODUCTION

A. OVERVIEW

Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper

gastrointestinal tract, commonly defined as bleeding arising from

the esophagus, stomach, or duodenum. Blood may be observed in vomit (hematemesis)

or in altered form in the stool (melena). Depending on the severity of the blood loss,

there may be symptoms of insufficient circulating blood volume and shock. As a result,

upper gastrointestinal bleeding is considered a medical emergency and typically

requires hospital care for urgent diagnosis and treatment. Upper gastrointestinal

bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and some

rarer causes such as gastric cancer.

Causes can include:

 Peptic ulcer. This is the most common cause of upper GI bleeding. Peptic

ulcers are sores that develop on the lining of the stomach and upper portion of

the small intestine. Stomach acid, either from bacteria or use of anti-

inflammatory drugs, damages the lining, leading to formation of sores.

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 Tears in the lining of the tube that connects your throat to your stomach

(esophagus).Known as Mallory-Weiss tears, they can cause a lot of bleeding.

These are most common in people who drink alcohol to excess.

 Abnormal, enlarged veins in the esophagus (esophageal varices). This

condition occurs most often in people with serious liver disease.

 Esophagitis. This inflammation of the esophagus is most commonly caused by

gastroesophageal reflux disease (GERD).

Clinical Manifestations

Persons with upper GI hemorrhage often present with;

 hematemesis,

 melena, or hematochezia (maroon colored stool) if the hemorrhage is

severe. The presentation of bleeding depends on the amount and location

of hemorrhage.

 Blood in the stool

 Vomiting blood or what looks like coffee grounds

 Abdominal cramps or diarrhea

 Fatigue

 Paleness in appearance

 Anemia

A person with an upper GI hemorrhage may also present with complications

of anemia, including chest pain, syncope, fatigue and shortness of breath.

The physical examination performed by the physician concentrates on the following

things:
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 Vital signs, in order to determine the severity of bleeding and the timing of

intervention

 Abdominal and rectal examination, in order to determine possible causes of

hemorrhage

 Assessment for portal hypertension and stigmata of chronic liver disease in

order to determine if the bleeding is from a variceal source.

Laboratory findings include anemia, coagulopathy, and an elevated BUN-to-creatinine

ratio.

B. STATISTICAL DATA

Local

In the Philippines, peptic ulcer prevalence decreased significantly over a seven-

year period, i.e., from 35.87% in 1996 to18.80% in 2002; although the prevalence of

peptic ulcer bleeding remained stable. This decline was notedin both GU and DU (20.05

vs 14.34%, and 15.83 vs7.02%, respectively), and was attributed largely to the decrease

in H. pylori-associated PUD.

Source: https://www.scribd.com/document/281268008/Philippine-Consensus-Statements-on-the-

Management-of-Non-Variceal-Upper-Gastrointestinal-Bleeding-2012-1

International

Upper gastrointestinal bleeding (UGIB) is a common problem with an

annual incidence of approximately 80 to 150 per 100,000 population, with estimated

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mortality rates between 2% to 15%. UGIB is classified as any blood loss from a

gastrointestinal source above the ligament of Treitz. It can manifest as hematemesis

(bright red emesis or coffee-ground emesis), hematochezia, or melena. Patients can also

present with symptoms secondary to blood loss, such as syncopal episodes, fatigue,

and weakness. UGIB can be acute, occult, or obscure. UGIB accounts for 75% of all

acute gastrointestinal (GI) bleeding cases. Its annual incidence is approximately 80 to

150 per 100,000 population. Patients on long-term, low-dose aspirin have a higher risk

of overt UGIB compared to placebo. When aspirin is combined with P2Y12 inhibitors

such as clopidogrel, there is a two-fold to three-fold increase in the number of UGIB

cases. When a patient requires triple therapy (i.e., aspirin, P2Y12 inhibitor and vitamin

K antagonist), the risk of UGIB is even higher.

C. SCOPE AND LIMITATION

On the 29th September of 2018, student nurses were assigned at Laguna Medical

Center, Santa Cruz, Laguna, Medical Ward 9Palacol III) from 6 am to 3 pm shift under

the supervision of Ma’am Gloria N Ramos, Ph.D., R.N. The patient was received lying

in bed, with IV PNSS. The assigned student nurses includes head-to-toe assessment,

monitoring and recording of vital signs, IV regulation, charting the patient’s data and

nurse’s management, and providing health teachings are part of their duty.

After the patient’s confinement, the assigned student nurses decided to conduct

a home visit last October 24, 2018. An interview was carried out for further health

history & assessment and also to grasp the patient’s progress. During the interview, the

assigned student nurses clarify their intentions and motives, they also asked the patient

to permit them to ask questions, and as a result, they had willingly participated all

throughout the interview.

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D. BACKGROUND OF THE STUDY

This case study aims to identify patient’s problems and health needs in order to

promote the general health of the patient by providing proper interventions through the

application of nursing process.

This case was chosen by the student nurses for them to practice their skills in

formulating and implementing a nursing care plan, in conducting a thorough assessment

to help in managing the patient's case and also to develop their sense of teamwork as

they execute their case study with the help of the concepts in Medical Surgical course,

Human Anatomy and Physiology and other science related studies.

General Objective:

At the end of the case presentation the nursing students from BSN IV-A will be

able to gain knowledge and comprehend their case even more, and also to further

understand and gain extensive knowledge form the case.

Specific Objectives:

 The student will be able to enumerate the predisposing and precipitating factors that

contribute to Upper Gastrointestinal Bleeding .

 Provide a thorough assessment and data gathering that could help and a significant

factor in formulating a nursing care plan.

 State and identify the appropriate nursing diagnosis and make interventions.

 Provide specific and suitable health teachings to promote awareness.

 Plan appropriate nursing care intervention.

 To implement plan of care.

 To formulate an individualized nursing care plan.

 Provide health teaching to the patient or to the significant others.

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 Determine the effectiveness of every plan and the outcome for the health education

provided.