Medical Surgical GI bleed #3

Question

The nurse is caring for a postprocedure client who just underwent treatment in the GI lab for actively bleeding peptic ulcers. What is the priority for this client?

Answers

  1. Appropriate hemodynamic monitoring and support
    • Rationale:

      This answer is correct because the goal of treatment is to control bleeding. Active bleeding can quickly cause hypovolemic shock. Hemodynamic monitoring and support will alert the nurse to shifts in vitals, blood loss, and volume status.

  2. Monitor lung sounds for the presence of respiratory distress
    • Rationale:

      This answer is not correct because although monitoring of lung sounds for respiratory distress is necessary, it is not the priority. Circulatory observation takes precedence.

  3. Elevate the head of the bed
    • Rationale:

      This answer is not correct because while elevating the head of the bed helps prevent aspiration and facilitate drainage, it is not more important that hemodynamic status be monitored with a client who has actively bleeding peptic ulcers.

  4. Avoiding activities that initiate vasovagal response
    • Rationale:

      This answer is not correct because when the vagus nerve is overstimulated, blood vessels dilate, more bleeding occurs, and the heart rate and blood pressure decrease. Due to the risk for hypovolemic shock in this client, vagal nerve stimulus is contraindicated.

Overview

Actively bleeding peptic ulcers are a medical emergency. The profuse bleeding can cause the client to go into hypovolemic shock so astute hemodynamic monitoring is essential and priority.

Explanation

Learning Outcomes

The client with actively bleeding peptic ulcers can bleed profusely. Active bleeding can quickly cause hypovolemic shock. The gastrointestinal specialist provider can perform various procedures to control the bleeding, the goal of treatment. For these reasons mentioned, hemodynamic monitoring and support takes priority. Monitoring lung sounds, elevating the head of the bed, and avoiding activities that initiate vasovagal responses are all interventions for the client with actively bleeding peptic ulcer but are not priority over hemodynamic monitoring.

Test Taking Tip

Know that when peptic ulcers are actively bleeding, it can bleed rapidly, causing hypovolemic shock, and cause death.

Video Rationale